SX21

Pelvic trauma

Content written by Irwin Goldstein, MD

The pelvis is a ring-like structure of bones at the lower end of the trunk that creates a bowl-like cavity below the rib cage. The two sides of the pelvis are actually three bones, the ilium, the ischium, and the pubis. Strong connective tissue ligaments join the pelvis to the large triangular bone, the sacrum, at the base of the spine. On each side, there is a hollow cup, the acetabulum that serves as the socket for the hip joint.

The sexual organs, along with many other organs, are located within the pelvic ring. Critical nerves and blood vessels that go to the sexual organs are located within the pelvic ring. The pelvis serves as an attachment point for important pelvic floor muscles. A pelvic fracture can be associated with substantial bleeding, nerve injury, and sexual organ damage.

Pelvic fractures often involve high-energy forces such as a motor vehicle accidents, and depending on the direction and degree of these forces, the injuries can be threatening to sexual and general health. If the fracture is due to a high-energy injury, there may also be injuries to other organs such as the head, chest, abdomen, or legs. There is often considerable bleeding. If these injuries are addressed, the pelvic fracture usually heals well. Subsequent problems, such as pain, impaired mobility, and sexual dysfunction, are usually the result of damage to nerves and organs that is associated with the pelvic fracture.

There are several articles in the peer-review medical literature on this topic. Collinge and others examined horse riding men who sustained a saddle-horn injury of the pelvis. This form of pelvic trauma occurs when a horse rider is thrown into the air and then falls back, with the perineum coming into contact with the saddle or saddle horn. They studied 20 such men over 30 months after the injury. A total of 90% men had erectile dysfunction that was unlikely to respond well to pharmacologic therapy.

Feng and others examined the sexual consequences of men who sustained a pelvic fracture involving a concomitant urethral injury. A total of 40 patients with traumatic urethral strictures secondary to blunt traumatic impact episode to the pelvis or perineum were studied. Twenty-eight percent of patients had erectile dysfunction. The blood flow in the erection artery was lower in patients with widening of the pubic bones (pubic diastasis).

Metze and others also assessed sexual function of 77 men who sustained a pelvic fracture. A total of 61% reported sexual problems and persistent erectile dysfunction was found in 19%. This study emphasized that major pelvic trauma may impair sexual function in men.

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