Sexual Function in Patients with Chronic Lumbar Disc Herniation. Is Epidural Steroid Injection Helpful?

Abstract

Pain due to lumbar disc herniation is common; most patients have significant sexual dysfunction, including a lack of interest and satisfaction. Transforaminal epidural steroid injections are one of the most frequently preferred interventional procedures for treating lumbar disc herniation. Our study aimed to determine the effect of transforaminal epidural steroid injections on sexuality in patients with chronic lumbar disc herniation. An observational study. A training and research hospital pain management center. Our study included sexually active patients aged 18-60 years with lumbar disc herniation who underwent a transforaminal epidural steroid injection. All patients were evaluated with the Numeric Rating Scale (NRS-11), pain during sexual activity, Oswestry Disability Index (ODI), Short-Form 12 (SF-12), and Hospital Anxiety and Depression Scale (HADS) at pretreatment and at one and 3 months posttreatment. Also, the International Index of Erectile Function (IIEF) and Female Sexual Function Index (FSFI) were used to evaluate sexual function for men and women, respectively. A power analysis was conducted using an effect size of 0.7. Statistical analyses were performed using appropriate tests (Friedman, Shapiro-Wilk test). Sixty patients (30 men and 30 women) were evaluated. The mean (SD) age of the patients was 46.60 (8.1) years, the mean (SD) body mass index (BMI [kg/m²]) was 29.2 (5.52), and the pretreatment pain duration was 69.0 (3-240) months. A statistically significant difference was found in the NRS-11 and NRS-11 scores for sexual activity, ODI, SF-12, and HAD scores at one and 3 months posttreatment compared to pretreatment. In women, there was a significant improvement in total FSFI at 3 months posttreatment (P < 0.05). For male sexual function scores, there was a significant improvement in the total IIEF score at one and 3 months posttreatment compared to pretreatment (P < 0.001). Our study has several limitations: it was conducted at a single-center, it did not assess the relationship between disc herniation severity and sexual dysfunction, it had a short 3-month follow-up, and it did not evaluate minimal clinically important differences or placebo effects. Despite these limitations, the study's strength lies in being the first to examine transforaminal epidural steroid injection's effect on sexual function. Transforaminal epidural steroid injection is an effective treatment in the short-to-medium term for pain, depression, and disability scores;, it also has a positive effect on sexual function in both men and women.