ASPECTS OF CURRENT MANAGEMENT Erectile dysfunction after fracture of the pelvis

©2005 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.87B3. 15662 $2.00 J Bone Joint Surg [Br] 2005;87-B:281-90. Male sexual dysfunction after fracture of the pelvis is more common than previously supposed with rates as high as 30% reported when the complaint is specifically sought. With the increase in survival from major injuries, the long-term consequences of trauma are being seen with increasing frequency. This review addresses the current understanding of the incidence, mechanism of injury, pathophysiology, acute management, subsequent investigation and long-term treatment of erectile dysfunction after injury to the pelvis. The intimate relationship of the soft tissues and the bony pelvic ring result in a high risk of concomitant local injury associated with fractures of the pelvis.1 The bladder and urethra are particularly vulnerable, with reported rates of injury of 5% to 10%.1-4 Even without severe urological injury, damage to the delicate vascular and nervous tissues supplying the genitalia can result in sexual dysfunction.5,6 Patients with polytrauma often have prolonged stays in hospital and require multiple operations on the pelvis, putting genitourinary structures at further risk of injury. Erectile dysfunction has been defined as the inability to achieve or maintain an erection adequate for sexual satisfaction.7 In 3% of patients with sexual dysfunction, this will be secondary to an episode of pelvic or perineal trauma.8 In younger impotent patients, often at the beginning of their sexual lives, the motivation to restore function is very high.