Sexual functioning after total versus subtotal laparoscopic hysterectomy

Aim To evaluate postoperative sexual functioning and the influence of patients’ expectations on the change in sexuality following laparoscopic total (TLH) versus subtotal hysterectomy (LASH).

A total of 120 women undergoing laparoscopic hysterectomy were preoperatively enrolled in this bicentric prospective study. Sexual functioning (SF) was evaluated using the female sexual function index (FSFI). Additionally, participants filled in a standardised questionnaire concerning expected changes in SF after surgery. At 3, 6 and 12 months following surgery, women were asked again to assess their level of SF (FSFI). Data of women who participated in at least one FSFI follow-up assessment were analysed (n = 92). We compared the change in SF after surgery between patients with TLH (n = 46) and LASH (n = 46). Additionally, we calculated regression analyses with the patients’ expectations as a predictor for change in FSFI scores.

Comparing the change of FSFI scores after surgery in both collectives revealed differences only 3 months after surgery, as improvement was stronger for the LASH collective compared to the THL group (p = 0.006). There were no changes comparing collectives after 6 (p = 0.663) and 12 (p = 0.326) months. Concerning patientsʼ expectations, for the LASH group baseline SF (p < 0.001), but not expectations (p = 0.567) predicted the strength of change at each of the follow ups: a lower level of baseline SF was linked to a stronger improvement after surgery. For the THL collective, both baseline SF (p < 0.001) as well as patients’ expectations (3 months: p = 0.077, 6 months: p = 0.37, 12 months: p = 0.024) predicted the strength of change: both, a lower level of baseline SF and higher expectations towards an improvement predicted a stronger improvement.

The preservation of the cervix does not show an advantage in improving SF after surgery. Both methods induce a comparable improvement in long-time SF, especially in patients with an impaired sexuality pre-surgery. Furthermore, patients’ expectations concerning this matter seem to have an impact on the postoperative outcome; therefore, this circumstance should be considered in future projects. Similar content being viewed by others

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Author information Authors and Affiliations Contributions SB project development, manuscript writing, BT data collection, manuscript editing, AW data collection, SJ data collection, OB data collection, ATK data collection, MS manuscript editing, SL data analysis, AH data collection, manuscript editing, project development. Corresponding author Ethics declarations Conflict of interest All authors declare to have no conflict of interest. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study. Rights and permissions About this article Cite this article Berlit, S., Tuschy, B., Wuhrer, A. et al. Sexual functioning after total versus subtotal laparoscopic hysterectomy. Arch Gynecol Obstet 298, 337–344 (2018). https://doi.org/10.1007/s00404-018-4812-7 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-018-4812-7