Prevalence and predictors of sexual dysfunction 12 months after major trauma: a national study.

BACKGROUND: To determine the prevalence and predictors of sexual dysfunction (SDF) after moderate-to-severe trauma in a large multicenter study. METHODS: The National Study on the Costs and Outcomes of Trauma was a prospective cohort study involving 69 hospitals from 15 regions in 14 states. Men and women aged 18 to 84 years with moderate-to-severe injures participated in 3 and 12 month postinjury interviews. At 12 months, sexual function was assessed using the Functional Capacity Index. Predictors of SDF were determined using adjusted multivariate Poisson regression. Sensitivity analyses were conducted on patients aged 18 to 30 years. RESULTS: Of 10,122 weighted subjects, 3,087 (30.5%) reported some degree of SDF, with the majority reporting severe SDF. On multivariate analysis, independent predictors of SDF included increasing age (aRR 1.02 per year age), decreasing household income category (aRR 1.12-1.60), lower baseline global health status (aRR 1.27-3.54), preexisting diabetes (aRR 1.34) increasing Injury Severity Score (aRR 1.02 per point increase), pelvic fracture (aRR 1.45), lower extremity fracture (aRR 1.48), and spinal cord injury (aRR 3.73). CONCLUSIONS: SDF is common and usually severe after major trauma. Injury severity is a significant independent predictor of SDF. This may be due to persistent physical, psychologic, or social limitations from injury. Given the effect on quality of life, these data support the need in the clinical setting to identify and address SDF after trauma. Further investigation is necessary to determine the mechanism by which injury severity mediates SDF and whether earlier interventions can decrease the later risk of SDF.