The effect of dexamethasone on sexual function in a randomized trial in robotic hysterectomy

The effect of dexamethasone on sexual function in a randomized trial in robotic hysterectomy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The effect of dexamethasone on sexual function in a randomized trial in robotic hysterectomy Karsten Kaiser, Mette Hulbaek, Dorte Teilmann Jørgensen, Thomas Strøm, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7510821/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and Aim The impact of hysterectomy on women's sexual functioning is a subject of debate. Some women report improvements in sexual function post-surgery, often due to the relief of symptoms like pain or bleeding, while others experience sexual dysfunction following the procedure. Factors such as preoperative health and the type of hysterectomy performed (e.g., laparoscopic or robotic) may contribute to these variations. Robotic-assisted hysterectomy, as a minimally invasive surgical method, was well-received due to its benefits, including reduced postoperative pain, quicker recovery, and shorter hospital stays. Dexamethasone, a corticosteroid commonly used in multimodal anesthesia regimens and known for its anti-inflammatory properties, can reduce surgical stress, decrease postoperative pain, and hasten recovery. The aim of this randomized trial was to assess whether adding dexamethasone to a robotic hysterectomy procedure would further improve postoperative outcomes besides of lowering inflammatory response, particularly regarding sexual functioning. Methods The study-recruited women scheduled for robotic-assisted hysterectomy and randomized into two groups: One receiving 24 mg of dexamethasone preoperatively and the other receiving a placebo. Various measures were taken, including blood tests, pain assessments using the visual analogue scale (VAS), and reports on postoperative vomiting, nausea, and medication usage at five time points: 0, 4, 8, 12, and 24 hours postoperatively. The primary outcome included inflammatory response and, secondarily, sexual functioning measures such as urinary incontinence during sex, orgasm intensity, and frequency of sexual desire. Results A total of 112 women participated, with complete data available from all participants for blood tests, medical interventions, and VAS measures at all time points. No significant differences were found in basic characteristics between the dexamethasone and placebo groups. However, the study observed the following differences in sexual functioning: Women in the dexamethasone group had a higher frequency of wanting sex at each weekly follow-up compared to the placebo group (p = 0.018). Orgasm intensity was significantly higher in the dexamethasone group (p = 0.044). The high and better score in QoR-15 at week 4 was associated with wanting more sex (p=0.04) and less pain during intercourse (p=0.047). No differences were found in the resumption of sex within the four-week study period, pain during sex or incontinency during intercourse. Conclusion The addition of dexamethasone in robotic-assisted hysterectomy was associated with an increased frequency of sexual desire and more intense orgasms in the first four weeks postoperatively. This suggests that dexamethasone may positively affect certain aspects of sexual functioning in women undergoing this procedure. These findings highlight the potential benefits of dexamethasone in the postoperative recovery phase, but further research may be needed to understand the full scope of its effects on sexual health after hysterectomy. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Urology Figures Figure 1 Figure 2 Introduction Hysterectomy is recognized as one of the most frequently performed gynecological surgeries globally, primarily indicated for benign conditions such as menometrorrhagia, uterine fibroids, pelvic pain, dyspareunia, adenomyosis, and endometriosis. The implications of hysterectomy on sexual function are a significant concern for many women, often leading to preoperative anxiety. Research indicates that the impact of hysterectomy on sexual functioning is variable and can be attributed to preoperative conditions and the specific surgical methods employed. While some women report improvements in sexual function post-surgery due to the alleviation of symptoms, others experience sexual dysfunction as a direct consequence of the procedure (1-4). Laparoscopic surgery has revolutionized minimally invasive surgical techniques, gaining popularity due to its ability to reduce postoperative pain, facilitate faster recovery, and shorten hospital stays. The use of dexamethasone as part of a multimodal analgesic regimen has been shown to mitigate surgical stress and has well-documented anti-inflammatory effects, which may confer several benefits in the surgical context. By attenuating the inflammatory response triggered by surgical trauma, dexamethasone may help reduce tissue damage, decrease postoperative pain, and expedite recovery. This is particularly relevant in laparoscopic procedures, where the risk of complications such as infections, adhesion formation, and delayed wound healing can be significant (5-7). Despite the potential advantages of dexamethasone in enhancing recovery, its specific effects on sexual function remain less understood. Systematic reviews have confirmed the effectiveness of various adjuncts in multimodal analgesia, such as ketamine, gabapentin, and nonsteroidal anti-inflammatory drugs, in reducing postoperative pain and opioid consumption (8-10). However, the role of dexamethasone in improving sexual outcomes after hysterectomy is not definitively established, indicating a need for further research in this area (11,12). This study represents a randomized trial aimed at assessing the impact of preoperative dexamethasone administration in robotic-assisted hysterectomy (13). Our objective is to evaluate whether the addition of dexamethasone by reducing the surgical stress can enhance postoperative outcomes, particularly concerning sexual functioning and recovery. This investigation is crucial as it may provide valuable insights into optimizing surgical practices and improving the quality of life for women undergoing hysterectomy (14,15). Methods The study described is a randomized trial designed to evaluate the effects of preoperative dexamethasone on women scheduled to undergo robotic-assisted hysterectomy at Aabenraa Hospital, Sygehus Sønderjylland. Women were randomly assigned to receive either to 24 mg of dexamethasone, which is equivalent to 128 mg methylprednisolone or placebo as saline. The randomization process involved assigning participants using Ciba-Geigy random numbers (even or uneven numbers) and storing the assignment in a sealed envelope. This process ensured the integrity of the randomization. The intervention was administered 15 minutes before the insertion of surgical instruments, ensuring that the provision occurred after the initiation of anesthesia to prevent any blinding bias. The content of the syringes appeared identical (6 ml), and the randomization process was managed by an independent third party (a midwife from the delivery department), who was not involved in the recruitment or treatment process. Inclusion criteria were women aged 18 years or older, able to understand Danish, no major comorbidities or use of morphine or similar substances. The exclusion criteria were use of insulin for diabetes, morphine as a regular medication, diagnoses of cancer and unable to communicate in Danish. Participants filled out diaries at baseline and weekly for four weeks post-surgery. The diaries contained parts or in full validated instruments for incontinence (ICIQ-UI), sexual health and life (PISQ-12) and postoperative rehabilitation (QoR-15). In a patient involvement process the questions to be selected for the study was evaluated where the women’s preferences and opinion of relevance was adhered to and incorporated for their evaluation. Remarkedly, the questions involving a partner were given low priority, as several of the women understood their sex life contained activities without intercourse, intercourse had ceased some time ago and were without a partner. These diaries were electronically sent to the participants through a secure e-mail app (e-box), which is widely used for communication between Danish citizens and public authorities. Multiple regulatory bodies approved the Study, including the European Medical Agency (EUDRACT no. 2021-000874-28), the National Medical Agency (2021-1041858), and the National Scientific Committee (S-20210054), the Regional Science Board (22/22766) and the unit of Good Clinical Practice (22.011). It was registered at ClinicalTrials.gov (NCT 04762381) and utilized a secure data storage system in the REDCap database, part of the Open Patient data Explorative Network (OPEN) at the University of Southern Denmark. All methods were performed in accordance with the relevant guidelines and regulations. Statistics With a primary outcome based on c-reactive protein level, the sample size for the trial was calculated to 48 women per group, as c-reactive protein was expected to rise to 40 mg/l (8). An intention-to-treat analysis was used for the outcome data. The sexual function was one of the secondary outcomes of the study (13). As part of the external validation the drop-out group was included for comparison. The repeated measurement was analyzed with GLM adjusted for baseline measurement when possible. At every time point the variables were compared between the groups with either Student’s t-test, if Gaussian distributed; otherwise, Mann-Whitney’s U-test was used. A two-tailed p-value of 0.05 was used for significance testing. Statistical analysis was performed using STATA-BE18 software. Results Between May 2022 and February 2024 112 women were included in the randomized trial and had complete blood sampling, medical provision and VAS data at all-time points during admittance. All the basic characteristics were similar in the included as well as excluded women (Table 1 ). All the excluded women were evaluated as separate drop-out group in their basal characteristics (Table 1 ). The prevalence of previous surgery and comorbidity was similar distributed in all groups. The three most frequent surgery types were cesarean section, conisation and cholecystectomy; the first one may directly have complicated hysterectomy. The operation time and blood loss were similar in all groups. We had 16 women in the drop-out group due to change of mind on the operation day (n = 1) or did not want be part of the trial in the first place (n = 4). Study violations consisted of applying extra dose of dexamethasone, one in each randomization groups (n = 2). Other were excluded due to insulindependent diabetes (n = 1), cancer diagnosis (n = 1), regular use of morphine (n = 1), not able to proper communicate in Danish (n = 1) and primary laparotomy (n = 1) and four women had a further mini-laparatomy on top of the robotic assisted laparoscopy. The included women answered the four times weekly postoperative diary by 72% on general work life-, home- and leisure-related questions, 63% on resumption of sex, 42% on pain at intercourse, 49% of on arousal during sex, 62% on orgasms intensity, 68% on incontinence, and 60% on QoR-15 (Table 2 – 4 ). At the regression analysis, no associations were found with trial’s primary outcome of c-reactive protein and the follow-up questionnaires, neither in the primary postoperative questions on pain, work and leisure life, the modified PISQ-12, ICIQ-UI nor QoR-15. In the questions regarding the domains of work and leisure activities, no differences were observed (Table 2 ), i.e. in use of pain medication, resuming work, pain as hindrance to work, too much nausea and uncomfortable to work, able to resume daily chores and resuming leisury activities. Regarding measures on sexual function, we found that intensity of orgasms and frequency of wanting sex were different in the two trial groups (Table 3 ) even if no significant difference was found in resumption of sex within four weeks postoperatively or pain at sex. Women in the dexamethasone group wanted sex more frequently at each weekly measure point compared to the placebo group (p = 0.018, adjusted for baseline frequency, Fig. 1). Further, the intensity of orgasms was increased in the intervention group (p = 0.044, adjusted for baseline intensity, Fig. 2). As for rehabilitation, the women who received dexamethasone reported that within the last 24 hours they had a better general well-being (p < 0.001) and felt more comfortable and in control (p = 0.018) than the placebo group, adjusted for baseline. As for the total score in QoR-15, no difference was found. At regression analysis the high and, thus, better score in QoR-15 at week 4 was associated with wanting more sex (p = 0.04) and less pain during intercourse (p = 0.047). Discussion After the intervention with dexamethasone, we saw better patient reported outcomes for specific end-points, in particular on frequency of wanting sex and on orgasm intensity but also on areas of general well-being. The sexual functions will vary due to other circumstances e.g. desire (16–18). We know urinary incontinence and the fear of it seem to be associated with sexual behavior (19, 20). However, we find significantly higher sexual desire for the intervention group. Taking validity of the original questionnaire of PISQ-12 into account, we note that it was tested with factor analysis and test-retest, but it was developed theoretically for sexual activities within a period of the last six month (21). Sexual activity after hysterectomy is a complex issue that varies among women, influenced by a multitude of factors including the type of surgery performed, the underlying reasons for this, and individual psychological and physiological responses. Research indicates that the timing for resuming sexual activity post-hysterectomy is often contingent upon both physical recovery and emotional readiness. We also know from a Danish cohort of hysterectomized women that 90% of them engaged in sexual activity other than the recommended and expected time after surgery similar to our observations (22). In terms of timing, many studies suggest that while some women may feel ready to resume sexual activity within weeks of surgery, others may require several months to regain their sexual confidence and comfort (23,4). It is essential for healthcare providers to discuss these timelines openly with patients, ensuring they understand that variations in recovery are normal and that they should not rush the process. Generally, medical professionals recommend waiting at least six to eight weeks after surgery before engaging in sexual intercourse, allowing for adequate healing of the surgical site and minimizing the risk of complications such as infection or pain during intercourse (24,10). One may assume that the better general well-being, feeling of comfort and control would be associated with physical, emotional and sexual recovery; however, the full estimate of recovery in the sum of scores in QoR-15 suggested similar recovery, thus, no difference in resuming recreational and occupational activities. We were only able to substantiate this association at the end of the follow-up when pain at intercourse and in wanting sex were associated with QoR-15. However, this coincidated with a time when more had resumed sex. We did not expect the issues of sexual health to be well represented in QoR-15. So, these issues were imperative to be added to the questionnaires by adding PISQ-12, a topic the women agreed upon in the pre-trial patient involvement process. A range of emotional and physical changes that may affect a woman’s sexual function can accompany the recovery period following a hysterectomy. Previous studies found that many women report alterations in their sexual desire and function post-surgery. For instance, some women experience a decrease in libido, while others may find that their sexual pleasure improves due to the alleviation of symptoms that necessitated the surgery in the first place, such as chronic pain or heavy menstrual bleeding (3,10, 25–29). This dichotomy underscores the importance of individualized assessments and counseling regarding sexual health after surgery. Moreover, the type of hysterectomy performed may also influence sexual outcomes. Research indicated that women may experience fewer negative sexual side effects by vaginal or laparoscopic hysterectomy compared to abdominal hysterectomy (25,14,6). Some reported of improvements in sexual function and satisfaction following vaginal hysterectomy, while others have noted persistent issues such as dyspareunia regardless of the surgical technique employed (3,28). The psychological impact of undergoing a hysterectomy cannot be overlooked. Many women express concerns about their femininity and sexual identity post-surgery, which can lead to anxiety and decreased sexual desire (2,1 ). Emotional support from partners and healthcare providers plays a crucial role in facilitating a positive sexual recovery. The interplay between surgical outcomes, hormonal changes, and psychological factors highlights the necessity for comprehensive postoperative care that addresses both physical and emotional aspects of recovery. Additionally, the quality of the relationship with a partner can significantly influence sexual recovery after hysterectomy. We found that in the patient involvement process the questions involving interaction with a partner were given low priority and were omitted in the final version of the questionnaire. We decided not to add new, unvalidated questions about these aspects as the PISQ-12 did nor comprise of such questions. Women who report strong emotional connections with their partners often find it easier to navigate the changes in their sexual lives, whereas those experiencing relationship difficulties may struggle more with sexual intimacy (29, 30). This indicates that addressing relational dynamics is as important as focusing on the physical aspects of recovery. Thus, it is important to collect and assess measurements for the relational aspects within and affect upon the sexual function of women. Furthermore, the lack of items for women without sexual function could influence these women’s compliance. Focusing upon these challenges the PISQ-12 has been revised and validated in several languages (PISQ-IR - IUGA revised version) (31). We applied relevant questions from the PISQ-12 even with the above challenges since a Danish version of the PISQ-IR is not validated, yet. Strengths and weaknesses The PISQ-12 is a validated, shortened questionnaire of the validated and original PISQ (21,31). Even if the PISQ-12 is used regularly for measurements in studies among Danish populations, a specific validation with psychometric testing has not yet been performed and thus, the validation of the questionnaire in a Danish population is not robust. Further, we picked relevant but single specific items out of a validated context for measuring our sexual function. This might have affected reliability of results (32, p. 235 − 44). The validation process for the original PISQ assessed the validity of all 31 questions as domains or one construct as does the PISQ-12 and not each specific item assessed out of context. Furthermore, the PISQ-12 was developed and validated in a condition specific population of women with pelvic organ prolapse and urinary incontinence, which was not the target group for our trial even if a certain percentage of the women had urinary incontinence seen at baseline (21). However, as for a genuine patient involvement in the pre-trial process this was discussed and addressed. The patient related outcomes were hampered by a moderate response rates and that at baseline data were not collected as anonymously as were the following weekly internet-based anonymous questionnaires results. This may produce some random but not systematic errors (32 p.100 − 44). The relative short follow-up may not show long-lasting effects of the trial. However, it indicated positive results for patients and their relationship even if they did not follow recommendations on sexual abstinence postoperatively. Noticably, no complications were observed that could be related to this e.g. vaginal vault prolapse, infections or bleeding. Conclusion Higher frequency of wanting intercourse sex and more intense orgasms were found in the women receiving dexamethasone in robotic-assisted hysterectomy during the first four weeks postoperatively. While robotic-assisted laparoscopic techniques and the use of dexamethasone show promise in improving recovery, the potential impact on sexual health necessitates evidence-based recommendations for enhancing sexual outcomes in women undergoing hysterectomy. Abbreviations BMI: Body mass index Declarations Ethics approval and consent to participate declarations: All Participants were informed and gave their written consent to participate ( all monitored by OPEN in the GCP guidelines) Competing interest: None Funding: no funding Key-words: Randomized trial, robotic-assisted surgery, hysterectomy, c-reactive protein, surgical stress Ethical aspects The trial was approved by the European Medical Agency (EUDRACT no. 2021-000874-28), the National Medical Agency (2021-1041858), the National Scientific Committee (S-20210054), the Regional Ethical Science Board (22/22766), the unit of Good Clinical Practice (22.011) and registered at clinicaltrials.gov (NCT 04762381). The Date of registration of the trial in the latter registry was June 1, 2022. Data were stored in a closed repository in Open Patient data Explorative Network (OPEN) under the University of Southern Denmark in a REDCap database no. 1377. Ciba-Geigy random numbers (even or uneven numbers) was used for the randomization before the very start of the trial and stored in a sealed envelope. Consent for publication Not applicable Availability of data and materials : yes on request by the corresponding author Competing Interests: no competing interest Funding : no funding KK: initiated the concept and writing of the manuscript, assessed studies FFL: initiated the concept and writing of the manuscript, assessed studies IG, TS, MH and DTJ contributed to the reviewing, editing and approving the final version of this paper Acknowledgements not applicable References Schmidt A, Sehnem GD, Cardoso LS, Quadros JS, Ribeiro AC, Neves ET. Sexuality experiences of hysterectomized women. 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Tables Table 1 Variable / group DEXA Placebo Included in trial Dropout No. 54 58 112 16 Age (years) 48 ± 10 49 ± 9 49 ± 9 48 (32–80) Height (cm) 168 ± 6 168 ± 5 168 ± 6 165 ± 6 Weight (kg) 82 ± 19 82 ± 15 82 ± 17 75 ± 13 BMI (kg/m 2 ) 29 ± 6 29 ± 5 29 ± 5 27 ± 5 Smoking (no.) 14 13 26 2 Parity (no.) 2 (0–2) 2 (0–2) 2 (0–2) 2 (0–3) Hgb preoperatively (mg/dl) 8.2 ± 0.7 8.3 ± 1 8.3 ± 0.8 8.2 ± 0.7 Uterine weight (g) 287 (26-1000) 315 (35-1365) 302(26-1365) 208 (40-2366) Peroperative blood loss (ml) 48 (0-750) 86 (0-1000) 66 (0-1000) 50 (20-1200) Operation time (min) 85 (27–225) 92 (30–270) 89 (27–270) 105 (27–215) Basal characteristics and intraoperative data Gaussian all data are given as mean ± SD, non-Gaussian as median (range) DEXA: Dexamethasone, Hgb: Hemoglobin Table 2 Resumption of work, daily chores and leisure activity one to four weeks postoperatively by dexamethasone and placebo Variable / group DEXA Placebo All p-value No. 54 58 112 Using painkillers : yes (n = 46) 1/2/3/4 wk 32/14/13/6 33/24/15/9 65/38/28/15 0.17* Working : yes (n = 46) 1/2/3/4 wk 2/5/4/9 1/4/11/18 3/9/15/27 0.34* Pain hindrance for work : yes (n = 53) 1/2/3/4 wk 29/22/21/13 29/27/27/22 58/49/48/25 0.14* Too tired to work : yes (n = 58) 1/2/3/4 wk 35/28/24/23 32/32/26/23 67/60/50/46 0.28* Too much nausea and uncomfortable to work : yes (n = 62) 1/2/3/4 wk 14/11/7/8 15/15/8/3 29/26/15/11 0.64* Able to resume daily chores (n = 80) Not at all/very limited/to some extent/nearly no limit/in full extent 1.0* Wk 1 2/15/17/6/1 4/11/16/9/2 6/26/33/15/3 0.57 Wk 2 2/7/15/11/6 2/6/20/11/3 4/13/35/22/9 0.66 Wk 3 1/3/1/16/7 2/6/20/11/3 4/13/35/22/9 0.7 Wk 4 1/2/8/14/16 0/1/11/12/17 1/3/19/20/33 0.9 Able to resume to leisure activity (n = 45) Not at all/very limited/to some extent/nearly no limit/in full extent 0.44* Wk 1 26/6/3/3/1 24/8/5/0/2 50/14/8/3/3 0.81 Wk 2 18/10/7/2/2 2/9/6/1/3 38/19/13/3/5 0.63 Wk 3 14/8/8/7/2 13/9/8/5/4 27/17/16/12/6 0.94 Wk 4 10/3/15/9/2 8/8/12/4/7 18/11/26/13/9 1.0 DEXA: Dexamethasone; wk: week, data are shown as numbers * and the rows 1/2/3/4 indicate analysis with GLM repeated measurement provided completeness of data and are adjusted for baseline value. Week 1–4 are tested with Mann-Whitney’s U-test. Table 3 Incontinence and sexual life one to four weeks postoperatively by dexamethasone and placebo Variable / group DEXA Placebo All p-value No. 54 58 112 Resumed intercourse: Yes (n = 35) 1/2/3/4 wk 1/4/5/9 1/5/4/11 2/9/9/20 0.12* Pain at intercourse: Yes (n = 45) 1/2/3/4 wk 12/10/11/9 11/9/9/10 33/19/20/19 0.33* Incontinence at intercourse? (n = 52) Always/Often/ sometimes/seldom/never 0.16* Wk 1 (n = 55) 0/0/0/2/26 1/0/1/3/22 1/0/1/5/48 0.14 Wk 2 (n = 56) 0/0/0/2/27 0/0/2/1/24 0/0/2/3/51 0.31 Wk 3 (n = 55) 0/0/0/0/28 0/0/2/2/23 0/0/2/3/51 0.046 Wk 4 (n = 53) 0/0/0/1/28 0/0/2/1/23 0/0/2/2/51 0.16 Intensity of orgasms are…. (n = 45) much less/less/same/more/much more 0.045* Wk 1 (n = 49) 1/2/18/3/0 6/4/15/1/0 7/6/33/3/0 0.038 Wk 2 (n = 49) 1/2/19/2/0 3/3/19/1/0 3/5/38/3/0 0.13 Wk 3 (n = 49) 0/1/20/1/1 4/3/19/0/0 4/4/39/1/1 0.012 Wk 4 (n = 49) 0/1/20/1/1 4/3/17/2/0 4/4/37/3/1 0.07 How often do you want sex? (n = 63) Always/often/sometimes/rarely/never 0.018* Wk 1 (n = 69) 4/8/10/4/5 2/7/12/10/7 6/15/22/14/12 0.16 Wk 2 (n = 69) 4/10/10/3/4 0/12/13/9/4 4/22/23/12/8 0.16 Wk 3 (n = 69) 4/8/12/5/2 1/11/10/10/6 5/19/22/15/8 0.11 Wk 4 (n = 69) 5/9/12/3/2 1/12/13/5/7 6/21/25/8/9 0.09 How often do you leak urine? (n = 77) never/once a wk/2–3 times a wk/once daily/more than once daily/all the time 0.2* Wk 1 (n = 81) 21/6/3/3/5/0 23/15/2/0/3/0 44/21/5/3/8/0 0.49 Wk 2 (n = 81) 18/8/6/3/2/1 23/13/3/2/2/0 41/21/9/5/4/1 0.24 Wk 3 (n = 82) 21/5/3/6/3/0 23/14/3/1/2/0 44/18/6/7/5/0 0.45 Wk 4 (n = 80) 20/6/5/3/2/1 22/15/3/2/1/0 42/21/8/5/3/1 0.53 How much do you leak urine? (n = 72) nothing/a little/moderately/large amounts 0.78* Wk 1 (n = 79) 21/14/3/0 23/16/2/0 44/30/5/0 0.76 Wk 2 (n = 79) 19/17/2/0 21/20/0/0 40/37/2/0 0.63 Wk 3 (n = 79) 22/14/2/0 20/21/0/0 42/35/2/0 0.67 Wk 4 (n = 79) 20/15/3/0 20/20/1/0 40/35/4/0 0.96 How much does leakage bother you (VAS) (n = 72) 1/2/3/4 wk 0/1/0/0 6/4/6/10 4.5/2/1.5/4 0.69* DEXA: Dexamethasone; wk: week Data are shown as numbers except the VAS scores in ‘ How much does leakage bother you’ (median) * and the rows 1/2/3/4 indicate analysis with GLM repeated measurement provided completeness of data and are adjusted for baseline value. Week 1–4 are tested with Mann-Whitney’s U-test. Bold type figures indicate p < 0.05 The number of patients in the mixed model calculations are less due to lacking baseline values in comparison to the weekly diaries. Table 4 Quality of recovery within the latest 24 hours one to four weeks postoperatively by dexamethasone and placebo group Variable / group DEXA Placebo All p-value No. 54 58 112 Able to breath (n = 60) 1/2/3/4 wk 10/10/10/10 9/10/10/10 10/10/10/10 0.67* Able to enjoy food (n = 61) 1/2/3/4 wk 10/10/10/10 10/10/10/10 10/10/10/10 0.99* Feeling rested (n = 58) 1/2/3/4 wk 5/7/7/8 5/5/7/7 5/6/7/8 0.18* Slept well (n = 59) 1/2/3/4 wk 7/7/7.5/8 7/6/7.5/8 7/6.5/7.5/8 0.66* Able to handle personal hygiene (n = 61) 1/2/3/4 wk 10/10/10/10 10/10/10/10 10/10/10/10 0.63* Able to communicate with friends and family (n = 60) 1/2/3/4 wk 10/10/10/10 10/10/10/10 10/10/10/10 1.0* Support from doctors and nurses (n = 52) 1/2/3/4 wk 10/10/10/10 10/10/10/10 10/10/10/10 0.24* Able to resume work or daily chores (n = 28) 1/2/3/4 wk 5/7/7/8.5 4.5/6/7/8 5/6/7/8 0.17* Feeling comfortable and in control (n = 60) 1/2/3/4 wk 6/8/9/9 7/7/8/8 6.5/8/9/9 0.027* Feeling of general well-being (n = 58) 1/2/3/4 wk 7/8/9/9 5/6.5/8/9 6/8/8.5/8 0.002* Experienced moderate pain (n = 59) 1/2/3/4 wk 5/8/8/9 5/6/8/8.5 5/7/8/9 0.08* Experienced strong pain (n = 58) 1/2/3/4 wk 9/10/10/10 9/10/10/10 9/10/10/10 0.72* Nausea and vomiting (n = 60) 1/2/3/4 wk 10/10/10/10 10/10/10/10 10/10/10/10 0.74* Feeling worried or anxious (n = 60) 1/2/3/4 wk 9/10/10/10 9/1810/10 9/10/10/10 0.2* Feeling sad or depressed (n = 60) 1/2/3/4 wk 10/10/10/10 9.5/9/9/10 10/10/9/10 0.3* QoR15 total (n = 55) 0.30* Baseline (n = 41) 107 ± 24 117 ± 27 111 ± 25 0.24 Wk1 (n = 68) 110 ± 19 111 ± 24 110 ± 22 0.91 Wk2 (n = 62) 118 ± 22 115 ± 25 117 ± 23 0.65 Wk3 (n = 60) 123 ± 22 125 ± 17 124 ± 20 0.69 Wk4 (n = 63) 135 ± 23 135 ± 23 135 ± 23 0.98 DEXA: Dexamethasone wk: week, all data are median scores except from QoR-15 (mean ± SD) * and the rows 1/2/3/4 indicate analysis with GLM repeated measurement. Week 1–4 are tested with Mann-Whitney’s U-test. Bold type figures indicate p < 0.05 Additional Declarations No competing interests reported. Supplementary Files consortsecundarysientreco69KK.docx consort2010flowdiagram6.1.2025.doc Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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2","display":"","copyAsset":false,"role":"figure","size":138062,"visible":true,"origin":"","legend":"\u003cp\u003eQuestion from postoperative diary on intensity of orgasms\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7510821/v1/a923194c9f66cc5d6f9b3a4e.png"},{"id":93753237,"identity":"6a6c7fd0-fd94-456e-8ccb-42fc28d97756","added_by":"auto","created_at":"2025-10-17 08:09:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1029041,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7510821/v1/d059a70c-15f5-44fc-beed-7e97809aea06.pdf"},{"id":92499468,"identity":"f642bc27-7f1a-4365-8fff-590fe5beb0c3","added_by":"auto","created_at":"2025-09-30 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one of the most frequently performed gynecological surgeries globally, primarily indicated for benign conditions such as menometrorrhagia, uterine fibroids, pelvic pain, dyspareunia, adenomyosis, and endometriosis. The implications of hysterectomy on sexual function are a significant concern for many women, often leading to preoperative anxiety. Research indicates that the impact of hysterectomy on sexual functioning is variable and can be attributed to preoperative conditions and the specific surgical methods employed. While some women report improvements in sexual function post-surgery due to the alleviation of symptoms, others experience sexual dysfunction as a direct consequence of the procedure (1-4).\u003c/p\u003e\n\u003cp\u003eLaparoscopic surgery has revolutionized minimally invasive surgical techniques, gaining popularity due to its ability to reduce postoperative pain, facilitate faster recovery, and shorten hospital stays. The use of dexamethasone as part of a multimodal analgesic regimen has been shown to mitigate surgical stress and has well-documented anti-inflammatory effects, which may confer several benefits in the surgical context. By attenuating the inflammatory response triggered by surgical trauma, dexamethasone may help reduce tissue damage, decrease postoperative pain, and expedite recovery. This is particularly relevant in laparoscopic procedures, where the risk of complications such as infections, adhesion formation, and delayed wound healing can be significant (5-7).\u003c/p\u003e\n\u003cp\u003eDespite the potential advantages of dexamethasone in enhancing recovery, its specific effects on sexual function remain less understood. Systematic reviews have confirmed the effectiveness of various adjuncts in multimodal analgesia, such as ketamine, gabapentin, and nonsteroidal anti-inflammatory drugs, in reducing postoperative pain and opioid consumption (8-10). However, the role of dexamethasone in improving sexual outcomes after hysterectomy is not definitively established, indicating a need for further research in this area (11,12).\u003c/p\u003e\n\u003cp\u003eThis study represents a randomized trial aimed at assessing the impact of preoperative dexamethasone administration in robotic-assisted hysterectomy (13). Our objective is to evaluate whether the addition of dexamethasone by reducing the surgical stress can enhance postoperative outcomes, particularly concerning sexual functioning and recovery. This investigation is crucial as it may provide valuable insights into optimizing surgical practices and improving the quality of life for women undergoing hysterectomy (14,15).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study described is a randomized trial designed to evaluate the effects of preoperative dexamethasone on women scheduled to undergo robotic-assisted hysterectomy at Aabenraa Hospital, Sygehus S\u0026oslash;nderjylland. Women were randomly assigned to receive either to 24 mg of dexamethasone, which is equivalent to 128 mg methylprednisolone or\u0026nbsp;placebo as saline. The randomization process involved assigning participants using Ciba-Geigy random numbers (even or uneven numbers) and storing the assignment in a sealed envelope. This process ensured the integrity of the randomization. The intervention was administered 15 minutes before the insertion of surgical instruments, ensuring that the provision occurred after the initiation of anesthesia to prevent any blinding bias. The content of the syringes appeared identical (6 ml), and the randomization process was managed by an independent third party (a midwife from the delivery department), who was not involved in the recruitment or treatment process.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInclusion criteria were women aged 18 years or older, able to understand Danish, no major comorbidities or use of morphine or similar substances. The exclusion criteria were use of insulin for diabetes, morphine as a regular medication, diagnoses of cancer and unable to communicate in Danish. Participants filled out diaries at baseline and weekly for four weeks post-surgery. The diaries contained parts or in full validated instruments for incontinence (ICIQ-UI), sexual health and life (PISQ-12) and postoperative rehabilitation (QoR-15). In a patient involvement process the questions to be selected for the study was evaluated where the women\u0026rsquo;s preferences and opinion of relevance was adhered to and incorporated for their evaluation. Remarkedly, the questions involving a partner were given low priority, as several of the women understood their sex life contained activities without intercourse, intercourse had ceased some time ago and were without a partner. These diaries were electronically sent to the participants through a secure e-mail app (e-box), which is widely used for communication between Danish citizens and public authorities.\u003c/p\u003e\n\u003cp\u003eMultiple regulatory bodies approved the Study, including the European Medical Agency (EUDRACT no. 2021-000874-28), the National Medical Agency (2021-1041858), and the National Scientific Committee (S-20210054), the Regional Science Board (22/22766) and the unit of Good Clinical Practice (22.011). It was registered at ClinicalTrials.gov (NCT 04762381) and utilized a secure data storage system in the REDCap database, part of the Open Patient data Explorative Network (OPEN) at the University of Southern Denmark.\u003c/p\u003e\n\u003cp\u003eAll methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWith a primary outcome based on c-reactive protein level, the sample size for the trial was calculated to 48 women per group, as c-reactive protein was expected to rise to 40 mg/l (8). An intention-to-treat analysis was used for the outcome data. The sexual function was one of the secondary outcomes of the study (13). As part of the external validation the drop-out group was included for comparison. The repeated measurement was analyzed with GLM adjusted for baseline measurement when possible. At every time point the variables were compared between the groups with either Student\u0026rsquo;s t-test, if Gaussian distributed; otherwise, Mann-Whitney\u0026rsquo;s U-test was used. A two-tailed p-value of 0.05 was used for significance testing. Statistical analysis was performed using STATA-BE18 software.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eBetween May 2022 and February 2024 112 women were included in the randomized trial and had complete blood sampling, medical provision and VAS data at all-time points during admittance. All the basic characteristics were similar in the included as well as excluded women (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAll the excluded women were evaluated as separate drop-out group in their basal characteristics (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). The prevalence of previous surgery and comorbidity was similar distributed in all groups. The three most frequent surgery types were cesarean section, conisation and cholecystectomy; the first one may directly have complicated hysterectomy. The operation time and blood loss were similar in all groups.\u003c/p\u003e\n\u003cp\u003eWe had 16 women in the drop-out group due to change of mind on the operation day (n\u0026thinsp;=\u0026thinsp;1) or did not want be part of the trial in the first place (n\u0026thinsp;=\u0026thinsp;4). Study violations consisted of applying extra dose of dexamethasone, one in each randomization groups (n\u0026thinsp;=\u0026thinsp;2). Other were excluded due to insulindependent diabetes (n\u0026thinsp;=\u0026thinsp;1), cancer diagnosis (n\u0026thinsp;=\u0026thinsp;1), regular use of morphine (n\u0026thinsp;=\u0026thinsp;1), not able to proper communicate in Danish (n\u0026thinsp;=\u0026thinsp;1) and primary laparotomy (n\u0026thinsp;=\u0026thinsp;1) and four women had a further mini-laparatomy on top of the robotic assisted laparoscopy.\u003c/p\u003e\n\u003cp\u003eThe included women answered the four times weekly postoperative diary by 72% on general work life-, home- and leisure-related questions, 63% on resumption of sex, 42% on pain at intercourse, 49% of on arousal during sex, 62% on orgasms intensity, 68% on incontinence, and 60% on QoR-15 (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eAt the regression analysis, no associations were found with trial\u0026rsquo;s primary outcome of c-reactive protein and the follow-up questionnaires, neither in the primary postoperative questions on pain, work and leisure life, the modified PISQ-12, ICIQ-UI nor QoR-15.\u003c/p\u003e\n\u003cp\u003eIn the questions regarding the domains of work and leisure activities, no differences were observed (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e), i.e. in use of pain medication, resuming work, pain as hindrance to work, too much nausea and uncomfortable to work, able to resume daily chores and resuming leisury activities.\u003c/p\u003e\n\u003cp\u003eRegarding measures on sexual function, we found that intensity of orgasms and frequency of wanting sex were different in the two trial groups (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e) even if no significant difference was found in resumption of sex within four weeks postoperatively or pain at sex. Women in the dexamethasone group wanted sex more frequently at each weekly measure point compared to the placebo group (p\u0026thinsp;=\u0026thinsp;0.018, adjusted for baseline frequency, Fig.\u0026nbsp;1). Further, the intensity of orgasms was increased in the intervention group (p\u0026thinsp;=\u0026thinsp;0.044, adjusted for baseline intensity, Fig.\u0026nbsp;2).\u003c/p\u003e\n\u003cp\u003eAs for rehabilitation, the women who received dexamethasone reported that within the last 24 hours they had a better general well-being (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and felt more comfortable and in control (p\u0026thinsp;=\u0026thinsp;0.018) than the placebo group, adjusted for baseline. As for the total score in QoR-15, no difference was found. At regression analysis the high and, thus, better score in QoR-15 at week 4 was associated with wanting more sex (p\u0026thinsp;=\u0026thinsp;0.04) and less pain during intercourse (p\u0026thinsp;=\u0026thinsp;0.047).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAfter the intervention with dexamethasone, we saw better patient reported outcomes for specific end-points, in particular on frequency of wanting sex and on orgasm intensity but also on areas of general well-being. The sexual functions will vary due to other circumstances e.g. desire (16\u0026ndash;18). We know urinary incontinence and the fear of it seem to be associated with sexual behavior (19, 20). However, we find significantly higher sexual desire for the intervention group.\u003c/p\u003e\u003cp\u003eTaking validity of the original questionnaire of PISQ-12 into account, we note that it was tested with factor analysis and test-retest, but it was developed theoretically for sexual activities within a period of the last six month (21). Sexual activity after hysterectomy is a complex issue that varies among women, influenced by a multitude of factors including the type of surgery performed, the underlying reasons for this, and individual psychological and physiological responses. Research indicates that the timing for resuming sexual activity post-hysterectomy is often contingent upon both physical recovery and emotional readiness. We also know from a Danish cohort of hysterectomized women that 90% of them engaged in sexual activity other than the recommended and expected time after surgery similar to our observations (22). In terms of timing, many studies suggest that while some women may feel ready to resume sexual activity within weeks of surgery, others may require several months to regain their sexual confidence and comfort (23,4). It is essential for healthcare providers to discuss these timelines openly with patients, ensuring they understand that variations in recovery are normal and that they should not rush the process. Generally, medical professionals recommend waiting at least six to eight weeks after surgery before engaging in sexual intercourse, allowing for adequate healing of the surgical site and minimizing the risk of complications such as infection or pain during intercourse (24,10).\u003c/p\u003e\u003cp\u003eOne may assume that the better general well-being, feeling of comfort and control would be associated with physical, emotional and sexual recovery; however, the full estimate of recovery in the sum of scores in QoR-15 suggested similar recovery, thus, no difference in resuming recreational and occupational activities. We were only able to substantiate this association at the end of the follow-up when pain at intercourse and in wanting sex were associated with QoR-15. However, this coincidated with a time when more had resumed sex. We did not expect the issues of sexual health to be well represented in QoR-15. So, these issues were imperative to be added to the questionnaires by adding PISQ-12, a topic the women agreed upon in the pre-trial patient involvement process.\u003c/p\u003e\u003cp\u003eA range of emotional and physical changes that may affect a woman\u0026rsquo;s sexual function can accompany the recovery period following a hysterectomy. Previous studies found that many women report alterations in their sexual desire and function post-surgery. For instance, some women experience a decrease in libido, while others may find that their sexual pleasure improves due to the alleviation of symptoms that necessitated the surgery in the first place, such as chronic pain or heavy menstrual bleeding (3,10, 25\u0026ndash;29). This dichotomy underscores the importance of individualized assessments and counseling regarding sexual health after surgery. Moreover, the type of hysterectomy performed may also influence sexual outcomes. Research indicated that women may experience fewer negative sexual side effects by vaginal or laparoscopic hysterectomy compared to abdominal hysterectomy (25,14,6). Some reported of improvements in sexual function and satisfaction following vaginal hysterectomy, while others have noted persistent issues such as dyspareunia regardless of the surgical technique employed (3,28).\u003c/p\u003e\u003cp\u003eThe psychological impact of undergoing a hysterectomy cannot be overlooked. Many women express concerns about their femininity and sexual identity post-surgery, which can lead to anxiety and decreased sexual desire (2,1 ). Emotional support from partners and healthcare providers plays a crucial role in facilitating a positive sexual recovery. The interplay between surgical outcomes, hormonal changes, and psychological factors highlights the necessity for comprehensive postoperative care that addresses both physical and emotional aspects of recovery. Additionally, the quality of the relationship with a partner can significantly influence sexual recovery after hysterectomy. We found that in the patient involvement process the questions involving interaction with a partner were given low priority and were omitted in the final version of the questionnaire. We decided not to add new, unvalidated questions about these aspects as the PISQ-12 did nor comprise of such questions. Women who report strong emotional connections with their partners often find it easier to navigate the changes in their sexual lives, whereas those experiencing relationship difficulties may struggle more with sexual intimacy (29, 30). This indicates that addressing relational dynamics is as important as focusing on the physical aspects of recovery. Thus, it is important to collect and assess measurements for the relational aspects within and affect upon the sexual function of women. Furthermore, the lack of items for women without sexual function could influence these women\u0026rsquo;s compliance. Focusing upon these challenges the PISQ-12 has been revised and validated in several languages (PISQ-IR - IUGA revised version) (31). We applied relevant questions from the PISQ-12 even with the above challenges since a Danish version of the PISQ-IR is not validated, yet.\u003c/p\u003e\u003cp\u003eStrengths and weaknesses\u003c/p\u003e\u003cp\u003eThe PISQ-12 is a validated, shortened questionnaire of the validated and original PISQ (21,31). Even if the PISQ-12 is used regularly for measurements in studies among Danish populations, a specific validation with psychometric testing has not yet been performed and thus, the validation of the questionnaire in a Danish population is not robust. Further, we picked relevant but single specific items out of a validated context for measuring our sexual function. This might have affected reliability of results (32, p. 235\u0026thinsp;\u0026minus;\u0026thinsp;44). The validation process for the original PISQ assessed the validity of all 31 questions as domains or one construct as does the PISQ-12 and not each specific item assessed out of context. Furthermore, the PISQ-12 was developed and validated in a condition specific population of women with pelvic organ prolapse and urinary incontinence, which was not the target group for our trial even if a certain percentage of the women had urinary incontinence seen at baseline (21). However, as for a genuine patient involvement in the pre-trial process this was discussed and addressed.\u003c/p\u003e\u003cp\u003eThe patient related outcomes were hampered by a moderate response rates and that at baseline data were not collected as anonymously as were the following weekly internet-based anonymous questionnaires results. This may produce some random but not systematic errors (32 p.100\u0026thinsp;\u0026minus;\u0026thinsp;44). The relative short follow-up may not show long-lasting effects of the trial. However, it indicated positive results for patients and their relationship even if they did not follow recommendations on sexual abstinence postoperatively. Noticably, no complications were observed that could be related to this e.g. vaginal vault prolapse, infections or bleeding.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHigher frequency of wanting intercourse sex and more intense orgasms were found in the women receiving dexamethasone in robotic-assisted hysterectomy during the first four weeks postoperatively. While robotic-assisted laparoscopic techniques and the use of dexamethasone show promise in improving recovery, the potential impact on sexual health necessitates evidence-based recommendations for enhancing sexual outcomes in women undergoing hysterectomy.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBMI: Body mass index\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate declarations:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll Participants were informed and gave their written consent to participate ( all monitored by OPEN in the GCP guidelines)\u003c/p\u003e\n\u003cp\u003eCompeting interest: None\u003c/p\u003e\n\u003cp\u003eFunding: no funding\u003c/p\u003e\n\u003cp\u003eKey-words: Randomized trial, robotic-assisted surgery, hysterectomy, c-reactive protein, surgical stress\u003c/p\u003e\n\u003cp\u003eEthical aspects\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe trial was approved by the European Medical Agency (EUDRACT no. 2021-000874-28), the National Medical Agency (2021-1041858), the National Scientific Committee (S-20210054), the Regional Ethical Science Board (22/22766), the unit of Good Clinical Practice (22.011) and registered at clinicaltrials.gov (NCT 04762381). The Date of registration of the trial in the latter registry was June 1, 2022.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData were stored in a closed repository in Open Patient data Explorative Network (OPEN) under the University of Southern Denmark in a REDCap database no. 1377.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCiba-Geigy random numbers (even or uneven numbers) was used for the randomization before the very start of the trial and stored in a sealed envelope. Consent for publication Not applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials : yes on request by the corresponding author\u003c/p\u003e\n\u003cp\u003eCompeting Interests: no competing interest\u003c/p\u003e\n\u003cp\u003eFunding : no funding\u003c/p\u003e\n\u003cp\u003eKK: initiated the concept and writing of the manuscript, assessed studies\u003c/p\u003e\n\u003cp\u003eFFL: initiated the concept and writing of the manuscript, assessed studies\u003c/p\u003e\n\u003cp\u003eIG, TS, MH and DTJ contributed to the reviewing, editing and approving the final version of this paper\u003c/p\u003e\n\u003cp\u003eAcknowledgements not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eSchmidt A, Sehnem GD, Cardoso LS, Quadros JS, Ribeiro AC, Neves ET. Sexuality experiences of hysterectomized women. Escola Anna Nery. 2019 Jul 29;23:e20190065.\u003c/li\u003e\n \u003cli\u003eDundar B, Dincgez Cakmak B, Aykanat Y, Macunluoglu AC. 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Available from: https://pubmed.ncbi.nlm.nih.gov/28913149/\u003c/li\u003e\n \u003cli\u003eThakar R. Is the Uterus a Sexual Organ? Sexual Function Following Hysterectomy. Sexual Medicine Reviews. 2015 Oct;3(4):264\u0026ndash;78.\u003c/li\u003e\n \u003cli\u003eNadia M. Impact on sexual functioning: total versus subtotal hysterectomy. International Journal of Advanced Studies in Sexology. 2023 Apr 1;5(1).\u003c/li\u003e\n \u003cli\u003eZimmerman J, Mats Br\u0026auml;nnstr\u0026ouml;m, Bergdahl C, Aziz A, Hermansson J. Long-Term Follow Up of Sexual Function and Steroid Levels in Women after Perimenopausal Hysterectomy with or without Concomitant Oophorectomy. Journal of clinical medicine [Internet]. 2023 Jul 28 [cited 2024 May 10];12(15):4976\u0026ndash;6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10419815/\u003c/li\u003e\n \u003cli\u003eRogers RG, Rockwood TH, Constantine ML, Thakar R, et al. A new measure of sexual function in women with pelvic floor disorders (PFD): The Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR). IUJ. 2013;24(7):1091-1103.\u003c/li\u003e\n \u003cli\u003eStreiner D, Norman GR, Cairney J. Health Measurement Scales - a practical guide to their development and use. Fifth edition ed. Great Clarendon Street, Oxford, OX2 6DP, United Kingdom: Oxford University Press; 2015.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable / group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDEXA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eIncluded in trial\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDropout\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48\u0026thinsp;\u0026plusmn;\u0026thinsp;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49\u0026thinsp;\u0026plusmn;\u0026thinsp;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48 (32\u0026ndash;80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHeight (cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e165\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u0026thinsp;\u0026plusmn;\u0026thinsp;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u0026thinsp;\u0026plusmn;\u0026thinsp;5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSmoking (no.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParity (no.)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0\u0026ndash;2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0\u0026ndash;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHgb preoperatively (mg/dl)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUterine weight (g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e287 (26-1000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e315 (35-1365)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e302(26-1365)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e208 (40-2366)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePeroperative blood loss (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48 (0-750)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86 (0-1000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66 (0-1000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50 (20-1200)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOperation time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85 (27\u0026ndash;225)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92 (30\u0026ndash;270)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89 (27\u0026ndash;270)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e105 (27\u0026ndash;215)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eBasal characteristics and intraoperative data\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eGaussian all data are given as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD, non-Gaussian as median (range)\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eDEXA: Dexamethasone, Hgb: Hemoglobin\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResumption of work, daily chores and leisure activity one to four weeks postoperatively by dexamethasone and placebo\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable / group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDEXA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eUsing painkillers\u003c/em\u003e: yes (n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32/14/13/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33/24/15/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65/38/28/15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.17*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eWorking\u003c/em\u003e: yes (n\u0026thinsp;=\u0026thinsp;46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/5/4/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/4/11/18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/9/15/27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.34*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003ePain hindrance for work\u003c/em\u003e: yes (n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29/22/21/13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29/27/27/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58/49/48/25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.14*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eToo tired to work\u003c/em\u003e: yes (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35/28/24/23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32/32/26/23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67/60/50/46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.28*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eToo much nausea and uncomfortable to work\u003c/em\u003e: yes (n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14/11/7/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15/15/8/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29/26/15/11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.64*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eAble to resume daily chores\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNot at all/very limited/to some extent/nearly no limit/in full extent\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/15/17/6/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/11/16/9/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/26/33/15/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/7/15/11/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/6/20/11/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/13/35/22/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/3/1/16/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/6/20/11/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/13/35/22/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/8/14/16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/1/11/12/17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/3/19/20/33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eAble to resume to leisure activity\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eNot at all/very limited/to some extent/nearly no limit/in full extent\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.44*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26/6/3/3/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24/8/5/0/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50/14/8/3/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18/10/7/2/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/9/6/1/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38/19/13/3/5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14/8/8/7/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13/9/8/5/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27/17/16/12/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/3/15/9/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8/8/12/4/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18/11/26/13/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eDEXA: Dexamethasone; wk: week, data are shown as numbers\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e* and the rows 1/2/3/4 indicate analysis with GLM repeated measurement provided completeness of data and are adjusted for baseline value. Week 1\u0026ndash;4 are tested with Mann-Whitney\u0026rsquo;s U-test.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eIncontinence and sexual life one to four weeks postoperatively by dexamethasone and placebo\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable / group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDEXA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eResumed intercourse: Yes\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/4/5/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/5/4/11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/9/9/20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.12*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cem\u003ePain at intercourse: Yes\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12/10/11/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11/9/9/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33/19/20/19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.33*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eIncontinence at intercourse?\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAlways/Often/ sometimes/seldom/never\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 1 (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/0/0/2/26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/0/1/3/22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/0/1/5/48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 2 (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/0/0/2/27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/0/2/1/24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/0/2/3/51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 3 (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/0/0/0/28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/0/2/2/23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/0/2/3/51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.046\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 4 (n\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/0/0/1/28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/0/2/1/23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/0/2/2/51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eIntensity of orgasms are\u0026hellip;.\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;45)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003emuch less/less/same/more/much more\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.045*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 1 (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/18/3/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/4/15/1/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/6/33/3/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.038\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 2 (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/19/2/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/3/19/1/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3/5/38/3/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 3 (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/1/20/1/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/3/19/0/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/4/39/1/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 4 (n\u0026thinsp;=\u0026thinsp;49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/1/20/1/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/3/17/2/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/4/37/3/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eHow often do you want sex?\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;63)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eAlways/often/sometimes/rarely/never\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.018*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 1 (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/8/10/4/5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2/7/12/10/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/15/22/14/12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 2 (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/10/10/3/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/12/13/9/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/22/23/12/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 3 (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4/8/12/5/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/11/10/10/6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/19/22/15/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 4 (n\u0026thinsp;=\u0026thinsp;69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/9/12/3/2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/12/13/5/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/21/25/8/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eHow often do you leak urine?\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;77)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003enever/once a wk/2\u0026ndash;3 times a wk/once daily/more than once daily/all the time\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 1 (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21/6/3/3/5/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23/15/2/0/3/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44/21/5/3/8/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 2 (n\u0026thinsp;=\u0026thinsp;81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18/8/6/3/2/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23/13/3/2/2/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41/21/9/5/4/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 3 (n\u0026thinsp;=\u0026thinsp;82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21/5/3/6/3/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23/14/3/1/2/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44/18/6/7/5/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 4 (n\u0026thinsp;=\u0026thinsp;80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20/6/5/3/2/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22/15/3/2/1/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42/21/8/5/3/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"4\"\u003e\n \u003cp\u003e\u003cem\u003eHow much do you leak urine?\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e\n \u003cp\u003e\u003cem\u003enothing/a little/moderately/large amounts\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.78*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 1 (n\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21/14/3/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23/16/2/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44/30/5/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 2 (n\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19/17/2/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21/20/0/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40/37/2/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 3 (n\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22/14/2/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20/21/0/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42/35/2/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk 4 (n\u0026thinsp;=\u0026thinsp;79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20/15/3/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20/20/1/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40/35/4/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cem\u003eHow much does leakage bother you (VAS)\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0/1/0/0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/4/6/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5/2/1.5/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.69*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eDEXA: Dexamethasone; wk: week\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eData are shown as numbers except the VAS scores in \u0026lsquo;\u003cem\u003eHow much does leakage bother you\u0026rsquo;\u003c/em\u003e (median)\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e* and the rows 1/2/3/4 indicate analysis with GLM repeated measurement provided completeness of data and are adjusted for baseline value. Week 1\u0026ndash;4 are tested with Mann-Whitney\u0026rsquo;s U-test.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e\u003cstrong\u003eBold type\u003c/strong\u003e figures indicate p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003eThe number of patients in the mixed model calculations are less due to lacking baseline values in comparison to the weekly diaries.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003e\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eQuality of recovery within the latest 24 hours one to four weeks postoperatively by dexamethasone and placebo group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable / group\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDEXA\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePlacebo\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eAble to breath\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.67*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eAble to enjoy food\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.99*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFeeling rested\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/7/7/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/5/7/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/6/7/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.18*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSlept well\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/7/7.5/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/6/7.5/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/6.5/7.5/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.66*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eAble to handle personal hygiene\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.63*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eAble to communicate with friends and family\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.0*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eSupport from doctors and nurses\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.24*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eAble to resume work or daily chores\u003c/em\u003e(n\u0026thinsp;=\u0026thinsp;28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/7/7/8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5/6/7/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/6/7/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.17*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFeeling comfortable and in control\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/8/9/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/7/8/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.5/8/9/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.027*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFeeling of general well-being\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7/8/9/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/6.5/8/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6/8/8.5/8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eExperienced moderate pain\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/8/8/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/6/8/8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5/7/8/9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.08*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eExperienced strong pain\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.72*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eNausea and vomiting\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.74*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFeeling worried or anxious\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/1810/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.2*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFeeling sad or depressed\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1/2/3/4 wk\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/10/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.5/9/9/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10/10/9/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.3*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003e\u003cem\u003eQoR15 total\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.30*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBaseline (n\u0026thinsp;=\u0026thinsp;41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107\u0026thinsp;\u0026plusmn;\u0026thinsp;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117\u0026thinsp;\u0026plusmn;\u0026thinsp;27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e111\u0026thinsp;\u0026plusmn;\u0026thinsp;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk1 (n\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110\u0026thinsp;\u0026plusmn;\u0026thinsp;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e111\u0026thinsp;\u0026plusmn;\u0026thinsp;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e110\u0026thinsp;\u0026plusmn;\u0026thinsp;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk2 (n\u0026thinsp;=\u0026thinsp;62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e118\u0026thinsp;\u0026plusmn;\u0026thinsp;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115\u0026thinsp;\u0026plusmn;\u0026thinsp;25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117\u0026thinsp;\u0026plusmn;\u0026thinsp;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk3 (n\u0026thinsp;=\u0026thinsp;60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123\u0026thinsp;\u0026plusmn;\u0026thinsp;22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e124\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWk4 (n\u0026thinsp;=\u0026thinsp;63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135\u0026thinsp;\u0026plusmn;\u0026thinsp;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135\u0026thinsp;\u0026plusmn;\u0026thinsp;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135\u0026thinsp;\u0026plusmn;\u0026thinsp;23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eDEXA: Dexamethasone wk: week, all data are median scores except from QoR-15 (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e* and the rows 1/2/3/4 indicate analysis with GLM repeated measurement. Week 1\u0026ndash;4 are tested with Mann-Whitney\u0026rsquo;s U-test.\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cstrong\u003eBold type\u003c/strong\u003e figures indicate p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7510821/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7510821/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and Aim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe impact of hysterectomy on women's sexual functioning is a subject of debate. Some women report improvements in sexual function post-surgery, often due to the relief of symptoms like pain or bleeding, while others experience sexual dysfunction following the procedure. Factors such as preoperative health and the type of hysterectomy performed (e.g., laparoscopic or robotic) may contribute to these variations. Robotic-assisted hysterectomy, as a minimally invasive surgical method, was well-received due to its benefits, including reduced postoperative pain, quicker recovery, and shorter hospital stays. Dexamethasone, a corticosteroid commonly used in multimodal anesthesia regimens and known for its anti-inflammatory properties, can reduce surgical stress, decrease postoperative pain, and hasten recovery. The aim of this randomized trial was to assess whether adding dexamethasone to a robotic hysterectomy procedure would further improve postoperative outcomes besides of lowering inflammatory response, particularly regarding sexual functioning.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study-recruited women scheduled for robotic-assisted hysterectomy and randomized into two groups: One receiving 24 mg of dexamethasone preoperatively and the other receiving a placebo. Various measures were taken, including blood tests, pain assessments using the visual analogue scale (VAS), and reports on postoperative vomiting, nausea, and medication usage at five time points: 0, 4, 8, 12, and 24 hours postoperatively. The primary outcome included inflammatory response and, secondarily, sexual functioning measures such as urinary incontinence during sex, orgasm intensity, and frequency of sexual desire.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 112 women participated, with complete data available from all participants for blood tests, medical interventions, and VAS measures at all time points. No significant differences were found in basic characteristics between the dexamethasone and placebo groups. However, the study observed the following differences in sexual functioning: Women in the dexamethasone group had a higher frequency of wanting sex at each weekly follow-up compared to the placebo group (p = 0.018). Orgasm intensity was significantly higher in the dexamethasone group (p = 0.044). The high and better score in QoR-15 at week 4 was associated with wanting more sex (p=0.04) and less pain during intercourse (p=0.047). No differences were found in the resumption of sex within the four-week study period, pain during sex or incontinency during intercourse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe addition of dexamethasone in robotic-assisted hysterectomy was associated with an increased frequency of sexual desire and more intense orgasms in the first four weeks postoperatively. This suggests that dexamethasone may positively affect certain aspects of sexual functioning in women undergoing this procedure. These findings highlight the potential benefits of dexamethasone in the postoperative recovery phase, but further research may be needed to understand the full scope of its effects on sexual health after hysterectomy.\u003c/p\u003e","manuscriptTitle":"The effect of dexamethasone on sexual function in a randomized trial in robotic hysterectomy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-30 10:57:03","doi":"10.21203/rs.3.rs-7510821/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"850876ea-5edc-45e1-a4c3-f754994ffea5","owner":[],"postedDate":"September 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55523269,"name":"Health sciences/Diseases"},{"id":55523270,"name":"Health sciences/Health care"},{"id":55523271,"name":"Health sciences/Medical research"},{"id":55523272,"name":"Health sciences/Urology"}],"tags":[],"updatedAt":"2025-10-17T08:09:06+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-30 10:57:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7510821","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7510821","identity":"rs-7510821","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}