Evaluation of Sexual Function Before and After Hip Arthroscopic Surgery for Symptomatic Femoroacetabular Impingement

Background: It is unknown if chronic hip pain due to femoroacetabular impingement (FAI) may cause sexual difficulties. Available evidence suggests that hip arthroscopic surgery may be effective for the treatment of symptomatic FAI; however, sexual function before and after hip arthroscopic surgery has not been reported. Purpose/Hypothesis: The purpose of this study was to determine the presence and significance of sexual difficulties in patients with chronic hip pain due to symptomatic FAI both before and after hip arthroscopic surgery. The hypotheses were that (1) chronic hip pain due to symptomatic FAI has a negative effect on sexual function, (2) hip arthroscopic surgery improves the level of sexual function postoperatively, (3) the characteristics of sexual difficulties may be dependent on sex or age, (4) patients lack knowledge of potential sexual activity changes in the preoperative and postoperative periods, and (5) patients desire a greater level of discussion regarding potential changes in sexual function. Study Design: Case series; Level of evidence, 4. Methods: A 23-item Likert-style questionnaire assessing preoperative and postoperative sexual function and a modified Harris Hip Score questionnaire were administered to 305 consecutive patients who underwent hip arthroscopic surgery for FAI with a minimum 1-year follow-up. Comparative analysis was performed between sexes and age groups (young: <40 years; old: >40 years). Results: Of 131 respondents, preoperative sexual difficulties were reported by 66%, occurring 30.8 49.1 days after the onset of FAI symptoms. Primary causes of difficulty included pain (77.9%), stiffness (47.1%), and loss of interest (21.4%). Sexual activity resumed 29.2 +/- 20.1 days postoperatively, while sex with minimal pain occurred at 48.8 +/- 40.6 days. Female patients and older patients (>40 years old) resumed sexual activity later (female: 34.8 +/- 23.2 days; male: 21.0 +/- 10.7 days; P < .0001) (young: 26.3 +/- 21.7 days; old: 35.7 +/- 13.5 days; P = .017). The frequency of sexual activity increased in 32.3%, decreased in 16.9%, and was unchanged in 48.5%. Among patients who reported an increase in the frequency of sexual activity, there was a greater proportion of male patients and younger patients (female: 38.1%; male: 61.9%; P < .0001) (young: 78.6%; old: 21.4%; P < .0001). More female patients reported alterations in sexual positioning (female: 82.3%; male: 17.7%; P < .0001). To obtain information on sexual function, 77.4% of patients preferred a discussion with the surgeon, and 67.4% preferred a booklet on the subject. Relief of pain after arthroscopic surgery was experienced by 88.9%, and only 10.8% reported current sexual difficulties. Conclusion: This study demonstrates the prevalence of sexual difficulties among the majority of patients with symptomatic FAI, the significant effect that these difficulties may have on quality of life, and the ability of hip arthroscopic surgery to improve sexual function postoperatively. While further studies are required to elucidate what specific factors are associated with sexual difficulties, the current study suggests that this is an important topic to explore.