Quality of life and sexual function of women operated on reproductive system organs

О. S. Lashkul
In: Zaporozhye Medical Journal · 2018 · vol. 0(1) · doi:10.14739/2310-1210.2018.1.121999 · W2791319327
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Planned gynecological operations improved quality of life and sexual function, particularly with FTS for vaginal hysterectomy and with FTS/without FTS for uterine appendage surgeries, though vaginal hysterectomy showed no significant sexual function change.

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This study evaluated how planned gynecologic operations affected quality of life and sexual function in 165 women, assessed preoperatively and at 3 months after surgery using the SF-36 (physical, psychological/emotional/social domains) and the Female Sexual Function Index (FSFI; desire, arousal, lubrication, orgasm, satisfaction, and dyspareunia). Participants were divided into six procedure groups (vaginal, abdominal, or laparoscopic operations on reproductive organs and uterine appendages) with or without a multimodal postoperative care strategy labeled FTS, and key outcomes were compared across time and groups. Quality-of-life physical and mental health indicators improved significantly across groups after 3 months, with the study reporting increased pain intensity and finding higher health physical component scores in some FTS groups, while psychological improvement was noted after abdominal hysterectomy with FTS; sexual function increased after abdominal hysterectomy with FTS and after uterine-appendage procedures both with and without FTS, but not significantly after vaginal hysterectomy (attributed to menopausal age). The paper does not explicitly detail long-term follow-up beyond 3 months as a limitation. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

Aim – to study the effect of planned gynecological operations on the integral characteristics of physical, psychological, emotional, social and sexual functioning of women.Materials and methods. Quality of life and sexual function were studied in 165 patients who underwent planned gynecological operations. Depending on the type of surgical treatment patients were divided into 6 groups: the 1st group – 20 patients (vaginal hysterectomy without FTS), the 2nd group – 23 patients (abdominal hysterectomy without FTS), the 3rd group – 54 patients (laparoscopic operations on the uterine appendages without FTS), the 4th group – 21 patients (vaginal hysterectomy with FTS), the 5th group – 20 patients (abdominal hysterectomy with FTS), the 6th group – 27 patients (laparoscopic operations on the uterine appendages with FTS). To assess the quality of life a short version of the SF-36 questionnaire was used. The questionnaire was developed at the US Institute of Health, author J. E. Ware, and contains 36 items. They are grouped so that they reflect 8 different aspects related to health. The results for each scale are presented in a point scale (from 1 to 100), where a higher score corresponds to a better quality of life. To assess the sexual function a questionnaire was conducted using the female sexual function index (FSFI). The questionnaire includes 19 items that provide of characteristics of desire, excitement, lubrication, orgasm, getting sexual satisfaction and dyspareunia presence assessment. The minimum score is 2, the maximum is 36. Stages of the questionnaire: before the operation and three months after the operation.Results. In patients before and after laparoscopic surgery on uterine appendages without FTS and with FTS, the mean values of the female sexual function index were significantly higher after surgery and reached the maximum value of 36.So, by questionnaire before and after 3 months it has been found that the indicators characterizing the quality of life (physical and vital activity, social and role functioning, emotional and mental health) in patients of all groups significantly improved, so the final result of surgical interventions was achieved. A significant contribution to the health physical component overall index was made by the index of pain intensity (BP), which in all groups increased by 2–3 times in comparison with the corresponding preoperative values. When comparing the similar operations with FTS and without FTS, it has been revealed that 3 months after vaginal hysterectomies and operations on the uterine appendages the health physical component total index was significantly higher in groups with FTS. In the group of patients who underwent abdominal hysterectomy, the physical component of health total score did not change significantly, whereas the psychological component of health total index increased significantly in patients who had been treated with a multimodal approach for maintaining the postoperative period. Sexual function in women 3 months after abdominal hysterectomy (FTS) and laparoscopic operations on the uterine appendages with FTS and without FTS increased significantly. There were no significant differences in FSFI in women who underwent vaginal hysterectomy. This fact can be explained by the age of patients who were in menopause.Conclusions. Indicators of physical and mental health components improved in patients of all groups three months after surgery. In patients operated by using the multimodal FTS strategy the most significant increase of health physical component was identified in the group of vaginal hysterectomy three months after the operation. There were no significant differences in the sexual function of women in the long-term postoperative period after vaginal hysterectomies. After abdominal hysterectomy with FTS a significant improvement of the female sexual function index was observed by 27.2 %. After operations on the uterine appendages without FTS and with FTS the index of female sexual function increased on average by 11.6 % and 12.8 %, respectively.
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Materials

and methods. Quality of life and sexual function were studied in 165 patients who underwent planned gynecological operations. Depending on the type of surgical treatment patients were divided into 6 groups: the 1st group – 20 patients (vaginal hysterectomy without FTS), the 2nd group – 23 patients (abdominal hysterectomy without FTS), the 3rd group – 54 patients (laparoscopic operations on the uterine appendages without FTS), the 4th group – 21 patients (vaginal hysterectomy with FTS), the 5th group – 20 patients (abdominal hysterectomy with FTS), the 6th group – 27 patients (laparoscopic operations on the uterine appendages with FTS). To assess the quality of life a short version of the SF-36 questionnaire was used. The questionnaire was developed at the US Institute of Health, author J. E. Ware, and contains 36 items. They are grouped so that they reflect 8 different aspects related to health. The results for each scale are presented in a point scale (from 1 to 100), where a higher score corresponds to a better quality of life. To assess the sexual function a questionnaire was conducted using the female sexual function index (FSFI). The questionnaire includes 19 items that provide of characteristics of desire, excitement, lubrication, orgasm, getting sexual satisfaction and dyspareunia presence assessment. The minimum score is 2, the maximum is 36. Stages of the questionnaire: before the operation and three months after the operation. Results. In patients before and after laparoscopic surgery on uterine appendages without FTS and with FTS, the mean values of the female sexual function index were significantly higher after surgery and reached the maximum value of 36. So, by questionnaire before and after 3 months it has been found that the indicators characterizing the quality of life (physical and vital activity, social and role functioning, emotional and mental health) in patients of all groups significantly improved, so the final result of surgical interventions was achieved. A significant contribution to the health physical component overall index was made by the index of pain intensity (BP), which in all groups increased by 2–3 times in comparison with the corresponding preoperative values. When comparing the similar operations with FTS and without FTS, it has been revealed that 3 months after vaginal hysterectomies and operations on the uterine appendages the health physical component total index was significantly higher in groups with FTS. In the group of patients who underwent abdominal hysterectomy, the physical component of health total score did not change significantly, whereas the psychological component of health total index increased significantly in patients who had been treated with a multimodal approach for maintaining the postoperative period. Sexual function in women 3 months after abdominal hysterectomy (FTS) and laparoscopic operations on the uterine appendages with FTS and without FTS increased significantly. There were no significant differences in FSFI in women who underwent vaginal hysterectomy. This fact can be explained by the age of patients who were in menopause. Conclusions. Indicators of physical and mental health components improved in patients of all groups three months after surgery. In patients operated by using the multimodal FTS strategy the most significant increase of health physical component was identified in the group of vaginal hysterectomy three months after the operation. There were no significant differences in the sexual function of women in the long-term postoperative period after vaginal hysterectomies. After abdominal hysterectomy with FTS a significant improvement of the female sexual function index was observed by 27.2 %. After operations on the uterine appendages without FTS and with FTS the index of female sexual function increased on average by 11.6 % and 12.8 %, respectively.

References

- Nelson, G., Altman, A. D., Nick, A., Meyer, L. A., Ramirez, P. T., Achtari, C., et al. (2016) Guidelines for pre- and intra-operative care in gynecologic/ oncology surgery: Enhanced Recovery аfter Surgery (ERAS®) Society recommendations. Part I. Gynecologic Oncology, 140(2), 313–322. doi: 10.1016/j.ygyno.2015.11.015. - Nelson, G., Altman, A. D, Nick, A., Meyer, L. A., Ramirez, P. T., Achtari, C. et.al. (2016) Guidelines for postoperative care in gynecologic/oncology surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations – Part II. Gynecologic Oncology, 140(2), 323–332. doi: http://dx.doi.org/10.1016/j.ygyno.2015.12.019. - Rahkola-Soisalo, P., Altman, D., Falconer, C., Morcos, E., Rudnicki, M., & Mikkola, T.S. (2017) Quality of life after Uphold vaginal support system surgery for apical pelvic organ prolapse. A prospective multicenter study. European journal of Obstetrics & Gynecology and Reproductive Biology, 208(1), 86–90. doi: 10.1016/j.ejogrb.2016.11.011. - Dawson, M. L., Rinko, R. C., Shah, N. M., & Whitmore, K. E. (2017) The impact reconstructive surgery for pelvic organ prolapse and urinary incontinence on female sexual dysfunction: a review. JSM Sexual Med. 2(1), 1006–1014. - Coroleuca, C., Ionescu, C. A., Dimitriu, M., Popescu, I., & Catalin, A. (2017) Sexual function and vaginal surgery. Gineco.eu, 13(47), 5–8. - Valentin, L., Canis, M., Pouly, J. L., Lasnier, C., Jaffeux, P., Aublet-Cuvelier, P., & Bourdel, N. (2017) SF-36 preoperative interest of improvement of quality of life after laparoscopic management of minimal endometriosis. Journal of Gynecology Obstetrics and Reproduction, 46(2), 137–142. doi: 10.1016/j.jogoh.2016.12.004. Downloads How to Cite Issue Section License Authors who publish with this journal agree to the following terms: Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

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