EFFECT OF TRAUMA AND PELVIC FRACTURE ON FEMALE GENITOURINARY, SEXUAL,AND REPRODUCTIVE FUNCTION

Objectives/Hypothesis: To evaluate the impact of a pelvic fracture on a woman's physical, sexual, and reproductive functioning. Design: Retr ospective review. Setting: Level one trauma center. Patients: Two grou ps of female multitrauma patients: those with pelvic fractures (subjec ts) and those with extremity fractures but no pelvic fracture (control s). Main Outcome Measurements: Of the 302 women eligible for participa tion in this study 255 (80%; 123 subjects, 118 controls) were intervie wed by blinded professional interviewers regarding genitourinary sympt oms, sexual function, and reproductive history. Results: Urinary compl aints occurred significantly more frequently in subjects than in contr ols (21 versus 7%, respectively; p = 0.003), in subjects with residual pelvic fracture displacement greater than or equal to 5 mm than in th ose without displacement (33 versus 14%, respectively; p = 0.018), and in subjects with residual lateral (60%) or vertical (67%) displacemen t than in those with medially displaced fractures (21.4%) (p = 0.04). Although both groups reported increased rates of cesarean section, thi s increase was statistically significant only subject group. 14.5% pre injury versus 48% postinjury (p < 0.0001). Adjusting for previous cesa rean sections, cesarean section was significantly more frequent in sub jects with fractures initially displaced greater than or equal to 5mm (80%) than in those with fractures initially displaced < 5mm (15%) (p = 0.02). There was no difference in the incidence of miscarriage or in fertility between the groups. Problems with physiologic arousal or org asm were rare. Pain during sex (dyspareunia) was more common in subjec ts with fractures displaced greater than or equal to 5mm than in those with nondisplaced fractures (43 versus 25%, respectively; p = 0.04). Conclusions: We found that pelvic trauma negatively affected the genit ourinary and reproductive function of female patients. The increased r ate of cesarean section in women after pelvic trauma may be multifacto rial in origin and warrants further investigation.