CORR Insights®: Hip Arthroscopy Improves Sexual Function in Receptive Partners With Femoroacetabular Impingement Syndrome

Where Are We Now?

Hip mobility and function profoundly impact our quality of life, influencing everything from routine activities to intimate aspects such as sexual function. The connection between sexual health and the condition known as femoroacetabular impingement (FAI) is an area that has not been fully explored, despite its significance. It is essential to recognize that partner intimacy, integral to quality of life, depends in large part on hip function, a fact that highlights a critical gap in our current medical understanding.

In orthopaedic sports medicine, the arthroscopic surgical correction of FAI and the resulting chondrolabral injuries have evolved dramatically, becoming arguably the fastest-growing aspect of the field [1]. Although this advancement underscores the significant attention given to improving lower extremity movements for activities like running, jumping, and pivoting, it is equally important to consider how these interventions affect sexual health—an area that is frequently impacted by hip dysfunction.

Arguably, all lower extremity movement is initiated from the hip. Given the centrality of the hip in so many facets of life, our continued quest to evaluate the value and quality of medical interventions must expand to address how treatments like hip arthroscopy influence sexual function. This holistic approach ensures that we provide the highest value of care, fully considering the wide-ranging effects of hip health on our patients’ lives.

In their investigation, published in this issue of Clinical Orthopaedics and Related Research®, Rynecki et al. [5] critically evaluate this important but frequently overlooked aspect of patient outcomes. In their retrospective evaluation of sexual function before and after hip arthroscopic surgery, the authors observed a measurable postsurgical improvement; however, a considerable number of patients reported some ongoing pain with sexual intercourse. The authors demonstrate a particular thoughtfulness in the formulation of their research questions, taking the additional step to consider the difference of symptoms experienced between the receptive and penetrative partner during intercourse. This level of detail in considering the patient experience is commendable and informs a level of detail for patient preoperative counseling that should become standard in our field.

Based on the findings of Rynecki et al. [5], surgeons performing hip arthroscopy should be intentional about presurgical counseling specific to postsurgical sexual function expectations. It is informative for patients to know that, even at full recovery, 42% of penetrative partners and 32% of receptive partners may continue to report some extent of pain with sexual activity. This information should be a crucial part of the shared decision-making process, ensuring patients can make informed choices about their treatment options.

Where Do We Need To Go?

The authors’ specific evaluation of the differing experiences between receptive and penetrative partners during intercourse opens an array of questions about how we determine value after hip arthroscopy. The amount of hip mobility needed varies considerably based on the position of the individual during sexual intercourse, which itself depends on the role the individual plays during intercourse (penetrative or receptive). From this standpoint, we must consider a wide variety of scenarios and patient-specific considerations as they pertain to counseling patients on this topic. Regarding FAI, our understanding has evolved well beyond the binary considerations of cam versus pincer impingement. The role of femoral/acetabular three-dimensional (3D) anatomy, variations in presentation (such as subspine impingement), and consideration of capsular morphology and makeup are critical to the holistic understanding of nonarthritic, intra-articular hip pain [4]. For example, specific to sexual intercourse, the authors astutely discuss the concern for capsular injury with extremes of motion after surgery. However, how does this consideration change for patients with hypermobility? In contrast, how should we counsel a patient with elevated combined anteversion? Sexual intercourse is an activity that may engage the extremes of hip mobility, and the specific movement patterns are certain to affect different patients differently. Although it is reasonable for the experienced hip arthroscopist to speculate which patients are at higher risk for complications with early end range of hip mobility, as it stands, we are unable to risk stratify patients with scientific confidence on this topic.

How Do We Get There?

Improving our capacity to counsel patients on expected outcomes related to sexual intimacy after hip arthroscopy calls for a paradigm shift for us as providers. We must establish a culture wherein we are equally comfortable critically evaluating the risk profile for sexual function as we are discussing return to sport. We must foster an environment where discussing and researching the impacts of hip arthroscopy on sexual function is as routine as any other postoperative outcome. To this end, the same level of detail that has gone into our understanding of a variety of sports-specific activities must be applied to sexual intercourse after hip arthroscopy [2]. The foundation set by the present retrospective study must be used to develop prospective investigations on the topic.

But before going too far down that road, our patient-reported outcomes should be expanded to include a validated outcomes measure tool specific to sexual function in this setting. Without this critical early step, the larger multicenter, prospective trials needed to develop risk stratification for patients will not be feasible. Effectively developing a validated outcome tool requires a respect for the importance of this topic to our patients and an acknowledgment of the sensitivity of the subject. Engaging with patients directly to understand their concerns and experiences can provide invaluable insights that can shape the development of more comprehensive care models. This approach not only enhances the validity of our research but also ensures that the care we provide is truly patient-centered. Once we have successfully developed these patient-focused metrics, we will need to apply them to a wide variety of patient profiles to improve our understanding of which patients are at highest risk.

Finally, the integration of biomechanical evaluations and 3D modeling techniques will additionally be important for evaluating at-risk positions in different patient populations. Through these concerted efforts, we can hope to not only advance our understanding of the sexual implications of hip arthroscopy but also to improve the quality of life of our patients by addressing an aspect of their health that is often overlooked and yet is deeply impactful.

Read This Next

• This meta-analysis provides an example of the level of detail applied to different groups of athletes relative to the type of common movements required after hip arthroscopy for FAI [2].

• This motion capture study used 3D models to assess at-risk sexual positions after THA [3].