International standards to document remaining autonomic function after spinal cord injury. Alexander M S,Biering-Sorensen F,Bodner D,Brackett N L,Cardenas D,Charlifue S,Creasey G,Dietz V,Ditunno J,Donovan W,Elliott S L,Estores I,Graves D E,Green B,Gousse A,Jackson A B,Kennelly M,Karlsson A-K,Krassioukov A,Krogh K,Linsenmeyer T,Marino R,Mathias C J,Perkash I,Sheel A W,Schilero G,Shilero G,Schurch B,Sonksen J,Stiens S,Wecht J,Wuermser L A,Wyndaele J-J Spinal cord STUDY DESIGN:Experts opinions consensus. OBJECTIVE:To develop a common strategy to document remaining autonomic neurologic function following spinal cord injury (SCI). BACKGROUND AND RATIONALE:The impact of a specific SCI on a person's neurologic function is generally described through use of the International Standards for the Neurological Classification of SCI. These standards document the remaining motor and sensory function that a person may have; however, they do not provide information about the status of a person's autonomic function. METHODS:Based on this deficiency, the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) commissioned a group of international experts to develop a common strategy to document the remaining autonomic neurologic function. RESULTS:Four subgroups were commissioned: bladder, bowel, sexual function and general autonomic function. On-line communication was followed by numerous face to face meetings. The information was then presented in a summary format at a course on Measurement in Spinal Cord Injury, held on June 24, 2006. Subsequent to this it was revised online by the committee members, posted on the websites of both ASIA and ISCoS for comment and re-revised through webcasts. Topics include an overview of autonomic anatomy, classification of cardiovascular, respiratory, sudomotor and thermoregulatory function, bladder, bowel and sexual function. CONCLUSION:This document describes a new system to document the impact of SCI on autonomic function. Based upon current knowledge of the neuroanatomy of autonomic function this paper provides a framework with which to communicate the effects of specific spinal cord injuries on cardiovascular, broncho-pulmonary, sudomotor, bladder, bowel and sexual function. 10.1038/sc.2008.121
    Sex life and the Oswestry Disability Index. Costa Michelle,Marshman Laurence A G The spine journal : official journal of the North American Spine Society BACKGROUND CONTEXT:Despite the option to not answer, there is widespread anecdotal belief that the Oswestry Disability Index (ODI) Section 8 (ODI-8/sex life) is answered inaccurately (ie, in relation to psychosocial factors, not pain) or that it repels ODI participation. Oswestry Disability Index versions have therefore been created that omit ODI-8; however, no evidence base justifies this. Interestingly, one recent study reported an ODI-8 response rate (RR) of 97%. PURPOSE:The aims of this study were to measure RR to sex life questions in patients with chronic low back pain (CLBP) and to validate that ODI-8 is answered appropriately and represents a specific measure of CLBP-mediated sexual inactivity. STUDY DESIGN:Original. PATIENT SAMPLE:Eighty-eight patients. OUTCOME MEASURES:The outcome measures used in this study were the ODI, the Sexual Quality of Life Scale-version 2 (SQOL-2), the Short Form-12 version 2 (mental and physical), the Depression Anxiety and Stress Scale, the Coping Strategies Questionnaire, the Short-Form McGill Pain Questionnaire-version 2, the Opioid Risk Tool, and the Fear-Avoidance Beliefs Questionnaire (work and physical). METHOD:Chronic low back pain patients older than 18 years attending a multicultural Western spinal clinic were prospectively offered the aforementioned questionnaires. Sex life disability questions--pain dependent (ODI-8) and pain independent (SQOL-2)--appeared first and fifth in every sequence. RESULTS:Results were obtained in 65 patients (male 29, female 36). Despite expected response attrition with battery progression (RRs for the first and eighth questionnaires were 100% and 64.61%, respectively), RRs for ODI-8 (52.31%) and SQOL-2 (52.31%) were equal and significantly lower than others (p<.001). Nonresponders to ODI-8 (60.57±13.3 years) and SQOL-2 (59.68±13.34 years) were significantly older than responders (ODI-8: 47.82±12.17 years, p<.001; SQOL-2: 48.27±12.76 years, p=.001). Among ODI-8 or SQOL-2 responders, ODI-8 and SQOL-2 were not correlated (r=-0.340, p=.104). Although ODI-8 significantly correlated with prospectively identified pain-correlated questionnaires, ODI-8 did not correlate significantly with non-pain-correlated questionnaires. CONCLUSION:Contrary to previous findings, 47.69% of CLBP patients specifically ignored ODI-8; however, 100% completed the ODI remainder. Among "responders," ODI-8 was validated as having measured CLBP-mediated sexual inactivity. The ODI-8 was therefore treated consistently, as directed: It was either answered appropriately (ie, in relation to pain) or it was ignored (respecting the clause "if applicable"). No ODI modification therefore appears required for adults older than 18 years attending a multicultural Western CLBP clinic: One standard form including ODI-8 appears to yield appropriate ODI-8 response-treatment, with unaffected ODI participation. Multiple ODIs circumventing ODI-8 appear unnecessary and redundant in this population. 10.1016/j.spinee.2015.02.022
    Discussing sexual health in spinal care. Korse N S,Nicolai M P J,Both S,Vleggeert-Lankamp C L A,Elzevier H W European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society BACKGROUND:The possible detrimental effects of spinal disease on sexual health are widely recognized; however, it is not known to what extent neurosurgeons discuss this topic with their patients. The aim of this study is to identify knowledge, attitude and practice patterns of neurosurgeons counseling their patients about sexual health. METHODS:All members of the Dutch Association of Neurosurgery (neurosurgeons and residents) were sent a questionnaire addressing their attitudes, knowledge and practice patterns regarding discussing sexual health. RESULTS:Response rate was 62% with 89 questionnaires suitable for analysis. The majority of participants (83%) were male; mean age, 42.4 years. The mean experience in neurosurgical practice was 9 years. Respondents assumed that in 34% of their patients, sexual health was affected due to spinal disease. The majority of respondents (64%) stated that responsibility for discussing sexual health lies (partly) with the neurosurgeon; however, 73% indicated to (almost) never do this. The main reasons for not discussing sexual health were patients' old age (42%), lack of knowledge (38%) and lack of patients' initiative to bring up the subject (36%). Twenty-six percent indicated lack of time as a reason. There was no evidence for gender or doctor's age discordance as important barriers. Fifty percent of participants wished to gain more knowledge on discussing sexual health with patients. CONCLUSION:This study shows that despite high prevalence of sexual dysfunction (SD) in spinal patients, counseling about sexual health is not often done in neurosurgical care. More training on sexual health counseling early in the residency program seems critical. By initiating the discussion, clinicians who deal with spinal patients have the potential to detect sexual dysfunction (SD) and to refer adequately when necessary, thereby improving overall quality of life of their patients. 10.1007/s00586-015-3991-1
    Assessment of sexual dysfunction before and after surgery for lumbar disc herniation. Akbaş Naz B,Dalbayrak Sedat,Külcü Duygu G,Yilmaz Mesut,Yilmaz Tevfik,Naderi Sait Journal of neurosurgery. Spine Object Sexuality is an important aspect of human life. Sexual activity may be affected in lumbar disc herniation through different mechanisms. The aim of this study is to evaluate patients' sexual problems and sexual behavior patterns before and after surgical treatment of lumbar disc herniation. Methods Forty-three patients were included in the study (mean age 41.4 years). A visual analog scale, the Oswestry Disability Index, the Hospital Anxiety and Depression Scale, and a sexuality assessment questionnaire developed for this study were administered to the patients to evaluate pain and sexual dysfunction. Results Fifty-five percent of the men and 84% of the women reported experiencing sexual problems after the onset of low-back pain. The most common sexual problems were decreased sexual desire (18%) and premature ejaculation together with erectile dysfunction (18%) for the male patients, and decreased sexual desire (47%) for the female patients. The frequency of sexual intercourse before the operation was reduced in 78% of cases compared with the pain-free period. Postoperatively, the patients first attempted sexual intercourse a mean of 26.5 days after surgery. The frequency of intercourse was found to have increased (p = 0.01), while description of any type of sexual problem had decreased (p = 0.005) significantly. Conclusions Lumbar disc herniation has negative effects on sexual life, and not enough attention is given to the patients' sexual problems by the physicians. Decreased sexual desire and decreased sexual intercourse are the most commonly reported problems. Taking time during examination and giving simple recommendations may improve sexuality and life quality of the patients. 10.3171/2010.5.SPINE09906
    Discopathy of the lumbar-sacral segment and its influence on sexual dysfunction. Dzierżanowski Maciej,Dzierżanowski Marcin,Wrzecion Katarzyna,Słomko Witold,Radzimińska Agnieszka,Kaźmierczak Urszula,Strojek Katarzyna,Srokowski Grzegorz,Żukow Walery Advances in clinical and experimental medicine : official organ Wroclaw Medical University BACKGROUND:Intervertebral disc disease is a widespread medical and social problem. Degeneration of intervertebral discs can lead to disc disease, commonly known as discopathy. One of the consequences of discopathy is pressure on the spinal cord or nerve roots that supply the genitals and sexual centers located in the core. In addition, the accompanying pain and limitation of mobility can lead to the occurrence of sexual dysfunction. OBJECTIVES:The goal of the study was to ascertain the influence of discopathy in the lumbosacral (L-S) segment on the occurrence of sexual dysfunction. MATERIAL AND METHODS:The study involved 50 hospitalized patients with discopathy in the L-S segment were asked to complete a specially prepared questionnaire (11 questions). The goal of the survey was to compare the patients' satisfaction with their sex life before and after the disease. The questions were constructed in a way that excluded other indicators that could affect their sexual activity, i.e.: bad moods, bad family relations, or a lack of sexual activity due to age or the lack of a partner. RESULTS:Discopathy in the lumbar-sacral segment has an influence on sexual activity. A decrease in the assessment of satisfaction with one's sex life can be observed among patients with discopathy. CONCLUSIONS:The pain and neurological symptoms associated with intervertebral disc disease reduce the patients' satisfaction with their sex lives. Patients in the group surveyed noted a change in sexual performance, often resulting in passivity, discouragement, weakness or a complete lack of interest in sex. The disorders also affect the emotional state. The patients also noted a significant decrease in physical activity.
    Sexual Dysfunction: Prevalence and Prognosis in Patients Operated for Degenerative Lumbar Spondylolisthesis. Chan Andrew K,Bisson Erica F,Fu Kai-Ming,Park Paul,Robinson Leslie C,Bydon Mohamad,Glassman Steven D,Foley Kevin T,Shaffrey Christopher I,Potts Eric A,Shaffrey Mark E,Coric Domagoj,Knightly John J,Wang Michael Y,Slotkin Jonathan R,Asher Anthony L,Virk Michael S,Kerezoudis Panagiotis,Alvi Mohammed A,Guan Jian,Haid Regis W,Mummaneni Praveen V Neurosurgery BACKGROUND:There is a paucity of investigation on the impact of spondylolisthesis surgery on back pain-related sexual inactivity. OBJECTIVE:To investigate predictors of improved sex life postoperatively by utilizing the prospective Quality Outcomes Database (QOD) registry. METHODS:A total of 218 patients who underwent surgery for grade 1 degenerative lumbar spondylolisthesis were included who were sexually active. Sex life was assessed by Oswestry Disability Index item 8 at baseline and 24-mo follow-up. RESULTS:Mean age was 58.0 ± 11.0 yr, and 108 (49.5%) patients were women. At baseline, 178 patients (81.7%) had sex life impairment. At 24 mo, 130 patients (73.0% of the 178 impaired) had an improved sex life. Those with improved sex lives noted higher satisfaction with surgery (84.5% vs 64.6% would undergo surgery again, P = .002). In multivariate analyses, lower body mass index (BMI) was associated with improved sex life (OR = 1.14; 95% CI [1.05-1.20]; P < .001). In the younger patients (age < 57 yr), lower BMI remained the sole significant predictor of improvement (OR = 1.12; 95% CI [1.03-1.23]; P = .01). In the older patients (age ≥ 57 yr)-in addition to lower BMI (OR = 1.12; 95% CI [1.02-1.27]; P = .02)-lower American Society of Anesthesiologists (ASA) grades (1 or 2) (OR = 3.7; 95% CI [1.2-12.0]; P = .02) and ≥4 yr of college education (OR = 3.9; 95% CI [1.2-15.1]; P = .03) were predictive of improvement. CONCLUSION:Over 80% of patients who present for surgery for degenerative lumbar spondylolisthesis report a negative effect of the disease on sex life. However, most patients (73%) report improvement postoperatively. Sex life improvement was associated with greater satisfaction with surgery. Lower BMI was predictive of improved sex life. In older patients-in addition to lower BMI-lower ASA grade and higher education were predictive of improvement. 10.1093/neuros/nyz406
    Lack of Current Recommendations for Resuming Sexual Activity Following Spinal Surgery. Thomas Cara Michelle,Levene Howard Benjamin Asian spine journal Patients are faced with many questions surrounding the after effects of the various surgical procedures and their ability to return to preoperative activities. While patients often question whether surgery would provide alleviation of pain, weakness, and instability, they often have additional questions about sexual activity during their convalescence that are not always addressed. Although the literature shows postsurgical improvement in sexual activity in association with improved low back pain, reports vaguely address the variability in sexual activity recommendations based on anatomic location and type of spinal surgery. We conducted a PubMed search of the English language from 1990 to 2018 with the following keywords: sexual activity, postoperative, spinal fusion, spinal decompression, functional outcomes, laminectomy, rehabilitation, biomechanics, lumbar disc surgery, metabolic energy expenditure, coital position, and Oswestry Disability Index. Additional studies are needed that survey both patients and spine surgeons to examine current recommendations and to help formulate future guidelines. 10.31616/asj.2018.0106
    Predictive Factors of Male Sexual Dysfunction After Traumatic Spinal Cord Injury. Ferro Josepha Karinne de Oliveira,Lemos Andrea,Silva Caroline Palácio da,Lima Claudia Regina Oliveira de Paiva,Raposo Maria Cristina Falcão,Cavalcanti Geraldo de Aguiar,Oliveira Daniella Araújo de Spine STUDY DESIGN:Observational study (Ethics Committee Number 973.648). OBJECTIVE:Evaluating the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction. SUMMARY OF BACKGROUND DATA:Besides the motor and sensory loss, sexual function changes after spinal cord injury, ranging from decreased sexual desire to erectile disorders, orgasm, and ejaculation. METHODS:Performed with 45 men, with traumatic spinal cord injury and sexually active. Sexual function was assessed by the International Index of Erectile Function and the level and degree of injury were determined following guidelines of International Standards for Neurological and Functional Examination Classification of Spinal Cord Injury. Bi and multivariate analysis was applied, with a 0.05 significance level. RESULTS:Forty-five subjects with mean injury time of 7.5 years (CI 5.2-9.9) were evaluated. Having a fixed partner is a protective factor (OR: 0.25; 95% CI: 0.07-0.92) of erectile dysfunction. Sexual desire is associated with the fixed partner (OR: 0.12; 95% CI: 0.02-0.66), masturbation (OR: 0.13; 95% CI: 0.02-0.62), and sexual intercourse in the last month (OR: 0.13; 95% IC: 0.01-0.92). Ejaculation (OR: 0.01; 95% CI: 0.00-0.15) and erectile dysfunction (OR: 15.7; 95% CI: 1.38-178.58) are associated with orgasm. Psychogenic erection (OR: 0.07; 95% CI: 0.01-0.69), monthly frequency of sexual intercourse (OR: 11.3; 95% CI: 2.0-62.8), and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1-44.8) are associated with satisfaction. CONCLUSION:Fixed partner, ejaculation, masturbation are protective factors for sexual dysfunction. Erectile dysfunction, orgasmic, and infrequent sex dysfunction are predictors of sexual dysfunction. LEVEL OF EVIDENCE:3. 10.1097/BRS.0000000000003049
    Sex Life and Impact of Operative Intervention on Sex Life-related Pain in Degenerative Spinal Conditions: An Analysis of the SPORT Study. Horst Patrick K,Khanna Krishn,Racine Linda,Theologis Alexander,Zhao Wenyan,Lurie Jon,Burch Shane Spine STUDY DESIGN:This study is a therapeutic retrospective cohort study OBJECTIVES.: This study aims to determine whether sexual function is relevant for patients with spinal stenosis (SPS) and degenerative spondylolisthesis (DS) and to determine the impact of operative inter vqAvention on sexual function for these patients. SUMMARY OF BACKGROUND DATA:The benefits of nonoperative versus operative treatment for patients with SPS and DS with regards to sexual function are unknown. METHODS:Demographic, treatment, and follow-up data, including the Oswestry Disability Index (ODI), were obtained on patients enrolled in the SPORT study. Based on the response to question #9 in the ODI, patients were classified into a sexual life relevant (SLR) or sexual life not relevant (NR) group. Univariate and multivariate analysis of patient characteristics comparing the NR and SLR group were performed. Operative treatment groups were compared to the nonoperative group with regards to response to ODI question #9 to determine the impact of surgery on sexual function. RESULTS:A total of 1235 patients were included to determine relevance of sex life. Three hundred sixty-six patients (29%) were included in the NR group. Eight hundred sixty-nine patients (71%) were included in the SLR group. Patients that were older, female, unmarried, had three or more stenotic levels, and had central stenosis were more likely to be in the NR group. Eight hundred twenty-five patients were included in the analysis comparing operative versus nonoperative treatment. At all follow-up time points, the operative groups had a lower percentage of patients reporting pain with their sex life compared to the nonoperative group (P < 0.05 at all time points except between more than one level fusion and nonoperative at 4 years' follow-up). CONCLUSION:Sex life is a relevant consideration for the majority of patients with DS and SPS; operative treatment leads to improved sex life-related pain. LEVEL OF EVIDENCE:3. 10.1097/BRS.0000000000001851
    Pain During Sex Before and After Surgery for Lumbar Disc Herniation: A Multicenter Observational Study. Holmberg Siril T,Salvesen Øyvind O,Vangen-Lønne Vetle,Hara Sozaburo,Fredheim Olav M,Solberg Tore K,Jakola Asgeir S,Solheim Ole,Nygaard Øystein P,Gulati Sasha Spine STUDY DESIGN:Observational multicenter study. OBJECTIVE:The aim of this study was to evaluate changes in pain during sexual activity after surgery for lumbar disc herniation (LDH). SUMMARY OF BACKGROUND DATA:There are limited data available on sexual function in patients undergoing surgery for LDH. METHODS:Data were retrieved from the Norwegian Registry for Spine Surgery. The primary outcome was change in pain during sexual activity at one year, assessed by item number eight of the Oswestry disability index (ODI) questionnaire. Secondary outcome measures included ODI, EuroQol-5D (EQ-5D), and numeric rating scale (NRS) scores for back and leg pain. RESULTS:Among the 18,529 patients included, 12,103 (64.8%) completed 1-year follow-up. At baseline, 16,729 patients (90.3%) provided information about pain during sexual activity, whereas 11,130 (92.0%) among those with complete follow-up completed this item. Preoperatively 2586 of 16,729 patients (15.5%) reported that pain did not affect sexual activity and at 1 year, 7251 of 11,130 patients (65.1%) reported a normal sex-life without pain. Preoperatively, 2483 (14.8%) patients reported that pain prevented any sex-life, compared to 190 patients (1.7%) at 1 year. At baseline, 14,143 of 16,729 patients (84.5%) reported that sexual activity caused pain, and among these 7232 of 10,509 responders (68.8%) reported an improvement at 1 year. A multivariable regression analysis showed that having a life partner, college education, working until time of surgery, undergoing emergency surgery, and increasing ODI score were predictors of improvement in pain during sexual activity. Increasing age, tobacco smoking, increasing body mass index, comorbidity, back pain >12 months, previous spine surgery, surgery in two or more lumbar levels, and complications occurring within 3 months were negative predictors. CONCLUSION:This study clearly demonstrates that a large proportion of patients undergoing surgery for LDH experienced an improvement in pain during sexual activity at 1 year. LEVEL OF EVIDENCE:2. 10.1097/BRS.0000000000003675
    Predictors and Long-term Outcome of Sexual Function After Surgical Treatment for Single-level Lumbar Disk Herniation Among Patients in a German Spine Center. Elsharkawy Alaa E,Lange Bettina,Caldas Fernando,Alabbasi Abdel H,Klassen Peter D Clinical spine surgery STUDY DESIGN:This is a retrospective, self-controlled cohort study, at a single center. OBJECTIVE:The aim of this study was to evaluate the long-term outcome of sexual function after surgical treatment of single-level lumbar disk herniation (LDH). SUMMARY OF BACKGROUND DATA:The impact of surgical treatment on sexual activity is still unknown and not well researched. MATERIALS AND METHODS:In total, 114 patients who underwent disk surgery for LDH between 2009 and 2015 were included in the study (mean age, 46.9 y). Two separate questionnaires evaluating general health and all aspects of sexual function were administered to all patients. RESULTS:Satisfaction with the overall outcome of surgery was reported by 84.2% of patients. In total, 82 patients (71.9%) rated their current sexual life as normal with no additional pain, 22 (19.3%) reported a normal sex life with some additional pain, and 2 reported that (2.6%) pain prevents them from having any sex life at all. Compared with their state before LDH and spine surgery, 79 patients (69.3%) rated their sexual function as quantitatively and qualitatively the same as before surgery, 19 patients (16.7%) as better, and 16 patients (14.0%) as worse. The ability to experience orgasm, complete intercourse, experience sexual desire, and experience sexual arousal was reported to be the same as before surgery by 87 (76.3%), 75 (65.8%), 79 (69.3%), and 85 (74.6%) patients, respectively. After surgery, 16 patients (14%) explored new sexual positions. Sexual function receives insufficient attention from physicians. Women reported more general and sexual problems such as decreased sexual desire and interest, taking medication, and seeking regular medical attention. Predictors of the outcome were leg pain, the intensity of back and leg pain, and the professional status of the patient. CONCLUSIONS:Lumbar disk surgery has a positive effect on sexual function. The majority of patients returned to their normal sexual activities in long-term follow-up. 10.1097/BSD.0000000000000669
    Postoperative Sexual Activity Recommendations: Survey of Neurosurgeons/Spine Surgeons. Thomas Cara M,Cajigas Iahn,Levene Howard B World neurosurgery OBJECTIVE:The impact of various types of spinal surgeries on sexual health and postoperative sexual activity is a common question among both patients and health care professionals. Unfortunately, there is no clear answer to this question in the scientific literature. Our goal was to survey the current practices and recommendations of neurosurgeons to see if there was a clinical consensus. METHODS:Participants in the survey included 50 spine surgeons: 47 males and 3 females. The average age of the participants was 45.7 years old, and the number of years of practice after residency was on average 11.7 years. Additional survey questions included the number of weeks recommended for patients to abstain before returning to sexual activity after specified small, medium, and large spinal surgeries. RESULTS:We found that there were no statically significant correlations between the participants' ages or years post residency and the time response for postoperative return to sexual activity. Some answers were significantly different among the participants. The results also showed a trend for spine surgeons to recommend longer intervals for return to sexual activities after more involved surgical procedures. CONCLUSIONS:The survey results and comments demonstrate the complete lack of physician consensus regarding recommendations for postoperative return to sexual activity and the need for further study. 10.1016/j.wneu.2020.04.171
    Male spine motion during coitus: implications for the low back pain patient. Sidorkewicz Natalie,McGill Stuart M Spine STUDY DESIGN:Repeated measures design. OBJECTIVE:To describe male spine movement and posture characteristics during coitus and compare these characteristics across 5 common coital positions. SUMMARY OF BACKGROUND DATA:Exacerbation of pain during coitus due to coital movements and positions is a prevalent issue reported by low back pain patients. A biomechanical analysis of spine movements and postures during coitus has never been conducted. METHODS:Ten healthy males and females engaged in coitus in the following preselected positions and variations: QUADRUPED, MISSIONARY, and SIDELYING. An optoelectronic motion capture system was used to measure 3-dimensional lumbar spine angles that were normalized to upright standing. To determine whether each coital position had distinct spine kinematic profiles, separate univariate general linear models, followed by Tukey's honestly significant difference post hoc analysis were used. The presentation of coital positions was randomized. RESULTS:Both variations of QUADRUPED, mQUAD1 and mQUAD2, were found to have a significantly higher cycle speed than mSIDE (P = 0.043 and P = 0.034, respectively), mMISS1 (P = 0.003 and P = 0.002, respectively), and mMISS2 (P = 0.001 and P < 0.001, respectively). Male lumbar spine movement varied depending on the coital position; however, across all positions, the majority of the range of motion used was in flexion. Based on range of motion, the least-to-most recommended positions for a male flexion-intolerant patient are mSIDE, mMISS2, mQUAD2, mMISS1, and mQUAD1. CONCLUSION:Initial recommendations-which include specific coital positions to avoid, movement strategies, and role of the partner-were developed for male patients whose low back pain is exacerbated by specific motions and postures. LEVEL OF EVIDENCE:N/A. 10.1097/BRS.0000000000000518
    Documenting female spine motion during coitus with a commentary on the implications for the low back pain patient. Sidorkewicz Natalie,McGill Stuart M European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society PURPOSE:To describe female lumbar spine motion and posture characteristics during coitus and compare these characteristics across five common coital positions. Exacerbation of low back pain during coital movements and positions is a prevalent issue reported by female low back pain (LBP) patients. To address this problem, the first study to examine lumbar spine biomechanics during coitus was conducted. METHODS:Ten healthy males and females performed coitus in the following pre-selected positions and variations: QUADRUPED (fQUAD1 and fQUAD2 where the female is supporting her upper body with her elbows and hands, respectively), MISSIONARY (fMISS1 and fMISS2 where the female is minimally and more flexed at the hips and knees, respectively), and SIDELYING. An electromagnetic motion capture system was used to measure three-dimensional lumbar spine angles that were normalized to maximum active range of motion-a transmitter and receiver were affixed to the skin overlying the lateral aspect of the pelvis and the spinous process of the twelfth thoracic vertebra, respectively. To determine if each coital position had distinct spine kinematic profiles (i.e., amplitude probability distribution function and total range of lumbar spine motion), separate univariate general linear models followed by Tukey's honestly significant difference post hoc analysis were used. The presentation of coital positions was randomized. RESULTS:Female lumbar spine movement varied depending on the coital position; both variations of QUADRUPED, fQUAD1 and fQUAD2, were found to use a significantly greater range of spine motion than fMISS2 (p = 0.017 and p = 0.042, respectively). With the exception of both variations of MISSIONARY, fMISS1 and fMISS2, the majority of the range of motion used was in extension. These findings are most pertinent to patients with LBP that is exacerbated by motions or postures. Based on the spine kinematic profiles of each position, the least-to-most recommended positions for a female flexion-intolerant patient are: fMISS2, fMISS1, fQUAD1, fSIDE, and fQUAD2. These recommendations would be contraindicated for the extension-intolerant patient. CONCLUSIONS:The findings provided here may guide the clinician's specific recommendations, including alternative coital positions and/or movement patterns or suggesting a lumbar support, depending on the female LBP patient's specific motion and posture intolerances. 10.1007/s00586-014-3626-y
    How does surgery affect sexual desire and activities in patients with lumbar disc herniation? Kanayama Masahiro,Horio Michiko,Umi Yumi,Yamaguchi Ai,Omata Junichi,Togawa Daisuke,Hashimoto Tomoyuki Spine STUDY DESIGN:A retrospective survey using privacy-conscious questionnaires. OBJECTIVE:To determine the quality and frequency of sexual activities in patients with lumbar disc herniation before and after surgery. SUMMARY OF BACKGROUND DATA:Patients and health care professionals often hesitate to talk about the effects of disease, illness, or surgery on sexuality, but it is imperative that sexuality issues be addressed. METHODS:Of 90 consecutive patients, 64 who had surgically-treated lumbar disc herniation participated in this survey after informed consent. There were 43 males and 21 females with mean age of 36 years. Duration of symptom was averaged 42 weeks. The patients were asked to complete questionnaires concerning sexual desire, activity, adjustment, and satisfaction. About 83% of the patients had sexual desire, and 89% achieved satisfaction during sexual activities in presick period. RESULTS:Lumbar disc herniation decreased sexual desire in 50% and frequency of sexual activity in 59% of the patients. About 67% of males and 81% of females felt discomfort during sexual activity; satisfaction decreased in 28% of male and 41% of females. Adjustment in sexual position was required in 54% of males and 86% of females. Surgery improved sexual desire, frequency of sexual activity, and satisfaction in 85%, 88%, and 94%, respectively. However, 31% of females did not regain sexual desire and 46% still felt discomfort during sexual activity (the rates were 7% and 17% in males, respectively). Sexual activity was resumed within 2 postoperative weeks in 23% (27% in males and 14% in females), and 4 weeks in 53%. Males resumed sexual activity earlier than females. CONCLUSION:Lumbar disc herniation largely impacted sexual desire, activity, and satisfaction. Adjustment in sexual position was required in large number of patients to avoid discomfort during sexual activities. Surgical treatment improved quality of sexual activities, but more females did not regain sexual desire, felt sexual discomfort, and thereby resumed sexual activities later than males after surgery. 10.1097/BRS.0b013e3181ba29f9
    Sexual activity after spine surgery: a systematic review. Malik Azeem Tariq,Jain Nikhil,Kim Jeffery,Khan Safdar N,Yu Elizabeth European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society INTRODUCTION:Sexual function is an important determinant of quality of life, and factors such as surgical approach, performance of fusion, neurological function and residual pain can affect it after spine surgery. Our aim was to perform a systematic review to collate evidence regarding the impact of spine surgery on sexual function. METHODS:A systematic review of studies reporting measures of sexual function, and incidence of adverse sexual outcomes (retrograde ejaculation) after major spine surgery was done, regardless of spinal location. Pubmed (MEDLINE) and Google Scholar databases were queried using the following search words "Sex", "Sex life", "Sexual function", "Sexual activity", "retrograde ejaculation", "Spine", "Spine surgery", "Lumbar surgery", "Lumbar fusion", "cervical spine", "cervical fusion", "Spinal deformity", "scoliosis" and "Decompression". All articles published between 1997 and 2017 were retrieved from the database. A total of 81 studies were included in the final review. RESULTS:Majority of the studies were retrospective case series and were low quality (Level IV) in evidence. Anterior lumbar approaches were associated with a higher incidence of retrograde ejaculation, especially with the utilization of transperitoneal laparoscopic approach. There is inconclusive evidence on the preferred sexual position following fusion, and also on the impact of BMP-2 usage on retrograde ejaculation/sexual dysfunction. CONCLUSION:Despite limited evidence from high-quality articles, there is a general trend towards improvement of sexual activity and function after spine surgery. Future studies incorporating specific assessments of sexual activity will be required to address this important determinant of quality of life so that appropriate pre-operative counselling can be done by providers. These slides can be retrieved under Electronic Supplementary Material. 10.1007/s00586-018-5636-7
    [Sexual quality of life in patients with low back pain and the radiological changes evaluated in magnetic resonance]. Łabuz-Roszak Beata,Babińska Anna,Skupiński Jarosław,Czech Elżbieta,Szczygieł Jarosław,Wawrzynek Wojciech Wiadomosci lekarskie (Warsaw, Poland : 1960) OBJECTIVE:Introduction: Literature data concerning the association between the back pain syndrome and the quality of sexual life are rare, especially in the Polish literature. There are also no reports on the association between magnetic resonance (MRI) results and sexual satisfaction in patients with low back pain (L-S). The aim: To assess the association between the severity of degenerative-discopathic changes in the MRI of L-S spine and the quality of sexual life in patients with low back pain. PATIENTS AND METHODS:Materials and methods: The study involved 200 patients (107 women and 93 men), referred for MRI of the L-S spine due to the back pain syndrome. The assessment of satisfaction with sexual life at present and before the disease was made by the self-constructed questionnaire and with the use of the Question No. 8 of the Oswestry Questionnaire (ODI). In addition, the VAS (Visual Analogue Scale) was used. MRIs were analyzed based on the author's scoring scale, assessing selected radiological changes at levels L1-S1. The total score was in the range of 0-50 points. RESULTS:Results: There was a statistically significant decrease in the quality of sexual life (8.9 points vs 6.3 points) (<0.001). Back pain did not affect sexual life only in 36.9% of respondents. 26.5% patients were sexually inactive, 7.5% of them declared that pain was the reason for this. There was no statistically significant correlation between the intensity of radiological changes and satisfaction with sexual life. CONCLUSION:Conclusions: Back pain affects the patients' sexual life. There was no association between the severity of degenerative-discopathic changes assessed in the MRI and the quality of sexual life in patients with L-S back pain syndrome.
    The Effect of Chronic Musculoskeletal Pain on Sexual Function and Quality of Life of Cardiac Rehabilitation Patients. Wittkopf Pricilla Geraldine,Cardoso Allana Alexandre,de Carvalho Tales,Cardoso Fernando Luiz The Journal of cardiovascular nursing BACKGROUND:Comorbidities are stressors to the body and have a negative impact on quality of life and sexual function. OBJECTIVE:The objective of this study was to investigate the effect of the coexistence of coronary heart disease and chronic musculoskeletal pain on sexual function and quality of life of patients undergoing an exercise-based cardiac rehabilitation program. METHODS:This cross-sectional observational study included 105 patients. Instruments used were the musculoskeletal system assessment inventory, Short-Form Health Survey quality-of-life questionnaire, International Index of Erectile Function, and Female Sexual Function Index. RESULTS:There were no differences in male sexual function compared between participants with and without pain. Participants with pain had lower quality-of-life scores related to socioemotional aspects. CONCLUSIONS:The coexistence of coronary heart disease and musculoskeletal pain does not seem to affect patients' sexual function, but it negatively affects Patients' quality of life. This study emphasizes the importance of a multidisciplinary team working in a cardiac rehabilitation program addressing issues related to pain, sexual function, and quality of life. 10.1097/JCN.0000000000000455
    Sexual function and associated factors in Iranian patients with chronic low back pain. Nikoobakht M,Fraidouni N,Yaghoubidoust M,Burri A,Pakpour A H Spinal cord STUDY DESIGN:Case-control study. OBJECTIVES:(i) To describe the prevalence of sexual dysfunction in chronic low back pain (CLBP) patients, (ii) to compare the range of sexual function outcomes between patients with CLBP and healthy controls and (iii) to investigate which factors are associated with sexual function within the cohort of individuals with CLBP. SETTING:Low back pain (LBP) clinic of Qazvin University of Medical Sciences, Qazvin, Iran. METHODS:A total of 702 patients with CLBP and 888 healthy controls participated in the study. The Female Sexual Function Index (FSFI), International Index of Erectile Function (IIEF) and Premature Ejaculation Diagnostic Tool (PEDT) were used to evaluate sexual function. In addition, quality of life, anxiety, functional status and pain intensity were assessed in patients. Univariate and multiple linear regression analyses were performed for the identification of factors associated with sexual function. RESULTS:The prevalence of sexual problems in female patients with CLBP was 71.1% (n=177) while the corresponding figure for healthy women was 36.8% (n=161). Erectile dysfunction was present in 59.5% of male patients and in 24.5% of healthy males. Higher sexual function in both male and female patients with CLBP were being younger, lower duration of back pain, lower BMI, higher education level, being unemployed, physically active shorter sick leave, lower level of pain intensity, lower disability, higher family income, lower levels of depressive and anxiety symptoms, and higher psychical functioning and mental functioning. CONCLUSIONS:CLBP patients report considerably higher prevalences of sexual problems compared with healthy controls. Sex therapy and sexual management should be added to routine care and treatment of patients with CLBP. 10.1038/sc.2013.151
    Discussing sexual concerns with chronic low back pain patients: barriers and patients' expectations. Bahouq H,Allali F,Rkain H,Hajjaj-Hassouni N Clinical rheumatology This study aims to explore patient's concerns when discussing sexual problems caused by chronic low back pain with their healthcare provider. It also aims to identify factors influencing and limiting such communication. A cross-sectional analysis of 100 consenting chronic low back pain sexually active patients was carried out. Patients answered questions on their disease characteristics and sex life. They also mentioned prohibitions of discussing sex with their healthcare provider and their expectations of such discussion. Factors influencing patient's experiences were analyzed. Median of chronic low back pain duration was 36 (24-72) months and back pain intensity using visual analogical scale (0-100 mm) was 50 ± 10.7 mm. Eighty-one percent of our patients complained of sexual problems, 66 % have never discussed the subject with their healthcare provider. Barriers which prevent discussion on sex include the taboo character of the topic, inappropriateness of visit conditions, and patient disinterest in sex. Ninety-three percent of patients expressed the need of sexual problems' management in chronic low back pain consulting. Seventy-four percent expected information and advice from their healthcare provider about recommended intercourse positions so as to avoid pain. Thirty-three percent of patients wanted their partner to be involved in the discussion and 81 % preferred talking with a healthcare provider of the same gender. Ability to communicate on the topic was associated with the decrease of patient sexual satisfaction and limited by patient illiteracy. Our study evidences that sex discussion between patient and healthcare provider is restricted by several barriers and that patients expect more involvement from their healthcare provider on the subject. Illiteracy and level of sexual satisfaction seem to be the strongest factors influencing this communication. 10.1007/s10067-013-2299-y