Discussing sexual health in spinal care

Korse, Nina S.; Nicolai, M. P. J.; Both, Stephanie; Vleggeert-Lankamp, Carmen; Elzevier, Henk W.

doi:10.1007/s00586-015-3991-1

Cited by 47 publications

(36 citation statements)

References 40 publications

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“…For all patients for whom it was documented that there were no complaints at presentation, there were no data available at FU 1; therefore, there is no grey bar at FU 1 the available data on sexual dysfunction at presentation is striking: 25 out of 26 patients experienced sexual dysfunction. The fact that sexual function is more often documented for male patients than for their female counterparts is something that is believed by the authors to be due to both patient factors as well as doctor factors [15].…”

Section: Discussionmentioning

confidence: 90%

“…This is remarkable considering the definition of CES. Recently, clinicians in spinal care were found to barely discuss sexual health and/or defecation at presentation and at follow-up, suggested to be due to, e.g., lack of knowledge or time [2,15,16]. Clinicians who do want to inform their patients about the prognosis of these functions are confronted with scarce data.…”

Section: Introductionmentioning

confidence: 99%

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Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

et al. 2017

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Background Even though micturition, defecation, and sexual function are substantially affected in cauda equina syndrome (CES), data on outcome are scarce. Methods Medical files of patients operated on lumbar herniated disc were screened for CES and retrospectively analyzed for baseline characteristics, outcome of micturition, defecation, and sexual function and possible predictors. Results Seventy-five CES patients (52% men) were included with a mean age of 44 years. L5-S1 was the most common affected level. Duration of CES complaints at presentation was, on average, 84 h (median 48 h). Prevalence of symptoms at presentation: sciatica (97%), altered sensation of the saddle area (93%), micturition dysfunction (92%), and defecation dysfunction (74%). Only 26 patients were asked about sexual dysfunction of whom 25 patients experienced dysfunction. Female gender was associated with more defecation dysfunction at presentation than male gender (OR 4.11; p = 0.039). All patients underwent decompressive surgery. Two post-operative follow-up (FU) moments took place after a mean of 75 h and 63 days.Outcomes at second FU moment: micturition dysfunction 48%, defecation dysfunction 42%, sexual dysfunction 53%, sciatica 48%, and altered sensation of the saddle area 57%. A shorter time to decompression was associated with more sciatica at FU 1 (p = 0.042) which effect had disappeared at FU 2. Conclusion This study is unique in (1) displaying the presenting features in a large cohort of CES patients, (2) demonstrating that recovery after decompression is slow and far from complete in the majority of patients with regard to micturition, defecation, and sexual function and (3) evaluating predictors for outcome.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

et al. 2017

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“…Investing in (continued) training on sexuality and in the residency program can contribute as well. By initiating the discussion, clinicians have the potential to detect sexual dysfunction and to refer adequately when necessary, thereby improving overall quality of life of their patients [3, 26, 32]. Ideally, standardized outcome measures such as the BREAST-Q will further objectify this improved (sexual) quality of life [2].…”

Section: Discussionmentioning

confidence: 99%

Discussing sexuality in the field of plastic and reconstructive surgery: a national survey of current practice in the Netherlands

et al. 2018

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BackgroundPatient-reported outcomes have become increasingly important to assess the value of surgical procedures. Sexual function is a proven important constituent of quality of life, but is often overlooked by health care professionals. We aim to investigate to what extent plastic surgeons address or discuss issues concerning sexuality with their patients, and if there is a need for improvement.MethodsWe developed a survey to assess whether topics pertaining to sexual function were discussed during plastic surgical consultations. In 2016, all 385 members of the Dutch Association for Plastic Surgery were invited via post mail to participate.ResultsWe received 106 completed surveys (27.5%). The median age of the respondents was 45 (29–66) years. Most participants (78.3%) indicated that they rarely to never discuss sexuality with their patients. Surgeons in the subspecialization gender and genital surgery discussed sexual function most frequently. Two thirds of all respondents indicated that their current knowledge on this topic was insufficient, yet there was generally no interest expressed in receiving additional training (78.6%). However, there was a need for proper patient brochures (43.4%) and an organized referral network (36.5%) regarding sexuality.ConclusionsIn plastic surgery practice, sexuality appears to be a rarely discussed subject, with the gender and genital surgery subspecialties as the exception. Although professionals and patients emphasize the importance of sexuality, plastic surgeons express limited urge to be trained and prefer written patient information and referring patients to other healthcare professionals. The authors stimulate more education on sexuality during (continued) plastic surgery training.Level of Evidence: Not ratable

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“…The questionnaire included 34 questions and was divided into the topics: sexual dysfunction and fertility issues. The results of the items on sexual dysfunction are discussed in a previous article [11].…”

Section: Participantsmentioning

confidence: 99%

“…For example, 44 % of all patients with cauda equina syndrome experiences sexual dysfunction (defined as any problem resulting in abnormal intercourse, ranging from, e.g., decreased penile or vaginal sensation to impotence or retrograde ejaculation), displaying that this group is potentially at high risk for in-or sub-fertility [10]. However, discussing reproductive health is far from first priority for spinal surgeons, which was shown in a recent survey among neurosurgeons, displaying only 26 % of neurosurgeons discuss sexual health with their patients [11]. The first article in English literature acknowledging decreased fertility in spinal cord patients was written in 1948 and discussed male patients with spinal cord injury (SCI) [12].…”

Section: Introductionmentioning

confidence: 99%

Discussing reproductive health in spinal care, part II: fertility issues

et al. 2016

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Purpose Due to advancing insights, discussing fertility in spinal care is an emerging topic. Studies among neurosurgeons to evaluate clinical practice about discussing fertility are non-existent. The aim of this study is to review knowledge, attitude and practice patterns regarding discussing fertility in spinal care. Methods Dutch neurosurgeons and residents were sent a mail-based questionnaire addressing attitude, knowledge and practice patterns regarding discussing fertility. Results Response rate was 62 % (compared to mean of 28 % in similar surveys) with 89 questionnaires suitable for analysis. Mean age was 42 years with 83 % of respondents being male. A quarter of respondents stated neurosurgeons are responsible to discuss fertility, with 12 % indicating to actually do this. Fertility is discussed more often with patients with cauda equina syndrome (70 %) and with men (p = 0.006). Merely 8 % of respondents stated to have adequate knowledge on fertility preservation (FP); this percentage was higher for doctors with spinal surgery as specialty (p = 0.015). In case of cauda equina syndrome, doctors with more knowledge discussed fertility more often (p = 0.002). Fifty-three percent of neurosurgeons wished to enhance their knowledge, in order to feel more comfortable to discuss fertility with their patients.Five percent indicated to have ever referred a patient to a fertility specialist. Conclusion With the exception of cauda equina syndrome, fertility is not routinely discussed in spinal care. Fertility is discussed more often with men. Recent guidelines state that discussing fertility is an essential part of good practice in spinal care. Education on fertility and FP needs to be integrated in the neurosurgical training program to create more awareness, and to enable clinicians to provide adequate information and care to the patient.

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Discussing sexual health in spinal care

Cited by 47 publications

References 40 publications

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

Discussing sexuality in the field of plastic and reconstructive surgery: a national survey of current practice in the Netherlands

Discussing reproductive health in spinal care, part II: fertility issues

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