(052) Characterization of Female Sexual Dysfunction Associated with Spinal Pathology and Surgery
Authors: Moscicki P , Bachmann G 
Published: June 2023

Abstract

Introduction
Sexuality and sexual function are understood as fundamental facets of the human experience. The disruption of sexual function is socially disruptive and emotionally distressing. Studies demonstrate the connection between adverse sexual function and medical conditions such as diabetes and heart disease, however in the areas of spinal pathologies, sexual function remains mostly studied in males or as a collective of male and female patients. The male and female sexual experience may be quite different, and a combined cohort may not appropriately characterize female-specific dysfunction.

Objectives
Sexual dysfunction associated with spinal pathologies in males is well studied. However, little research exists addressing this issue in females. This review presents data on female sexual dysfunctions associated with spinal pathologies.

Methods
PubMed and Google Scholar identified case reports and primary studies evaluating female sexual dysfunction associated with spinal pathology as well as surgical intervention success were reviewed to contextualize and characterize female sexual dysfunction in this population.

Results
Female sexual dysfunction has been cited to arise from the spine due to traumatic etiologies, malignant tumors, and benign tumors with and without bony involvement. Surgeons identify the absence of bowel, bladder, and/or sexual dysfunction as one of the key preoperative predictors in maintenance or improvement of neurologic status, however sexuality is rarely addressed in the pre-operative or post-operative neurosurgical care plan. In data generated from males and females with spinal stenosis and degenerative spine disease, over half of patients report pain with sexual activity. Post-operatively, there appears to be a significant decrease in sexual pain. However, the data do not separately report results for females versus males. Importantly, while pain can hinder sexual activity in females, there also are other sexual issues, including desire and subjective arousal, lubrication, orgasm, and satisfaction that should be explored. By the use of the Female Sexual Function Index (FSFI), one study compared sexually active females with protruding disc herniation with healthy females. These data showed a lower FSFI, a lower number of weekly sexual intercourse and a higher score for depression in women with this condition. Further detangling painful intercourse from other types of sexual dysfunction, case studies have shown pre and post op sexual dysfunction from perianal hypoesthesia, and reduced sensation in the sacral area associated with an L5-S1 disc pathology. It is suggested that these other types of sexual dysfunction with lack of coital pain fail to improve after surgical intervention.

Conclusions
There is a gender disparity when addressing sexual dysfunction and the implications of spinal surgery. The lack of high-quality research with adequate numbers of female participants that appropriately characterizes the nuances of female sexual dysfunction across various spinal pathologies, with post- surgical intervention analysis and consideration of surgical approach, necessitates consideration for study. Pre-op and post-op sexual history should be included for all women with spinal health issues.

Disclosure
No.