St' Pauls Hospital Lets Talk about SEX

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St. Pauls HospitalLets Talk about SEX!

• Mary Cho OT
• Michelle Bech NP(A)

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St. Pauls Hospital Team
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Lets talk about SEXsince no one else will

• Do you talk to your arthroplasty patients about
  safe sexual positions after surgery?

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Lets talk about SEXsince no one else will

• In a survey done by Stern SH et al. (1991)
  found 89 of patients desired more information
  regarding sexual activity after arthroplasty.

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Lets talk about SEX

• BC Orthopedic Hip and Knee Assessment Tool
  Version 1.0 asks about
• Other functional limitations (eg putting on
  shoes, managing stairs, sitting to standing,
  sexual activity, bathing, cooking, recreation or
  hobbies)

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Lets talk about SEX since no one else will

• A survey of orthopaedic surgeons
• was done in 2004
• The following questions were asked

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Lets talk about SEX since no one else will

• QUESTION
• Who asked more often about sex after THA

• RESULTS
• MEN

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Lets talk about SEX since no one else will

• QUESTION
• How frequently did the surgeon or a member of
  their team discuss sex after THA with their
  patients

• RESULTS
• More than 80 of the respondents stated they
  rarely or never discussed it.
• 96 stated they spent 5 minutes or less in
  discussion

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Lets talk about SEX since no one else will

• QUESTION
• Are you aware of at least one patient who had a
  hip dislocation during sexual activity

• RESULTS
• 20 of the surgeons were aware of a dislocation

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Lets talk about SEX since no one else will

• QUESTION
• When can patients return to sexual activity after
  THA

• RESULTS
• 67 of respondents recommended delay of sexual
  activity until 1-3 months post-operatively
  with acceptable positions

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Lets talk about SEX since no one else will

• We surveyed the 3 orthopedic surgeons at SPH
• When is it ok to resume sexual activity?
• All 3 said When comfortable and whatever
  position is comfortable

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Lets talk about SEX since no one else will

• How often do you discuss safe sexual positions
  with your patients post THA?
• Very rarelyonly if they bring it up.

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Lets talk about SEX since no one else will

• Are you aware of any dislocations during sexual
  activity?
• 2 -NO
• 1 - YES

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Lets talk about SEX since no one else will

• Sketches of 12 common sexual positions were
  provided to the American surgeons and they were
  asked to deem each position as either acceptable
  or unacceptable in a patient of each gender after
  THA

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4 recommended positions for men with THA

• Men on the top
• More than 90 of the surgeons recommended these
  positions

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Recommended positions for men with THA(men on
bottom)
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2 recommended positions for women with THA

• Women on the bottom
• More than 90 of the surgeons recommended these
  positions

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Recommended positions men and women with THAs

• Considered acceptable by greater than 90 of
  physicians when both individuals have had THAs

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Recommended positions for TKA

• Bottom position
• Usually the most comfortable position
• 1-2 pillows may be placed under affected knee for
  comfort, bend the knee as comfort allows
• Side-lying position
• Use this position on the unaffected leg
  immediately after surgery
• Pillows may be used under the knee to support the
  affected leg and increase comfort.

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Patient information available

• Limited information available on the web
• Approved Positions
• http//aboutjoints.com/patientinfo/topics/sexualco
  ncerns/approvedpositions.html
• Positions to avoid
• http//aboutjoints.com/patientinfo/topics/sexualco
  ncerns/avoidpositions.html

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Approved Positions
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Positions to avoid
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Patient information available
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IDEAS?

• How to bring it up.
• When to bring it up
• Who to bring it up with

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THANKS!!
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References

• Dahm, DL, Jacofsky, D, and Lewallen, D.G.
  Surgeons Rarely Discuss Sexual Activity with
  Patients after THA. Clinical Orthopaedics and
  Related Research428 237-240, 2004.
• Stern SH, Fuchs MD, Ganz SB, et al Sexual
  function after total hip arthroplasty. Clinical
  Orthopedic 269 228-235, 1991.
• http//aboutjoints.com/patientinfo/topics/sexualco
  ncerns/approvedpositions.htm
• http//aboutjoints.com/patientinfo/topics/sexualco
  ncerns/avoidpositions.html