Abstract
Objectives:
1) To evaluate if femoracetabular impingement syndrome (FAI) interferes with sexual relations and influences patientdecision to pursue surgical intervention. 2) To determine when patients return to sexual intercourse after hip arthroscopy for the treatment of FAI. 3) To compare preoperative to postoperative improvement in pain experienced during sexual intercourse based on sexual role assumed (receptive or penetrative) and position.
Methods:
This was a retrospective cohort study of patients undergoing hip arthroscopy for FAI between January 2019 and January 2022. Hip symptoms during sexual intercourse were evaluated using a Likert- style questionnaire. Patients were also asked to rate the severity of their hip pain with 12 common sexual positions before and after surgery. Patients who primarily participate as the penetrative role during intercourse were compared to those who participate as the receptive role. The difference in preoperative and postoperative pain experienced with each position was assessed using a series of Wilcoxon signed-rank tests for ordinal data. To confirm the results, each comparison was also evaluated using a series of ordered logistic regressions.
Results:
Sixty-one patients with a mean age of 33.8 +/- 8.48 and a mean follow up time of 1.96 +/- 0.88 years were included in the analysis. 47.5% of patients primarily assume the receptive role during sexual intercourse (36.1%: penetrative role; 13.1%: both). A significantly greater proportion of patients participating in receptive intercourse reported hip symptoms that interfered with sexual intercourse compared to patients participating in penetrative intercourse (p =.007). Furthermore, a greater proportion of patients in the receptive group reported that the hip pain during intercourse contributed to the decision to pursue hip surgery (p =.009) (Table 1). Following surgery, 94.9% of patients had returned to sexual intercourse by the time of latest follow up. These patients resumed sexual intercourse at a mean of 7.6 +/- 3.4 weeks postoperatively. There was no difference in time to resume intercourse between patients participating in receptive intercourse and those participating in penetrative intercourse (p = 0.277) (Figure 1). Overall, 52.2% of patients reported no pain or little pain with sexual intercourse at the time of latest follow up. Patients in the receptive group continued to report worse pain symptoms during intercourse compared to the penetrative group postoperatively. However, these patients experienced significantly greater improvement in preoperative to postoperative symptomatology during intercourse, specifically in sexual positions involving greater degrees of flexion and abduction (Figures 2, 3). For patients assuming the penetrative role during intercourse, there was no difference in hip pain after surgery based on sexual position (Figure 2, 4).
Conclusions:
Hip pain secondary to FAI interferes with sexual intercourse, particularly for patients who participate in the receptive role, and it influences their decision to undergo hip arthroscopy. These patients experience pain specifically in sexual positions involving greater degrees of flexion and abduction. Hip arthroscopy successfully improves the pain experienced while participating in these positions postoperatively.
