title: Effect of trauma and pelvic fracture on female genitourinary, sexual, and reproductive function.
abstract: OBJECTIVE
  To evaluate the impact of a pelvic fracture on a woman's physical, sexual, and reproductive functioning.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level one trauma center.
  
  
  METHODS
  Two groups of female multitrauma patients: those with pelvic fractures (subjects) and those with extremity fractures but no pelvic fracture (controls).
  
  
  METHODS
  Of the 302 women eligible for participation in this study, 255 (80%; 123 subjects, 118 controls) were interviewed by blinded professional interviewers regarding genitourinary symptoms, sexual function, and reproductive history.
  
  
  RESULTS
  Urinary complaints occurred significantly more frequently in subjects than in controls (21 versus 7%, respectively; p = 0.003), in subjects with residual pelvic fracture displacement > or = 5 mm than in those without displacement (33 versus 14%, respectively; p = 0.018), and in subjects with residual lateral (60%) or vertical (67%) displacement than in those with medially displaced fractures (21.4%) (p = 0.04). Although both groups reported increased rates of cesarean section, this increase was statistically significant only in the subject group: 14.5% preinjury versus 48% postinjury (p < 0.0001). Adjusting for previous cesarean sections, cesarean section was significantly more frequent in subjects with fractures initially displaced > or = 5 mm (80%) than in those with fractures initially displaced < 5 mm (15%) (p = 0.02). There was no difference in the incidence of miscarriage or infertility between the groups. Problems with physiologic arousal or orgasm were rare. Pain during sex (dyspareunia) was more common in subjects with fractures displaced > or = 5 mm than in those with nondisplaced fractures (43 versus 25%, respectively; p = 0.04).
  
  
  CONCLUSIONS
  We found that pelvic trauma negatively affected the genitourinary and reproductive function of female patients. The increased rate of cesarean section in women after pelvic trauma may be multifactorial in origin and warrants further investigation.
authors.affiliation: R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore 21201, USA.
authors.forename: C E
authors.initials: CE
authors.lastname: Copeland
authors.forename: M J
authors.initials: MJ
authors.lastname: Bosse
authors.forename: M L
authors.initials: ML
authors.lastname: McCarthy
authors.forename: E J
authors.initials: EJ
authors.lastname: MacKenzie
authors.forename: G M
authors.initials: GM
authors.lastname: Guzinski
authors.forename: C S
authors.initials: CS
authors.lastname: Hash
authors.forename: A R
authors.initials: AR
authors.lastname: Burgess
mesh_terms: D000293:Adolescent; D000328:Adult; D003710:Demography; D005069:Evaluation Studies as Topic; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000150:complications*; D005831:Genital Diseases, Female / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D009104:Multiple Trauma / Q000150:complications*; D010384:Pelvic Bones / Q000293:injuries*; D011379:Prognosis; D012044:Regression Analysis; D012098:Reproduction; D012189:Retrospective Studies; D012307:Risk Factors; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology / Q000209:etiology*; D011795:Surveys and Questionnaires