Men’s Experiences with Sexual Dysfunction Following Traumatic Pelvic Fracture: A Qualitative Study

Abstract

Introduction: Sexual dysfunction in men following traumatic pelvic fracture is common. However, little is known of how men experience changes in their sexual health after injury and how they interact with the healthcare system to address these issues. Aim: To explore in-depth the personal and interpersonal impacts of sexual dysfunction in men after pelvic injury, and to understood how interactions with the healthcare system can be optimized to improve patient-centered survivorship care. Methods: Fifteen semi-structured interviews were conducted with men who had a history of traumatic pelvic fracture and self-reported sexual dysfunction. Interviews were audio recorded, transcribed, and uploaded to a web-based qualitative analysis platform. A codebook was developed and intercoder reliability verified. Inductive thematic analysis was performed to identify notable themes related to patient post-injury sexual health experiences. Outcomes: Identification of themes related to the impact of post-injury sexual dysfunction and the provision of care. Results: Median age of interviewees was 46 years (IQR 44, 54), with a median time since injury of 41 months (IQR 22, 55). Five primary themes were identified from the analysis: effects on self-image and romantic relationships; unknown care pathways and lack of communication; inconsistencies with healthcare provider priorities; provision of sexual health information and resources; and the importance of setting expectations. Men struggled with the impact that new sexual dysfunction had on both them individually and on their relationships. They reported a decreased sense of confidence and virility. Men felt alone and uninformed, and that there were no available outlets to seek information or treatment. Furthermore, they often felt that sexual health concerns were delegitimized by providers. Interviewees suggested that improved communication, provision of information related to possible side-effects of their injuries, and expectation setting would improve experiences. Clinical Implications: Sexual dysfunction after traumatic pelvic fractures can have significant effects on both individuals and their relationships, but these effects can be modified by improvements in communication and resource provision after injury. Strengths & Limitations: Strengths include a rigorous qualitative methodology that provided in-depth descriptions of personal experiences and healthcare interactions. Limitations include single-center experience and limited heterogeneity in terms of race and sexual orientation. Conclusion: Men’s experiences with sexual dysfunction after pelvic trauma can be heavily influenced by their interactions with healthcare providers and the value that is placed on sexual health as a component of survivorship. Incorporating these findings into a patient-centered trauma survivorship program may improve patient experiences.