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Sexual problems reported by men after anterior lumbar spine surgery

Swedish Lumbar Spine Study Group found more genital function problems were reported by men.

Issue: November 2003

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PRAGUE — Although sexual function improves for both men and women after lumbar spine surgery due to decreased back pain, specific genital function may be adversely affected in men after anterior surgery, according to a report from the Swedish Lumbar Spine Study Group.

Olle Hägg, MD, of the department of orthopedics, Sahlgrenska University Hospital in Göteborg, Sweden, said in a presentation at EuroSpine 2003 that a “surprisingly large proportion of men reported orgasm and ejaculation disturbances and genital numbness after anterior surgery.”

Hägg said sexual ability after lumbar spine surgery has mainly focused on male biological function, or retrograde ejaculation. Less is known about female sexual disturbance and sexual enjoyment. The aim of the study was to assess the sexual function and enjoyment in men and women after both posterior and anterior fusion for chronic low back pain.

Retrospective study

There were 294 patients in the retrospective trial. Data about sexual function and enjoyment were assessed from routine preoperative and postoperative questionnaires that included questions from the Oswestry and Zung scales.

Investigators also mailed a semi-anonymous questionnaire to surgery patients two years postoperative, asking specific questions related to genital function. The type of surgery and the gender of the patient were traced through the questionnaires, but no other information, including patient age, was available. Seventy-eight percent of patients responded. Of these, 58 women and 67 men were randomized to posterior fusion; 27 women and 17 men were randomized to anterior plus posterior fusion.

Overall, sexual function and enjoyment increased by 42% in women after PLF and 66% after anterior plus posterior fusion. Sexual function/enjoyment was unchanged in 40% and 22%, respectively, and decreased in 18%/12%, respectively.

Improvement in women was reported as less than 6% for any of the questions posed, Hägg said. There was a trend for sensory change that was greater after anterior fusion. There were no significant differences, however, for women between the types of fusion.

The situation was different for men, with improvement on specific questions less than 5%. Ejaculatory disturbance was 41% in anterior fusion and 11% in posterior fusion. Sensory change, or genital numbness, was 47% in anterior fusion vs. 12% in posterior fusion. Retrograde ejaculation was 13% in anterior fusion and 5% in posterior fusion.

Hägg said he had no explanation about why there would be more sexual disturbance for men after anterior surgery. He said the type of questionnaire used at follow-up did not allow researchers to correlate the complications to the age of the patients.

For more information:

• Hägg O, Fritzell P, Nordwall A, Swedish Lumbar Spine Study Group. Sexual function after surgery for chronic low back pain. #45. Presented at 5th Annual Meeting of the Spine Society of Europe. Oct. 1-4, 2003. Prague.