Sexual Function Following Elective Endovascular Surgery for Abdominal Aortic Aneurysm

88% of male AAA patients were never warned their procedure could affect sexual function—yet it did

Journal: Journal of Vascular Nursing | Published: 2025-12-20 | Type: Descriptive sub-study within a prospective RCT | PMID: 41819863 Authors: Nilsson J, Nordanstig J, Skoog P, Ringdal M, Pettersson ME (University of Gothenburg, Sahlgrenska Academy, Sweden) Funding/COI: Funding not listed; authors declare no competing interests

Summary

Endovascular aortic repair (EVAR) for abdominal aortic aneurysm carries known vascular and autonomic risks to sexual function, but patients are rarely told about them. This single-centre Swedish study tracked self-reported sexual function before and one year after elective EVAR. It found measurable declines in specific sexual function domains for both sexes, despite most patients wanting and not receiving any relevant counseling.

Claims

• 88% of male patients reported receiving no information from their clinician about potential procedure-related sexual function changes before surgery; the majority wanted such information
• Male patients reported a statistically significant decrease in sexual interest and ejaculatory function at 12 months post-op (p = 0.036)
• Paradoxically, the same male patients reported a statistically significant improvement in global sexual health at 12 months (p = 0.003)
• Among female patients, only 12.5% reported interest in sex post-surgery
• Only 12.5% of female patients reported a preserved ability to achieve orgasm post-surgery, down from 37.5% at baseline

Study Quality

This is a descriptive quantitative sub-study nested within a prospective open-label single-centre RCT. Despite the "RCT" label on the parent trial, this sub-study is observational and descriptive—it uses Friedman's test to compare pre- and post-operative questionnaire scores within the same cohort, not between randomized arms. The instrument used, the Male Sexual Function-4 (MSF-4), is a validated 4-item questionnaire; the authors adapted it for female participants by substituting two anatomy-specific items. Results are reported per CONSORT guidelines, which is appropriate.

The study is single-centre and based in Sweden, which limits generalizability. No sample size calculation is reported for this sub-study specifically. The female cohort is notably small—at baseline only 8 women appear to have contributed orgasm data (37.5% of some small N), making those percentages statistically fragile.

Red Flags

• Female sample size is tiny; percentages like "12.5%" and "37.5%" represent very small absolute numbers and should be treated with caution
• Funding source is not disclosed—for a vascular surgery outcomes study, industry relationships are worth knowing
• Single-centre design (one Swedish hospital) limits external validity
• The paradox of declining ejaculatory function alongside improved global sexual health is not adequately explained in the abstract; this tension deserves deeper analysis
• "Descriptive statistics and Friedman's test" is a modest analytical toolkit—no multivariable adjustment for age, comorbidities, baseline sexual function, or medication changes
• Open-label parent trial introduces potential bias; participants knew they were being studied

Strengths

• Prospective design with pre-surgical baseline measurements, not retrospective recall
• Includes female patients, who are severely underrepresented in vascular surgery sexual outcomes literature
• Uses a validated instrument (MSF-4) with a reasonable female adaptation
• Addresses an informed consent gap with direct patient-reported data—88% not warned is a concrete, actionable finding
• CONSORT-reported methodology adds transparency

Verdict

The clinical finding here—that most patients undergoing elective EVAR are never warned about sexual function risks, and that measurable declines occur anyway—is genuinely useful and underreported. The informed consent angle gives this paper practical significance beyond its modest methodology. But the female cohort is too small to draw conclusions from, the paradoxical global-vs-specific sexual health results are unexplained, and the absence of disclosed funding is a minor irritant. Read it for the consent gap data; treat the female results as hypothesis-generating only.