Sexual dysfunction not determined by hysterectomy technique

By Piriya Mahendra, medwireNews Reporter

The prevalence of hypoactive sexual desire disorder (HSDD) after hysterectomy does not vary with the surgical technique used, researchers report.

Johannes Lermann (Erlangen University Hospital, Germany) and co-authors say that, despite their findings, further research using a prospective study design is required to identify a surgical option that preserves sexual function after hysterectomy.

The Brief Profile of Female Sexual Function (B-PFSF) score was used to assess the postoperative prevalence of HSDD after surgery in 258 women. A score below 20 on a scale of 0-35 indicates poor sexual function and greater distress, and was used to categorize women as having HSDD.

The researchers found that the median B-PFSF score was highest in women who underwent laparoscopy-assisted supracervical hysterectomy (LASH), at 26, compared with 25 in those with who underwent total laparoscopic hysterectomy (TLH). The median B-PFSF score was 23.5 in those with vaginal hysterectomy (VH), 23 in those with laparoscopy-assisted vaginal hysterectomy (LAVH), and 21 in those with abdominal hysterectomy (AH).

The cutoff B-PFSF score of 20 was achieved by 37.1% of women after AH, 29.4% after VH, 27.7% after LAVH, 23.3% after LASH, and 27.4% after TLH operations. Despite the apparent variation, there was no statistically significant difference in B-PFSF score among the five groups.

For the study, Lermann and colleagues analyzed 258 questionnaires that were completed by women who underwent hysterectomy for benign disease including uterine leiomyoma (n=353), hypermenorrhea or dysmenorrhea (n=183), and adenomyosis (n=54).

As reported in the European Journal of Obstetrics & Gynecology and Reproductive Biology, 70 of the women underwent AH, 34 underwent VH, 36 had LAVH, 56 had LASH, and 62 had TLH.

Women who underwent LASH and TLH were followed up for 2 years, while those who underwent AH, VH and LAVH were followed up for 3 years. Women who underwent AH were significantly older, at an average of 54.0 years, than those in the LASH group, at 48.8 years, while those in the VH group were significantly older, at 55.8 years, than those in the LASH and TLH groups, at 51.1 years. The difference in average age between the groups may have been a limitation of the study, the authors note.

Lermann et al explain that the uterus and cervix may be important factors in the physiology of orgasm. The sensation of orgasm is affected by sensory stimuli from contractions of the uterus, cervix, and vagina, they say.

They add that conscious recognition of these sensory impulses influences the experience of orgasm, and so hysterectomy could, theoretically, have a negative influence on this feedback system in the brain.

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