Studies: Sexual Function Not Hurt by Hysterectomy

From the Article by Norra MacReady, Los Angeles

Sexual function does not diminish and may even improve after hysterectomy, according to two new studies.

In the first study, 70% of 70 women said they had no net change or an increased desire for sex at an average follow-up of 170 days after hysterectomy, compared with baseline levels.

In the second study, overall sexual satisfaction increased significantly in 352 women evaluated 6 months postoperatively.

Both reports showed that sexual outcomes did not differ by hysterectomy approach.

All participants in the first study underwent hysterectomy at the same hospital and were interviewed immediately before and an average of 170 days after the procedure, Dr. Katherine Dragisic said in a poster presentation at the annual meeting of the Central Association of Obstetricians and Gynecologists.

Fibroids, bleeding or menstrual problems, and pelvic pain were the most common indications for the surgery, and many women had multiple indications, said Dr. Dragisic and associates of Northwestern University, Chicago.

The percentage of women reporting pain during intercourse decreased significantly from baseline levels, dropping from 40% to 7%. There were no significant changes in the percentage of patients who were sexually active before and after hysterectomy, and there were no changes in the strength or frequency of orgasm in 65% and 60% of the women, respectively.

Finally, there were no significant differences in reports of pain during sex or desire for sex associated with the different surgical techniques.

The second study, which was published in the British Medical Journal, included 413 women who underwent hysterectomy for benign disease.

Before surgery patients completed a questionnaire designed to screen for sexual dysfunction; it included questions about problems such as lubrication, pain, and arousal.

Patients also were asked to evaluate sexual satisfaction, which they rated on a scale of 0-10, with a higher score indicating greater satisfaction (BMJ 327[7418]:774-78, 2003).

A total of 352 women again completed the survey 6 months after surgery: 104 had undergone vaginal hysterectomy, 84 had subtotal abdominal hysterectomy, and 164 had total abdominal hysterectomy. In each group, ratings of general sexual satisfaction increased significantly, from a preoperative mean of 7 to a postoperative mean of approximately 7.5.

Among women in each surgical group who reported any type of sexual problem before surgery, the reports decreased by 41% – 46% after surgery; these decreases did not differ significantly between groups, reported Dr. Jan-Paul WR Roovers and colleagues of the University Medical Center of Utrecht, the Netherlands.

These findings suggest that de novo sexual problems arising after hysterectomy are scarce, and that the type of surgery has no bearing on postoperative sexual function, they said.

“Apparently, more extensive disruption of local innervation and anatomical relations during total hysterectomy does not lead to more sexual dysfunction,” the authors commented.

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