Sex After Hip Surgery: Advice That Patients May Not Receive

Neil Chesanow

Disclosures

November 30, 2015

When to Offer Advice to THR Patients

When it comes to THR patients, who should bring up the subject of sex—patient or doctor--and when?

Dr Lajam recommends that the surgeon does it, introducing the subject as matter-of-factly and objectively as any other clinical subject, which can help to allay any patient inhibitions. A patient who doesn't want to discuss sex is free to refuse but at least should be given the opportunity to do so.

"The last thing you want to happen is to have a patient dislocate their hip in the middle of sex," says Dr Lajam. "You need to counsel patients based on their interoperative stability and what positions are safe for them. I think it's easiest just to bring it up yourself and not wait for patients to ask. A lot of people are reluctant to ask that question."

"I usually do it before surgery when we’re talking about the surgery," Dr Lajam says. "You just add that to your speech. Tell patients that it’s going to be 2-6 weeks before you can drive and 2-6 weeks before you can have sex."

"If you don’t tell them in the preoperative discussion, usually you see someone about 2-3 weeks after their surgery to check their wound and just to make sure everything is okay," Dr Lajam says. "You can bring it up then: 'Now you can do this; you can do that. I want you to do outpatient physical therapy, and if you want to resume having sex, you can go ahead and do it. Just be careful about such-and-such positions.'"

"I would recommend making sexual activity after hip replacement a routine part of the postoperative discussion," Dr Luu advises. "At the third-week mark would be a good time to bring up the topic with your patient. If you make the routine standard, it takes any discomfort from the patient out of it."

"You could say, for example, 4-6 weeks after hip replacement, 'If you're comfortable having sex, you could resume having it,'" Dr Luu says. "Some patients are willing to resume earlier. A lot of it is how uncomfortable they are in their pain. As long as they adhere to the precautions we tell them about hip replacements, it's safe."

From a patient's perspective, is the surgeon who performs the procedure the best person to have this discussion, as opposed to, say, an orthopedic nurse, physical therapist, or even primary care physician?

Most of the time, studies show, the surgeon is preferred. One survey of 135 patients (58 women and 77 men) under 65 years of age who had THR found that most favored the surgeon, followed by the physical therapist, to deliver sexual information verbally--and also to provide patient literature. When the surgeon had this discussion, partner attendance was generally preferred.

In another study of 59 women and 22 men whose sexual activity was limited by arthritis and who had THR, 13 (16%) preferred to discuss their problems with their family physician, 17 (21%) with a hospital physician, 5 (6%) with a female medical social worker, and 39 (48%) preferred not to have a discussion with anyone but did want to receive patient literature on the subject.[11] On the other hand, a survey of 86 patients who had successful THR found that 65% would have found a discussion on sexual function with their surgeons helpful--had it been offered.[12]

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