Discussing sexual health with patients eligible for spine surgery: An online survey in spine surgeon and pain physicians

Abstract

Introduction: Spinal pain syndromes have a severe impact on the patient's sex life, contributing to a decrease in sexual function and sexual satisfaction. Despite the importance of sexual health on mental and physical wellbeing, sexual health is rarely discussed during consultations.

Research question: The aim of this study is to explore to what extent influencing factors can alter the discussion about sexual health during consultations. More specifically, we will evaluate the influence of healthcare profession, sex of the patient and the surgical approach that is proposed.

Material and methods: An online survey was sent to neurosurgeons, pain physicians and orthopedists in Belgium and The Netherlands in April 2019. Participants were asked about; counseling routine, knowledge, and opinion on sexual health. Answers were scored on a 5-point Likert scale. Independence between the response levels and type of surgery as well as profession were tested.

Results: In total, 350 respondents were approached of whom 57 completed the survey. The majority of respondents (61.4%) indicated that they rarely or never discussed sexual disturbances. Profession and type of surgery had an influence on discussing erectile dysfunction, retrograde ejaculation, and alterations in orgasms. Thirty-five percent of healthcare providers considered it the patient's responsibility to bring up the subject of sexual health.

Discussion and conclusion: Sexual health is rarely addressed by healthcare providers during spinal care. Profession as well as type of surgery seems to play a role on whether sexual health is discussed during consultations.

Keywords: Counseling; Patient care; Sexual dysfunction; Sexual health; Spine procedures.

Fig. 1

Bar plots of the proportion of response levels for sexual functionality, separated by type of surgery and profession of healthcare providers. Physicians could give a rating on a 5-point Likert scale with the following options: (1) never; (2) rarely; (3) sometimes; (4) usually; (5) always. Pain physicians are indicated in green, neurosurgeons in red and orthopedists in blue. The upper row presents the frequency of asking patients about sexual functionality before surgery, and the lower row the same question after surgery. Abbreviations. ALIF: anterior lumbar interbody fusion procedures; DHS: herniated disc surgery; PLIF: posterior lumbar interbody fusion (PLIF). (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Mosaic plots with a cell-by-cell comparison of the observed and expected counts, calculated on standardized Pearson residuals. A standardized Pearson residuals that exceeds about two or three in absolute value indicates a lack of fit of the null hypothesis of independence in that specific cell. Blue colors indicate a higher observed count than expected; red colors indicate a lower observed count than expected under the null hypothesis of independence. Abbreviations. ALIF: anterior lumbar interbody fusion procedures; anes: pain physicians; DHS: herniated disc surgery; neur: neurosurgeons; orth: orthopedists; PLIF: posterior lumbar interbody fusion (PLIF). (For interpretation of the references to color in this figure legend, the reader is referred to the Web version of this article.)