Sexual Dysfunction and Urinary Incontinence in Female Patients Following Primary Anterior Lumbar Interbody Fusion: A Survey of 84 Patients.

Background: Anterior lumbar interbody fusion (ALIF) surgery can damage nerve fibers and has been linked to retrograde ejaculation in men. In women, sexual dysfunction following ALIF is rarely investigated. The aim of this study was to investigate the frequency of postoperative changes in sexual function and incontinence in women following ALIF.

Methods: For this study, 173 female patients aged 18 to 60 years who had undergone a primary ALIF surgery in 2015 to 2022 in a large spine center to retrospectively answer a questionnaire about sexual function and incontinence pre- and postoperatively; they were also asked to rate their satisfaction with the surgery. McNemar tests were used to compare the prevalence of specific problems pre- vs postoperatively.

Results: Of all respondents (n = 84), 23 (27%) reported a worsening of sexual function following ALIF surgery, and these changes were persistent in 83% of those patients. Among individual symptoms of sexual dysfunction, the highest increase was observed for the prevalence of vaginal dryness, which increased from 12% preoperatively to 32% postoperatively (P < 0.001), followed by dyspareunia, which increased from 8% to 21% (P = 0.001). Urinary incontinence increased from 25% to 41% (P < 0.001). Patient age, level of surgery, and fusion material were not associated with worsening of sexual function. However, worsening of sexual function was associated with a lower level of satisfaction with the surgery outcome and a lower proportion of patients who would have the surgery again.

Conclusions: Female patients undergoing ALIF should receive adequate preoperative information about potential changes in sexual function to enable them to make an informed decision.

Clinical relevance: An improved understanding among patients will lead to more realistic patient expectations and higher patient satisfaction.

Level of evidence: 4: