Sexual health as an overlooked dimension of holistic recovery after adult spine surgery: an evidence-informed narrative review

Abstract

Abstract Background Sexual health is a meaningful but under-recognized dimension of recovery after spine surgery. Pain, neurological impairment, mobility, body image, psychological distress, relationship context, and procedure-specific injury may all affect postoperative sexual well-being, yet most spine studies omit the domain or reduce it to a single disability-item response. Methods This evidence-informed narrative review was supported by a structured four-database search of PubMed/MEDLINE, Embase, Web of Science Core Collection, and Scopus from database inception through June 30, 2026, supplemented by reference tracking and targeted appraisal of seminal and contemporary studies. The final search was executed on July 1, 2026. Two reviewers independently reviewed title/abstract records and candidate full texts for narrative relevance; disagreements were resolved by consensus, with a third reviewer available for adjudication. The review was not designed as a systematic review or meta-analysis. 26 representative sources were discussed in depth, and a broader 106-source report-level evidence ledger was used to support construct-based narrative mapping. Results Direct recovery evidence is concentrated in small, heterogeneous cohorts, chiefly after lumbar decompression or discectomy. Updated evidence through June 2026 adds large registry-based cohorts showing improvement in pain-related sexual interference after lumbar discectomy and coccygectomy, but these data remain based on ODI Item 8 rather than multidomain sexual-function instruments. The organizational map separated direct postoperative sexual-function recovery evidence from postoperative-status support, procedure-specific sexual safety outcomes, and isolated sexual-health PROM domains. Female outcomes, genital sensation, and preoperative baseline assessment were inconsistently reported. Follow-up in the representative sources ranged from 8 weeks to 13.8 years. Conclusions Sexual health should be considered a patient-centered dimension of postoperative recovery rather than a surrogate for overall surgical success. A two-step strategy, consisting of brief routine inquiry followed by targeted use of validated measures and referral when indicated, can make assessment feasible while limiting questionnaire burden.