Hysterectomy and sexual function: a systematic review and meta-analysis

Abstract

Background Sexual function after hysterectomy can be a concern for patients, and research remains inconclusive about changes in sexual function associated with hysterectomy. Aim We meta-analyzed studies on change in sexual function from pre- to posthysterectomy and the role of total vs subtotal hysterectomy and concomitant bilateral salpingo-oophorectomy (BSO) in differences in such change. Methods We searched PubMed, Embase, and Cochrane databases from inception to January 2022. Two reviewers screened and included studies if they were published in a peer-reviewed journal and reported on sexual function pre- and posthysterectomy for benign nonprolapse indication. Methodological quality was assessed with the STROBE checklist. We used random effects multilevel models to meta-analyze standardized mean differences in pre- to postoperative sexual function and the posthysterectomy Female Sexual Function Index mean across study groups in R (RStudio). Outcomes Outcomes included overall sexual function, dyspareunia, desire, arousal, lubrication, and orgasm. Results Thirty-two articles were analyzed: 8 randomized controlled trials, 20 prospective studies, 2 retrospective studies, 1 cross-sectional study, and 1 secondary analysis, comprising a total of 4054 patients. Each study provided data for at least 1 outcome. Study quality was moderate, and effect sizes showed large between-study heterogeneity. Hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route, with patients tending to report potentially remaining sexual dysfunction posthysterectomy. Cervix removal was not significantly associated with differences in magnitude of change. Hysterectomy without BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with BSO, which was not the case for desire, arousal or overall sexual function. However, these significant differences were not replicated within studies that directly compared cases with and without BSO. Clinical Implications Clinicians should address remaining sexual dysfunction posthysterectomy, and BSO should not be considered if not medically required. Strengths and Limitations We analyzed a comprehensive number of trials and studied clinically relevant factors that might relate to differences in change in sexual function. Conclusions need to be interpreted with caution since many studies showed moderate methodological quality and large effect size heterogeneity. Conclusion Subtotal and total hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route, with patients tending to report potentially remaining sexual dysfunction posthysterectomy. Hysterectomy without BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with BSO. Future research on hysterectomy should analyze predictors of sexual function change trajectories, such as different indications.

Pelvic floor and sexual function 3 years after hysterectomy – A prospective cohort study

“…The sexually active group were predominantly premenopausal, but we recognize that changes to the menopausal status could represent a possible confounder. A concomitant bilateral salpingo‐oophorectomy in premenopausal women can more severely affect sexual function postoperatively, but in our cohort, this was not a common procedure 8 . Sexual function after hysterectomy is a complicated multifactorial process that depends on various factors, such as body image, emotional factors, the sexual partner as well as communicative matters.…”

“…A concomitant bilateral salpingo‐oophorectomy in premenopausal women can more severely affect sexual function postoperatively, but in our cohort, this was not a common procedure. 8 Sexual function after hysterectomy is a complicated multifactorial process that depends on various factors, such as body image, emotional factors, the sexual partner as well as communicative matters. Hysterectomy results in loss of the uterus, cervix and upper part of the vagina, which may reduce vasocongestion and interrupt the nerve supply resulting in an impairment of sensibility, arousal and the lubrication‐swelling process.…”

“…7 A significant number of studies suggest unchanged or even improved sexual function after hysterectomy, although there is a lack of extended long-term follow-up. 8 Patients usually have symptoms before surgery, such as abnormal uterine bleeding, pressure from leiomyomas and pelvic pain, and when these discomforts cease, sexual life might be improved. 9 There is at present no consensus regarding how minimally invasive hysterectomy techniques affect female sexual function.…”

“…Several cohort studies have recognized that hysterectomy is a risk factor for pelvic organ prolapse (POP) but it is unclear whether the type of hysterectomy affects rates of future POP 7 . A significant number of studies suggest unchanged or even improved sexual function after hysterectomy, although there is a lack of extended long‐term follow‐up 8 . Patients usually have symptoms before surgery, such as abnormal uterine bleeding, pressure from leiomyomas and pelvic pain, and when these discomforts cease, sexual life might be improved 9 …”

Sexual Behaviors and Intimate Relationships of Sexual Partners of Young Patients with Early-Stage Cervical Cancer: A Qualitative Study

“…Ovaries are very important for premenopausal and postmenopausal women to produce steroid hormones, which can regulate the central response to sexual stimulation and the sensitivity of genital tissue to tactile stimulation, thus ensuring the comfort of both men and women. 36 It is worth noting that some partners indicated that changes in the patient's body form can also lead to unpleasant sexual experiences. Body image is an important multi-dimensional and complex concept.…”