A study from NSpine has shown that a majority of women experience problems in sexual function following anterior spinal surgery. The study, which was presented at Spineweek (Singapore; 16-20 May 2016) by Irene Hernandez-Sanchez (Birmingham, UK) during the “All you ever wanted to know about Sex and the Spine but were afraid to ask” session, surveyed 139 women who had undergone anterior spinal surgery about their sexual health following the procedures.
The research team, recognising a lack of focus in the literature on female sexual and reproductive health following spinal surgery, designed a questionnaire covering topics from continence and pregnancy, to sexual function. “Not surprisingly, there is a bulky literature about sexual disfunction in male patients after this type of surgery,” Hernandez told Spinal News International. “We decided to focus on women’s sexual health following anterior spinal surgery because very little is known about it. Taking into account that most of spinal surgeons are male doctors, we suspected that probably did not specifically query female patients about sexual problems in follow up consultations. Both the topic being a bit delicate and intrusive, and potential cultural barriers could play a role in making the consultation difficult in this scenario.”
The NSpine survey collected both quantitative and qualitative retrospective data. Responses revealed that a number of changes following anterior spinal surgery were experienced by the majority of women questioned. Fifty-five percent of women experience changes in their menstrual cycle, while 61% experienced more difficulty reaching orgasm. Forty percent of women noticed a reduction in vaginal lubrication, while 22% reported reduced ability to achieve orgasm, and 21% experienced a decrease in sensation. A small number of women reported urinary incontinence (13 preoperative, 35 postoperative, p=0.0007) and/or faecal incontinence (10 preoperative, 15 postoperative, p=0.42) following surgery. Thirteen women reported urinary incontinence associated to orgasm following surgery, with a baseline of seven (p=24).
Women commented on the frequency of these symptoms, as well as the ways that they had changed in the months following surgery. One limitation of the study was its failure to take into consideration how long had elapsed between surgery and survey participation. Whilst women spoke about this period of time, no quantitative data was collected for statistical analysis.
“The most important learning point is about informed consent.” Hernandez-Sachez told SNI, “Any woman with back pain who undergoes this type of surgery should be warned that there is a risk that her sexual function will deteriorate as shown in our study; it is all about expectations.” Commenting on the attitudes of the women surveyed, Hernandez-Sanchez said, “Women will probably not base their decisions solely on this risk. Most of our patients who experienced poor outcomes in terms of sexual function emphasised that pain relief was so beneficial that the procedure was totally worth it, regardless of these unexpected adverse results.”
Patient care can be improved, Hernandez-Sanchez said, “not only by warning patients of these adverse outcomes, but also by identifying those ladies that silently suffer these problems, we can offer a better care to patients.” Commenting on the future of research into anterior spinal surgery and sexual function, Hernandez-Sanchez told SNI, “We still do not know with certainty what it is about the surgery that brings these problems…Prospective studies looking at different types of anterior lumbar spinal surgery, and at the same time compared to posterior approaches, could possibly give us the answer to this question.”
The NSpine session also presented data detailing the impact of the position and size of scars resulting from anterior lumbar spinal surgery for spondylolisthesis or degenerative disc disease in adult female patients. Using the Patient Assessment Scar Questionnaire (PSAQ), researchers aimed to address the dearth of data available on the effect of scars on sexual health and wellbeing following anterior spinal surgery. “This value is very often overlooked in spinal surgery,” Hernandez-Sanchez told SNI. The PSAQ covers four areas; characteristics of the scar, symptoms from the scar, awareness and satisfaction.
The team, led by Jennie Walker from Queen’s Medical Centre, Nottingham, UK, received survey responses from 113 women. They discovered that the length of a scar “can negatively influence sexual satisfaction”. The majority of women considered their scars to be “long” (54%) or “very long” (16%), while 13% of women were “dissatisfied” with sexual functioning, and 8% “very dissatisfied”. Researchers noted a p-value of 0.02 associated with these variables.
The team discovered that, whilst the majority of women questioned would prefer a horizontal scar (44%), only 25% had a one in this direction. Seventy-three percent of patients had a vertical scar—an option desired by only 36% of respondents. Twenty percent of women who answered the question had no preference as to the direction of their surgical scar. Seventy-three percent of women were happy with the appearance of their scar overall with 23% considering it “excellent”, 33% “good” and 31% “okay”. The majority of patients did not experience physical discomfort associated with their scars, but a majority experienced pain either “sometimes” (36%) or “often” (20%).
Hernandez-Sanchez told SNI, “A significant number our study participants showed dissatisfaction, since they did not expect their scar to be so long.” Emphasising the importance of discussing scar placement prior to surgery, she said, “This was absolutely not emphasised enough.”