Female Sexual Dysfunction, Failed Back Surgery, and Low Back Pain

Marc Darrow, MD, JD.

This article will provide general information on sexual dysfunction in female patients suffering from back pain. Researchers have tried to discern the exact impact of lumbar back pain and/or failed back surgery on sexual function in female patients. The answers are not easy to find.

A September 2015 study (1) Sexual and reproductive health is important quality of life outcomes, which can have a major impact on patient satisfaction. Spinal pathology arising from trauma, deformity, and degenerative disease processes may be detrimental to sexual and reproductive function. Furthermore, spine surgery may impact sexual and reproductive function due to post-surgical mechanical, neurologic, and psychological factors. . . Spine surgeons and non-operative healthcare providers should be aware of the issues surrounding sexual and reproductive function as related to spine pathology and spine surgery. It is important for spine surgeons to educate their patients on the operative risks that spine surgery encompasses with regard to sexual dysfunction.

A July 2022 paper (2) Although identified as a key preoperative predictor in maintenance or improvement of neurologic status, sexuality is rarely addressed in the neurosurgical care plan. In spinal stenosis and degenerative spine disease, over half of patients report pain with sexual activity. Importantly, while pain can hinder sexual activity in females, there are other sexual issues, including desire and subjective arousal, lubrication, orgasm, and satisfaction that are usually not explored. Studies show the impact of spinal pathologies on frequency of sexual intercourse, hypoesthesia, anorgasmia, and depression. Surgical intervention of spinal pathologies has been cited to improve back pain however other types of sexual dysfunction usually fails to improve after surgical intervention.

An October 2018 study (3) 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. . . Despite limited evidence from high-quality articles, there is a general trend towards improvement of sexual activity and function after spine surgery.

A July 2022 paper (4) Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) consists of persistent or recurrent unwanted sensations of genital arousal that may include other types of genito-pelvic dysesthesia, which occur without concomitant sexual interest or thoughts. . . .Sacroiliac joint dysfunction may be a trigger for PGAD/GPD in some cases. Lack of relevant knowledge among patients and healthcare providers is the biggest challenge of the proper diagnosis and treatment of PGAD/GPD at present.

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1 Albright TH, Grabel Z, DePasse JM, Palumbo MA, Daniels AH. Sexual and reproductive function in spinal cord injury and spinal surgery patients. Orthopedic reviews. 2015 Sep 28;7(3).
2 Moscicki P, Bachmann GA. Characterization of Female Sexual Dysfunction Associated with Spinal Pathology and Surgery. Sexual Medicine Reviews. 2022 Jul 16.
3 Malik AT, Jain N, Kim J, Khan SN, Yu E. Sexual activity after spine surgery: a systematic review. European Spine Journal. 2018 Oct;27(10):2395-426.
4 Zhang Y, Su L, Ge H, Wang Q. Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia caused by Sacroiliac Joint Dysfunction. Sexual Medicine. 2022 Oct 1;10(5):100544.


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