J Neurol Surg A Cent Eur Neurosurg 2024; 85(01): 026-031
DOI: 10.1055/s-0042-1759824
Original Article

Evaluation of Sexual Function in Patients with Lower Lumbar Disc Herniation: A Comparison of Pre- and Postoperative Status

Göksal Günerhan
1   Department of Neurosurgery, University of Health Science, Ankara City Hospital, Ankara, Turkey
,
Can Aykanat
2   Department of Urology, University of Health Science, Ankara City Hospital, Ankara, Turkey
,
Ozhan Merzuk Uçkun
1   Department of Neurosurgery, University of Health Science, Ankara City Hospital, Ankara, Turkey
,
Yılmaz Aslan
2   Department of Urology, University of Health Science, Ankara City Hospital, Ankara, Turkey
,
Denizhan Divanlıoğlu
1   Department of Neurosurgery, University of Health Science, Ankara City Hospital, Ankara, Turkey
,
Egemen Işıtan
1   Department of Neurosurgery, University of Health Science, Ankara City Hospital, Ankara, Turkey
,
Bekir Tunç
1   Department of Neurosurgery, University of Health Science, Ankara City Hospital, Ankara, Turkey
,
Altuğ Tuncel
2   Department of Urology, University of Health Science, Ankara City Hospital, Ankara, Turkey
,
Ahmet Deniz Belen
1   Department of Neurosurgery, University of Health Science, Ankara City Hospital, Ankara, Turkey
,
Ali Dalgıç
1   Department of Neurosurgery, University of Health Science, Ankara City Hospital, Ankara, Turkey
› Author Affiliations
Funding None.

Abstract

Background Neuroregulation of sexual functions requires coordination of parasympathetic, sympathetic, and somatosensory neuronal pathways. The nerves formed by the lower lumbar plexus provide the innervation of the urogenital organs. Lower lumbar disc hernias (LDHs) might impair the neuroregulation of sexual functions by compressing the neural structures. This prospective study aims to evaluate the effect of lower LDHs on libido and sexual dysfunctions.

Methods A total of 61 sexually active patients diagnosed with single-level LDH who underwent unilateral microdiscectomy were included in the study. The patients' healthy sex partners were included in study as controls. The International Sexual Function Index-5 (IIEF-5) and Female Sexual Function Index (FSFI) were used for sexual assessment of male and female participants, respectively. Visual Analog Scale (VAS) was used for pain assessment.

Results According to the FSFI scores, all 20 female patients had preoperative sexual dysfunction, which improved in 15 (75%) patients after surgery (p < 0.001). According to the IIEF-5 score for men, 38 of 41 male patients had preoperative sexual dysfunction, which improved in 26 (68.4%) patients postoperatively (p < 0.001).

Conclusion The preoperative sexual dysfunctions of LDH patients improved significantly after the microdiscectomy.

Ethics Statement

This study was approved by the Institutional Review Board (TUEK 1476/2018), and written informed consent was obtained from each patient.




Publication History

Received: 30 March 2022

Accepted: 01 September 2022

Article published online:
01 June 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Çaylı SR. Spinal cord and spine anatomy. In: Zileli M, Korfalı E. eds. Basic Neurosurgery. Vol. 1. Turkish Neurosurgery Society Publications No. 10. Ankara: Turkish Neurosurgical Society; 2010: 81-90
  • 2 Clark R, Weber RP, Kahwati L. Surgical management of lumbar radiculopathy: a systematic review. J Gen Intern Med 2020; 35 (03) 855-864
  • 3 Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin 2007; 25 (02) 387-405
  • 4 Steers WD. Neuroanatomy and neurophysiology of erection. Sex Disabil 1994; 12: 117-127
  • 5 Panneerselvam K, Kanna RM, Shetty AP, Rajasekaran S. Impact of acute lumbar disk herniation on sexual function in male patients. Asian Spine J 2022; 16 (04) 510-518
  • 6 Dzierżanowski M, Dzierżanowski M, Wrzecion K. et al. Discopathy of the lumbar-sacral segment and its influence on sexual dysfunction. Adv Clin Exp Med 2013; 22 (01) 93-100
  • 7 Malavaud B, Mouzin M, Tricoire JL. et al. Evaluation of male sexual function after pelvic trauma by the International Index of Erectile Function. Urology 2000; 55 (06) 842-846
  • 8 Thormann U, Erli HJ, Brügmann M. et al. Association of clinical parameters of operatively treated thoracolumbar fractures with quality of life parameters. Eur Spine J 2013; 22 (10) 2202-2210
  • 9 Cong ML, Gong WM, Zhang QG. et al. Urodynamic study of bladder function for patients with lumbar spinal stenosis treated by surgical decompression. J Int Med Res 2010; 38 (03) 1149-1155
  • 10 Akbaş NB, Dalbayrak S, Külcü DG, Yilmaz M, Yilmaz T, Naderi S. Assessment of sexual dysfunction before and after surgery for lumbar disc herniation. J Neurosurg Spine 2010; 13 (05) 581-586
  • 11 Kanayama M, Horio M, Umi Y. et al. How does surgery affect sexual desire and activities in patients with lumbar disc herniation?. Spine (PhilaPa1976) 2010; 35 (06) 647-651
  • 12 Turunc T, Deveci S, Güvel S, Peşkircioglu L. Evaluation of the Turkish ValidityStudyofthe5- Question Version of the International Index of Erectil Function (IIEF-5). Turk J Urol 2007; 33 (01) 45-49
  • 13 Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49 (06) 822-830
  • 14 Rosen R, Brown C, Heiman J. et al. The Female Sexual Function Index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther 2000; 26 (02) 191-208
  • 15 Wiegel M, Meston C, Rosen R. The female sexual function index (FSFI): cross-validation and development of clinical cutoff scores. J Sex Marital Ther 2005; 31 (01) 1-20
  • 16 El-Sakka AI. Association of risk factors and medical comorbidities with male sexual dysfunctions. J Sex Med 2007; 4 (06) 1691-1700
  • 17 Yazici CM, Sarifakioglu B, Guzelant A, Turker P, Ates O. An unresolved discussion: presence of premature ejaculation and erectile dysfunction in lumbar disc hernia. Int Urol Nephrol 2013; 45 (03) 659-667
  • 18 Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151 (01) 54-61
  • 19 Okutan O, Solaroglu I. Anatomy of peripheral nerves and plexuses. In: Zileli M, Korfalı E. eds. Basic Neurosurgery. Vol. 1. Turkish Neurosurgery Society Publications No. 10. Ankara: Turkish Neurosurgical Society; 2010: 91-106
  • 20 Ahn UM, Ahn NU, Buchowski JM, Garrett ES, Sieber AN, Kostuik JP. Cauda equina syndrome secondary to lumbar disc herniation: a meta-analysis of surgical outcomes. Spine 2000; 25 (12) 1515-1522
  • 21 Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil 2009; 90 (11) 1964-1968
  • 22 Hellstrom P, Kortelainen P, Kontturi M. Late urodynamic findings after surgery for cauda equina syndrome caused by a prolapsed lumbar intervertebral disk. J Urol 1986; 135: 308-312