Vaginal Length Measurement and Examination of Sexual Functions in Patients Who Had Total or Subtotal Hysterectomy for Benign Reasons

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Materials and Methods: 85 patients who were decided to undergo hysterectomy for benign reasons were included in the study. Vaginal lengths of all patients and cervical lengths of patients who underwent subtotal hysterectomy were recorded before and after the operation. In addition, the Female Sexual Function Index (FSFI) questionnaire was administered to the patients before and 24 months after the operation, and the International Index of Erectile Function (IIEF) questionnaire was administered to their spouses. Results: While there was no significant change in the vaginal length of women who underwent subtotal hysterectomy after the operation (p>0.05), a significant shortening was detected in the total hysterectomy group (p:<0.0001). There was a decrease in the total FSFI scores of the patients after the operation in both groups (p<0.0001). However, the decrease in FSFI scores in the subtotal hysterectomy group was significantly less than that in the total hysterectomy group. Conclusion: The decreasing FSFI scores of the patients after the operation show that both operations have negative effects on sexual functions. However, due to the vaginal tissue loss seen in the total hysterectomy group, the sexual functions of the patients were more negatively affected than the subtotal hysterectomy group. Sexual Function subtotal hysterectomy Vaginal lengths hysterectomy FSFI IIEF Figures Figure 1 Brief Summary Due to the vaginal tissue loss seen in the total hysterectomy group, the sexual functions of the patients were more negatively affected than the subtotal hysterectomy group. Introduction Hysterectomy has been reported as the most frequently performed surgical procedure in gynecology practice after cesarean section [1,2]. According to the application methods, it can be divided into vaginal, laparoscopic or abdominal. Additionally, it can be applied total or subtotal depending on the patient's indication [3,4]. Fear of deterioration in sexual functions after hysterectomy is a very common problem. Moreover, since the majority of hysterectomy patients are in the sexually active age, this problem is too important to be ignored. The concern that sexual, bowel or urinary functions may be impaired after hysterectomy still remains valid [5–8]. Sexual dysfunction may manifest itself with symptoms such as decreased libido, pain during sexual intercourse, vaginal dryness, difficulty in reaching orgasm or inability to orgasm. Although vaginal length varies in size and shape in women with different demographic characteristics, it varies between 7 and 9 cm on average [9]. Although there are conflicting results in the literature, shortened vaginal length after hysterectomy has been associated with sexual dysfunction [10]. This study aimed to reveal vaginal tissue loss in patients who underwent total or subtotal hysterectomy and to evaluate the effect of this situation on sexual functions. Materials and Methods This retrospective study was conducted among patients who applied to the gynecology outpatient clinic between 2021 and 2023 and underwent hysterectomy or subtotal hysterectomy. The applied methods were approved by the clinical research ethics committee (Istanbul Esenyurt University-12/23). Each patient participating in the study was informed about all possible risks and complications associated with the surgery, as well as the expected benefits of the procedure technique. Patients who underwent surgery for benign reasons, such as patients diagnosed with abnormal uterine bleeding, uterine leiomyoma and endometrial polyp but who did not benefit from medical treatment, were included in the study. Operated patients were divided into two probabilistically equivalent groups by random assignment. Demographic data, detailed medical history, pelvic examination, FSFI scores and vaginal ultrasound information of the patients were collected by retrospective file review. Vaginal lengths of the patients were measured before and after surgery by the same physician in the lithotomy position while the patients were awake. Using a speculum, the posterior vaginal fornix was identified with the help of the fornix, and the speculum was removed to avoid unnecessary vaginal tension. The distance between the vaginal posterior fornix and the hymen was measured with forceps and noted in centimeters. A uterine manipulator was not used during total abdominal hysterectomy, and the cervix of all patients was closed with a continuous lock. During laparoscopy, a uterine manipulator was used and the cervix was closed with a continuous lock in the same way. The patients included in the study were called for control at the 24th month after the operation and FSFI scoring was applied to determine the sexual functions of the patients. At the same time, the IIEF questionnaire was applied to the spouses of the patients to determine their sexual function status. Patients who were operated on for reasons other than the benign reasons mentioned, who were lost follow-up, who changed partners within two years or had more than one partner, or who had missing important preoperative data were excluded from the study. Patients who underwent simultaneous oophorectomy during surgery, postmenopausal patients, and patients with pelvic pain or endometriosis were also excluded from the study on the grounds that sexual functions may be affected. A Samsung Hera W9 Obstetrics/GYN Brand ultrasound device was used during the examination. All ultrasounds and surgeries were performed by the same, experienced physician with the same technique. The questionnaires were filled out manually by the same physician, who took the patients and their partners into a private room and gave them sufficient time to think. Statistical Analysis Parametric methods were used for measurement values suitable for normal distribution. In accordance with parametric methods, "Independent Sample-t" test (t-table value) is used to compare the measurement values of two independent groups; “Paired Sample-t” test (t-table value) method was used to compare two dependent groups. For measurement values that do not comply with normal distribution, "Mann-Whitney U" test (Z-table value) is used to compare the measurement values of two independent groups in accordance with non-parametric methods; “Wilcoxon” test (Z-table value) method was used to compare two dependent groups. Power analysis was based on the statistics obtained from the previously conducted study on this subject using the G Power 3.1 program [11]. "Evaluation of Sexual Functions and Vaginal Lengths" was conducted in two groups under conditions where the effect level was 0.76, the error level (a) was 0.05 and the power of the test (1-B) was 0.80. The minimum sample size required for a significant difference in terms of data was obtained by the Mann-Whitney U analysis method as 48. This method is used to compare measurements of two groups and is an alternative method to the independent groups t test method. When the number of data is not normally distributed and the number of data in two groups is low or if the measurements are of the ordinal scale type, this alternative method is used. Statistical analyzes were performed using the package program SPSS (IBM SPSS Statistics 27). Frequency tables and descriptive statistics were used to interpret the findings. A value of p < 0.05 was considered sufficient for statistical significance. Results A total of 85 patients were included in the study. 42 of these patients underwent total (abdominal: 20; laparoscopic: 22) and 43 underwent subtotal hysterectomy. Of the patients who underwent total hysterectomy, 38% (n:16) had uteri myoma, 38% (n:16) had abnormal uterine bleeding resistant to treatment, and 23% (n:10) had endometrial polyps. In the subtotal hysterectomy group, there were 72% (n:31) patients diagnosed with myoma uteri, 20% (n:9) with abnormal uterine bleeding resistant to treatment, and 0.6% (n:3) with endometrial polyps. Demographic data of the patients according to groups are shown in Table 1 . Table 1 Demographic Data of Groups Undergoing Total and Subtotal Hysterectomy Total Hysterectomy (n = 42) Subtotal Hysterectomy (n = 43) Statistical analysis * \(\stackrel{-}{\mathbf{X}}\pm \mathbf{S}.\mathbf{S}.\) Median [IQR] \(\stackrel{-}{\mathbf{X}}\pm \mathbf{S}.\mathbf{S}.\) Median [IQR] Age (year) 44,1 ± 2,80 44,0 [3,2] 41,7 ± 2,39 41,0 [4,0] t = 4,244 p < 0,0001 Gravida 3,47 ± 1,75 3,0 [2,0] 3,41 ± 1,34 3,0 [1,0] Z=-0,423 p = 0,7771 Parite 2,28 ± 1,04 2,0 [1,0] 2,3 ± 1,03 2,0 [1,0] Z=-0,715 p = 0,8549 BKİ (kg/m 2 ) 25,72 ± 2,37 25,5 [3,2] 25,63 ± 2,76 26,0 [5,0] t = 0,1685 p = 0,8666 * “Independent Sample-t” test (t-table value) statistics were used to compare the measurement values of two independent groups in data with normal distribution. “Mann-Whitney U” test (Z-table value) statistics were used to compare the measurement values of two independent groups in data that did not have a normal distribution. While there was no statistically significant difference in terms of gravida, parity and BMI (kg/m2) values according to the groups (p > 0.05); a statistically significant difference was detected in terms of age (years) (t = 4.244; p < 0.0001). It was determined that the age (years) values of those in group 2 were significantly lower than those in group 1. When the vaginal lengths measured before and after the operation are compared, no significant change is observed in the subtotal hysterectomy group (p > 0.05); in the total hysterectomy group, a significant shortening was detected after the operation compared to the pre-operative period (t = 25.54, p: <0.0001). In patients with subtotal hysterectomy, no statistically significant difference was observed when comparing the preoperative cervical length (mean = 38.19mm) and the postoperative cervical length (mean = 38.12mm) (p > 0.05). The distribution of cervical lengths in the total hysterectomy group before and after the operation is shown in Fig. 1. When FSFI scoring was applied to the patients in the 2nd year after surgery, a statistically significant decrease was detected in the preoperative - postoperative desire, aurosal, lubrication, orgasmic function, satisfaction and pain scores of the total hysterectomy group (p < 0.0001). Total FSFI scores also showed a significant decrease compared to the preoperative period (t = 46.55, p < 0.0001). Likewise, a statistically significant decrease was detected in the preoperative and postoperative aurosal, lubrication, orgasmic function and satisfaction scores in the subtotal hysterectomy group (p < 0.0001). Subtotal FSFI scores decreased significantly compared to before surgery (t = 10.61, p < 0.0001). Desire and pain scores showed less decrease after the operation than before (desire: t = 2.235, p = 0.0308; pain: t = 3.104, p = 0.0034). Comparison of pre- and post-operative FSFI scores of the groups is shown in Table 2 . Table 2 Comparison of Preoperative and Postoperative FSFI Scores of Total and Subtotal Hysterectomy Groups Total Hysterectomy (n = 42) Statistical analysis * Subtotal Hysterectomy (n = 43) Statistical analysis * Pre-Op Post-Op Pre-Op Post-Op \(\stackrel{-}{\mathbf{X}}\pm \mathbf{S}.\mathbf{S}.\) \(\stackrel{-}{\mathbf{X}}\pm \mathbf{S}.\mathbf{S}.\) \(\stackrel{-}{\mathbf{X}}\pm \mathbf{S}.\mathbf{S}.\) \(\stackrel{-}{\mathbf{X}}\pm \mathbf{S}.\mathbf{S}.\) Desire Arousal Lub. Orgas. Func. Satis. Pain Total \(\text{4,8}\pm \text{0,7}\) \(\text{4,3}\pm\) 0,6 \(\text{5,2}\pm\) 0,6 \(\text{4,5}\pm \text{0,5}\) \(\text{4,5}\pm \text{0,8}\) \(\text{5,7}\pm \text{0,4}\) \(\text{29,3}\pm \text{2,9}\) 3,6 \(\pm \text{0,7}\) \(\text{3,0}\pm\) 0,6 \(\text{4,0}\pm\) 0,5 \(\text{3,0}\pm\) 0,4 \(\text{3,3}\pm \text{0,7}\) \(\text{2,8}\pm \text{0,4}\) \(\text{20,3}\pm \text{2,2}\) p < 0.0001 t = 20.32 p < 0.0001 t = 20.26 p < 0.0001 t = 19.54 p < 0.0001 t = 20.81 p < 0.0001 t = 11.98 p < 0.0001 t = 37.62 p < 0.0001 t = 46.55 \(\text{5,0}\pm \text{0,7}\) \(\text{4,6}\pm\) 0,6 \(\text{5,4}\pm\) 0,6 \(\text{4,8}\pm \text{0,5}\) \(\text{5,0}\pm \text{0,8}\) \(\text{5,7}\pm \text{0,4}\) \(\text{30,7}\pm \text{2,8}\) \(\text{4,9}\pm \text{0,7}\) \(\text{4,4}\pm\) 0,6 \(\text{5,1}\pm\) 0,6 \(\text{4,5}\pm \text{0,6}\) \(\text{4,6}\pm \text{0,8}\) \(\text{5,5}\pm \text{0,5}\) \(\text{29,3}\pm \text{2,8}\) p = 0.0308 t = 2.235 p < 0.0001 t = 5.620 p < 0.0001 t = 5.512 p < 0.0001 t = 5.240 p < 0.0001 t = 5.419 p = 0.0034 t = 3.104 p < 0.0001 t = 10.61 Lub:Lubrication; Orgas:Orgasmic; Func:Function; Satis:Satisfaction; * "Independent Sample-t" test (t-table value) when comparing the measurement values of two independent groups in normally distributed data; “Paired Sample-t” test (t-table value) statistics were used to compare two dependent groups. When compared before and after the operation, the decrease in FSFI scores in the total hysterectomy group was significantly greater than in the subtotal hysterectomy group. In the IIEF scale applied to the spouses of the total hysterectomy group, no statistical difference was observed between pre- and post-operative erection function and orgasmic function (p > 0.05). A significant decrease was noted in sexual satisfaction scores after the operation (mean = 8.7) compared to before (mean = 11.2) (t = 11.80, p < 0.0001). A significant decrease was noted in sexual desire scores after the operation (mean = 8.1) compared to before (mean = 9.2) (t = 8.979, p < 0.0001). A significant decrease was detected in general satisfaction scores after the operation (mean = 6.6) compared to before the operation (mean = 8.5) (t = 9.299, p < 0.0001). In the IIEF scale applied to the spouses of the subtotal hysterectomy group, no statistical difference was observed in terms of erectile function and orgasmic function before and after the operation (p > 0.05). A significant decrease was noted in sexual satisfaction scores after the operation (mean = 10.9) compared to before (mean = 11.4) (t = 3.975, p = 0.0003). A significant decrease was noted in sexual desire scores after the operation (mean = 9.1) compared to before (mean = 9.3) (t = 2.468, p = 0.0178). A significant decrease was detected in general satisfaction scores after the operation (mean = 8.6) compared to before the operation (mean = 8.8) (t = 2.351, p = 0.0235). Discussion The impact of vaginal tissue loss on sexual functions remains unclear. Previous studies have not found a direct connection between vaginal length and sexual function [12,13]. Although Cruz et al. found that the vaginal length was shorter in vaginal hysterectomy compared to robotic hysterectomy, they could not show a significant difference in terms of sexual function [14]. However, disruption of the autonomic and somatic neuronal network of the upper vagina may cause decreased lubrication, negatively affecting orgasm. In addition to vaginal tissue loss and nerve damage, scar formation secondary to the operation is also one of the postoperative problems. Parys et al. suggested that the closely related plexus may be damaged when the cervix is removed [15]. Similarly, Hasson et al. emphasized that the cervix may be associated with sexual arousal and orgasm through the uterovaginal nerves via the Frankenhauser plexus, and therefore the cervix should be protected in appropriate cases to avoid nerve damage [16]. Another study comparing vaginal hysterectomy with abdominal hysterectomy associated the dyspareunia seen after vaginal hysterectomy with vaginal shortening [17]. In this study, increased vaginal tissue loss was detected in the patient group that underwent total hysteretomy compared to the subtotal hysterectomy group. This tissue loss, when evaluated together with the significant decrease in FSFI scores observed in the total hysterectomy group compared to the subtotal hysterectomy group, may be related to the loss of erogenous zones in the vagina and nerve damage previously suggested in the literature. Conflicting results in studies investigating sexual functions after hysterectomy increase the need to elucidate the relationship between vaginal anatomy and sexual function. Radosa et al. suggested that regardless of the surgical technique used, hytrectomy has a positive effect on sexual functions because it eliminates the organic cause that negatively affects sexual functions [21]. Likewise, Dedden et al. found a significant increase in the FSFI scores of patients after hysterectomy [22]. Flory et al., however, could not detect a significant difference between subtotal hysterectomy and total hysterectomy in terms of sexual function[23]. In these studies, patient groups that could seriously negatively affect sexual function, such as endometriosis and chronic pelvic pain, were included in the study, and the sexual dysfunctions of the patients were determined by pre-operative FSFI scores. Elimination of the negative effects of these diseases on sexual function through hysterectomy; It may have positively affected sexual functions despite the loss of vaginal tissue. In this study, the existing diseases of the patients did not have a significant negative effect on sexual functions, and no sexual dysfunction was observed in any patient before the operation. In addition, thanks to the IIEF scoring applied to the spouses of the patients, sexual dysfunction of the sexual partner, which could cause confusion, was excluded. Kilkko et al. While they found that the frequency of orgasm was significantly reduced in the 1st year after total hysterectomy compared to the pre-operative period, they did not encounter such a problem in supravaginal hysterectomy [18]. Kiremitli et al., who investigated the effect of hysterectomy types on vaginal length and sexual functions, also found that FSFI scores were significantly reduced in patients with high vaginal tissue loss [19]. Kiyak et al., who used a uterine manipulator during abdominal hysterectomy, suggested that this technique protected vaginal tissue and sexual functions [20]. In this study, although a uterine manipulator was not used during abdominal hysterectomy, the decrease in FSFI scores in the subtotal hysterectomy group, which was not accompanied by vaginal tissue loss, was significantly less than the total hysterectomy group. The decrease observed in FSFI scores in both groups shows that sexual functions are negatively affected by the operation, regardless of the protection of the cervix. However, the reason why the FSFI scores of patients who underwent total hysterectomy decreased significantly compared to the subtotal hysterectomy group may be related to the neural damage that occurs due to the loss of erogenous zones along with the cervix. However, controversial results in the literature reveal that more studies are needed on this subject. Conclusions This study shows that vaginal tissue loss has a direct negative impact on sexual functions. Regardless of the type of hysterectomy chosen, sexual functions of patients are negatively affected. However, the lower FSFI values of patients who underwent total hysterectomy may be associated with the loss of erogenous zones and neural damage identified in previous studies. For this reason, the subtotal approach should be evaluated in appropriate patients to protect them from loss of sexual function. Declarations Authorship Credits: The authors declare that are qualified for authorship and have participated sufficiently in the work to take public responsibility for appropriate portions of the content. The authors declare that; the authors made a substantial contribution to the concept or design of the work; or acquisition, analysis or interpretation of data, drafted article or revised it critically for important intellectual content, approved the version to be published and each author have participated sufficiently in the work and take public responsibility for appropriate portions of the content. Conflict of interest: The authors declare that they have no conflict of interest. Authors declare that no funding or any type of sponsorships was received. Disclosure Statement No potential conflict of interest was reported by the author(s). No financial assistance was received. References Wu JM, Wechter ME, Geller EJ, Nguyen T V., Visco AG. Hysterectomy rates in the United States, 2003. Obstetrics and Gynecology. 2007;110(5). Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990-1997. Obstetrics and Gynecology. 2002;99(2). Neis F, Reisenauer C, Kraemer B, Wagner P, Brucker S. Retrospective analysis of secondary resection of the cervical stump after subtotal hysterectomy: why and when? Arch Gynecol Obstet. 2021;304(6). Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: Systematic review and meta-analysis of randomised controlled trials. Vol. 330, British Medical Journal. 2005. Engh MAE, Jerhamre K, Junskog K. A randomized trial comparing changes in sexual health and psychological well-being after subtotal and total hysterectomies. Acta Obstet Gynecol Scand. 2010;89(1). Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after Total versus Subtotal Abdominal Hysterectomy. New England Journal of Medicine. 2002;347(17). Lethaby A, Mukhopadhyay A, Naik R. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database of Systematic Reviews. 2012; Thakar R, Manyonda I, Stanton SL, Clarkson P, Robinson G. Bladder, bowel and sexual function after hysterectomy for benign conditions. Vol. 104, BJOG: An International Journal of Obstetrics and Gynaecology. 1997. Luo J, Betschart C, Ashton-Miller JA, DeLancey JOL. Quantitative analyses of variability in normal vaginal shape and dimension on MR images. Int Urogynecol J. 2016;27(7). Ercan Ö, Özer A, Köstü B, Bakacak M, Kiran G, Avci F. Comparison of postoperative vaginal length and sexual function after abdominal, vaginal, and laparoscopic hysterectomy. International Journal of Gynecology and Obstetrics. 2016;132(1). Till SR, Schrepf A, Pierce J, Moser S, Kolarik E, Brummett C, As-Sanie S. Sexual function after hysterectomy according to surgical indication: a prospective cohort study. Sex Health. 2022 Mar;19(1):46-54. doi: 10.1071/SH21153. PMID: 35226836; PMCID: PMC9297198. Mweber A, Dwalters M, Rschover L, Mıtchınson A. Vaginal anatomy and sexual function. Obstetrics & Gynecology. 1995 Dec;86(6):946–9. Schimpf MO, Harvie HS, Omotosho TB, Epstein LB, Jean-Michel M, Olivera CK, et al. Does vaginal size impact sexual activity and function? Int Urogynecol J. 2010;21(4). De La Cruz JF, Myers EM, Geller EJ. Vaginal versus robotic hysterectomy and concomitant pelvic support surgery: A comparison of postoperative vaginal length and sexual function. J Minim Invasive Gynecol. 2014;21(6). Long CY. The effect of simple hysterectomy on lower urinary tract function. In: Hysterectomies: Prevalence, Methods and Postoperative Complications. 2015. Hasson HM. Cervical removal at hysterectomy for benign disease: Risks and benefits. Vol. 38, Journal of Reproductive Medicine for the Obstetrician and Gynecologist. 1993. Abdelmonem AM. Vaginal length and incidence of dyspareunia after total abdominal versus vaginal hysterectomy. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2010;151(2). Kilkku P, Grönroos M, Hirvonen T, Rauramo L. Supra Vaginal Uterine Amputation VS. Hysterectomy: Effects on libido and orgasm. Acta Obstet Gynecol Scand. 1983;62(2). Kiremitli S, Kiremitli T, Ulug P, Yilmaz N, Yilmaz B, Kulhan M, et al. The effect of hysterectomy types on vaginal length, vaginal shortening rate and FSFI scores. Taiwan J Obstet Gynecol. 2022;61(3). Kiyak H, Karacan T, Ozyurek ES, Turkgeldi LS, Kadirogullari P, Seckin KD. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3818818","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":272481676,"identity":"e84fbe1a-e9c7-4ca9-9739-520db879062b","order_by":0,"name":"Duygu ucar kartal","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDCCAwwGEAZ7A5AwsCBFC88BkBYJUrRIJIBJwjr4bh/eJvm1zU7efObzqxt+FEgw8Ld3J+DVInkurUxati3ZcM7tnLKbPUCHSZw5uwGvFoMzPGbSkm0HGGdI56Td4AFqMZDIJU6L/QzJM2k3/xCrRfJj24HEGRLsx24TZYvkGbZia4ZzyckzeHLYbssYSPAQ9AvfGeaNN3+U2dnOYD/+7OabPzZy/O29+LUAAYs0D5jmAUcQDyHlIMD88QeYZn9AjOpRMApGwSgYgQAAdeFHWhYOGt4AAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0003-4751-5944","institution":"Manisa State Hospital: Manisa Devlet Hastanesi","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Duygu","middleName":"ucar","lastName":"kartal","suffix":""},{"id":272481677,"identity":"bfc918cc-92ac-4184-a6bd-05b9b3367a3f","order_by":1,"name":"Ozan Dogan","email":"","orcid":"","institution":"","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ozan","middleName":"","lastName":"Dogan","suffix":""}],"badges":[],"createdAt":"2023-12-29 00:19:05","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-3818818/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3818818/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51139863,"identity":"70bd5e28-2c4c-49d8-9812-2a21ee0d47e5","added_by":"auto","created_at":"2024-02-14 19:51:44","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19516,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of Vaginal Lengths Before and After Total Hysterectomy\u003c/p\u003e","description":"","filename":"figure.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3818818/v1/7947de22a5908ff477c80190.jpg"},{"id":51590125,"identity":"4a94d72a-a83d-4ee5-a811-09413eefc917","added_by":"auto","created_at":"2024-02-24 17:38:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":290966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3818818/v1/0eef58d6-4345-4c37-9ac0-8c68c512ed67.pdf"}],"financialInterests":"","formattedTitle":"Vaginal Length Measurement and Examination of Sexual Functions in Patients Who Had Total or Subtotal Hysterectomy for Benign Reasons","fulltext":[{"header":"Brief Summary","content":"\u003cp\u003eDue to the vaginal tissue loss seen in the total hysterectomy group, the sexual functions of the patients were more negatively affected than the subtotal hysterectomy group.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eHysterectomy has been reported as the most frequently performed surgical procedure in gynecology practice after cesarean section [1,2]. According to the application methods, it can be divided into vaginal, laparoscopic or abdominal. Additionally, it can be applied total or subtotal depending on the patient's indication [3,4].\u003c/p\u003e \u003cp\u003eFear of deterioration in sexual functions after hysterectomy is a very common problem. Moreover, since the majority of hysterectomy patients are in the sexually active age, this problem is too important to be ignored. The concern that sexual, bowel or urinary functions may be impaired after hysterectomy still remains valid [5\u0026ndash;8]. Sexual dysfunction may manifest itself with symptoms such as decreased libido, pain during sexual intercourse, vaginal dryness, difficulty in reaching orgasm or inability to orgasm.\u003c/p\u003e \u003cp\u003eAlthough vaginal length varies in size and shape in women with different demographic characteristics, it varies between 7 and 9 cm on average [9]. Although there are conflicting results in the literature, shortened vaginal length after hysterectomy has been associated with sexual dysfunction [10].\u003c/p\u003e \u003cp\u003eThis study aimed to reveal vaginal tissue loss in patients who underwent total or subtotal hysterectomy and to evaluate the effect of this situation on sexual functions.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eThis retrospective study was conducted among patients who applied to the gynecology outpatient clinic between 2021 and 2023 and underwent hysterectomy or subtotal hysterectomy. The applied methods were approved by the clinical research ethics committee (Istanbul Esenyurt University-12/23). Each patient participating in the study was informed about all possible risks and complications associated with the surgery, as well as the expected benefits of the procedure technique.\u003c/p\u003e \u003cp\u003ePatients who underwent surgery for benign reasons, such as patients diagnosed with abnormal uterine bleeding, uterine leiomyoma and endometrial polyp but who did not benefit from medical treatment, were included in the study. Operated patients were divided into two probabilistically equivalent groups by random assignment. Demographic data, detailed medical history, pelvic examination, FSFI scores and vaginal ultrasound information of the patients were collected by retrospective file review. Vaginal lengths of the patients were measured before and after surgery by the same physician in the lithotomy position while the patients were awake. Using a speculum, the posterior vaginal fornix was identified with the help of the fornix, and the speculum was removed to avoid unnecessary vaginal tension. The distance between the vaginal posterior fornix and the hymen was measured with forceps and noted in centimeters.\u003c/p\u003e \u003cp\u003eA uterine manipulator was not used during total abdominal hysterectomy, and the cervix of all patients was closed with a continuous lock. During laparoscopy, a uterine manipulator was used and the cervix was closed with a continuous lock in the same way. The patients included in the study were called for control at the 24th month after the operation and FSFI scoring was applied to determine the sexual functions of the patients. At the same time, the IIEF questionnaire was applied to the spouses of the patients to determine their sexual function status. Patients who were operated on for reasons other than the benign reasons mentioned, who were lost follow-up, who changed partners within two years or had more than one partner, or who had missing important preoperative data were excluded from the study. Patients who underwent simultaneous oophorectomy during surgery, postmenopausal patients, and patients with pelvic pain or endometriosis were also excluded from the study on the grounds that sexual functions may be affected. A Samsung Hera W9 Obstetrics/GYN Brand ultrasound device was used during the examination. All ultrasounds and surgeries were performed by the same, experienced physician with the same technique. The questionnaires were filled out manually by the same physician, who took the patients and their partners into a private room and gave them sufficient time to think.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eParametric methods were used for measurement values suitable for normal distribution. In accordance with parametric methods, \"Independent Sample-t\" test (t-table value) is used to compare the measurement values of two independent groups; \u0026ldquo;Paired Sample-t\u0026rdquo; test (t-table value) method was used to compare two dependent groups. For measurement values that do not comply with normal distribution, \"Mann-Whitney U\" test (Z-table value) is used to compare the measurement values of two independent groups in accordance with non-parametric methods; \u0026ldquo;Wilcoxon\u0026rdquo; test (Z-table value) method was used to compare two dependent groups.\u003c/p\u003e \u003cp\u003ePower analysis was based on the statistics obtained from the previously conducted study on this subject using the G Power 3.1 program [11]. \"Evaluation of Sexual Functions and Vaginal Lengths\" was conducted in two groups under conditions where the effect level was 0.76, the error level (a) was 0.05 and the power of the test (1-B) was 0.80. The minimum sample size required for a significant difference in terms of data was obtained by the Mann-Whitney U analysis method as 48. This method is used to compare measurements of two groups and is an alternative method to the independent groups t test method. When the number of data is not normally distributed and the number of data in two groups is low or if the measurements are of the ordinal scale type, this alternative method is used.\u003c/p\u003e \u003cp\u003eStatistical analyzes were performed using the package program SPSS (IBM SPSS Statistics 27). Frequency tables and descriptive statistics were used to interpret the findings. A value of p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered sufficient for statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 85 patients were included in the study. 42 of these patients underwent total (abdominal: 20; laparoscopic: 22) and 43 underwent subtotal hysterectomy. Of the patients who underwent total hysterectomy, 38% (n:16) had uteri myoma, 38% (n:16) had abnormal uterine bleeding resistant to treatment, and 23% (n:10) had endometrial polyps. In the subtotal hysterectomy group, there were 72% (n:31) patients diagnosed with myoma uteri, 20% (n:9) with abnormal uterine bleeding resistant to treatment, and 0.6% (n:3) with endometrial polyps. Demographic data of the patients according to groups are shown in Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\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\n \u003cp\u003eDemographic Data of Groups Undergoing Total and Subtotal Hysterectomy\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTotal Hysterectomy (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSubtotal Hysterectomy (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eStatistical analysis *\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\mathbf{X}}\\pm \\mathbf{S}.\\mathbf{S}.\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e[IQR]\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\mathbf{X}}\\pm \\mathbf{S}.\\mathbf{S}.\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e[IQR]\u003c/strong\u003e\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\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44,1\u0026thinsp;\u0026plusmn;\u0026thinsp;2,80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44,0\u003c/p\u003e\n \u003cp\u003e[3,2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41,7\u0026thinsp;\u0026plusmn;\u0026thinsp;2,39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41,0\u003c/p\u003e\n \u003cp\u003e[4,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;4,244\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0,0001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,47\u0026thinsp;\u0026plusmn;\u0026thinsp;1,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,0\u003c/p\u003e\n \u003cp\u003e[2,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,41\u0026thinsp;\u0026plusmn;\u0026thinsp;1,34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3,0\u003c/p\u003e\n \u003cp\u003e[1,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ=-0,423\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,7771\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eParite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,28\u0026thinsp;\u0026plusmn;\u0026thinsp;1,04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,0\u003c/p\u003e\n \u003cp\u003e[1,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,3\u0026thinsp;\u0026plusmn;\u0026thinsp;1,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,0\u003c/p\u003e\n \u003cp\u003e[1,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eZ=-0,715\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,8549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBKİ (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25,72\u0026thinsp;\u0026plusmn;\u0026thinsp;2,37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25,5\u003c/p\u003e\n \u003cp\u003e[3,2]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25,63\u0026thinsp;\u0026plusmn;\u0026thinsp;2,76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26,0\u003c/p\u003e\n \u003cp\u003e[5,0]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;0,1685\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0,8666\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e* \u0026ldquo;Independent Sample-t\u0026rdquo; test (t-table value) statistics were used to compare the measurement values of two independent groups in data with normal distribution. \u0026ldquo;Mann-Whitney U\u0026rdquo; test (Z-table value) statistics were used to compare the measurement values of two independent groups in data that did not have a normal distribution.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eWhile there was no statistically significant difference in terms of gravida, parity and BMI (kg/m2) values according to the groups (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05); a statistically significant difference was detected in terms of age (years) (t\u0026thinsp;=\u0026thinsp;4.244; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). It was determined that the age (years) values of those in group 2 were significantly lower than those in group 1.\u003c/p\u003e\n\u003cp\u003eWhen the vaginal lengths measured before and after the operation are compared, no significant change is observed in the subtotal hysterectomy group (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05); in the total hysterectomy group, a significant shortening was detected after the operation compared to the pre-operative period (t\u0026thinsp;=\u0026thinsp;25.54, p: \u0026lt;0.0001). In patients with subtotal hysterectomy, no statistically significant difference was observed when comparing the preoperative cervical length (mean\u0026thinsp;=\u0026thinsp;38.19mm) and the postoperative cervical length (mean\u0026thinsp;=\u0026thinsp;38.12mm) (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The distribution of cervical lengths in the total hysterectomy group before and after the operation is shown in Fig.\u0026nbsp;1.\u003c/p\u003e\n\u003cp\u003eWhen FSFI scoring was applied to the patients in the 2nd year after surgery, a statistically significant decrease was detected in the preoperative - postoperative desire, aurosal, lubrication, orgasmic function, satisfaction and pain scores of the total hysterectomy group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Total FSFI scores also showed a significant decrease compared to the preoperative period (t\u0026thinsp;=\u0026thinsp;46.55, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\n\u003cp\u003eLikewise, a statistically significant decrease was detected in the preoperative and postoperative aurosal, lubrication, orgasmic function and satisfaction scores in the subtotal hysterectomy group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Subtotal FSFI scores decreased significantly compared to before surgery (t\u0026thinsp;=\u0026thinsp;10.61, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Desire and pain scores showed less decrease after the operation than before (desire: t\u0026thinsp;=\u0026thinsp;2.235, p\u0026thinsp;=\u0026thinsp;0.0308; pain: t\u0026thinsp;=\u0026thinsp;3.104, p\u0026thinsp;=\u0026thinsp;0.0034). Comparison of pre- and post-operative FSFI scores of the groups is shown in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003c/p\u003e\u0026nbsp;\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\u003eComparison of Preoperative and Postoperative FSFI Scores of Total and Subtotal Hysterectomy Groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eTotal Hysterectomy (n\u0026thinsp;=\u0026thinsp;42)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eStatistical analysis *\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSubtotal Hysterectomy (n\u0026thinsp;=\u0026thinsp;43)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eStatistical analysis *\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ePre-Op\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ePost-Op\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ePre-Op\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ePost-Op\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\mathbf{X}}\\pm \\mathbf{S}.\\mathbf{S}.\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\mathbf{X}}\\pm \\mathbf{S}.\\mathbf{S}.\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\mathbf{X}}\\pm \\mathbf{S}.\\mathbf{S}.\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\stackrel{-}{\\mathbf{X}}\\pm \\mathbf{S}.\\mathbf{S}.\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\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\u003e\u003cstrong\u003eDesire\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eArousal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLub.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOrgas. Func.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSatis.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,8}\\pm \\text{0,7}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,3}\\pm\\)\u003c/span\u003e\u003c/span\u003e 0,6\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{5,2}\\pm\\)\u003c/span\u003e\u003c/span\u003e0,6\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,5}\\pm \\text{0,5}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,5}\\pm \\text{0,8}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{5,7}\\pm \\text{0,4}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{29,3}\\pm \\text{2,9}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3,6\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm \\text{0,7}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{3,0}\\pm\\)\u003c/span\u003e\u003c/span\u003e 0,6\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,0}\\pm\\)\u003c/span\u003e\u003c/span\u003e0,5\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{3,0}\\pm\\)\u003c/span\u003e\u003c/span\u003e0,4\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{3,3}\\pm \\text{0,7}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{2,8}\\pm \\text{0,4}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{20,3}\\pm \\text{2,2}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;20.32\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;20.26\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;19.54\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;20.81\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;11.98\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;37.62\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;46.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{5,0}\\pm \\text{0,7}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,6}\\pm\\)\u003c/span\u003e\u003c/span\u003e 0,6\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{5,4}\\pm\\)\u003c/span\u003e\u003c/span\u003e0,6\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,8}\\pm \\text{0,5}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{5,0}\\pm \\text{0,8}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{5,7}\\pm \\text{0,4}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{30,7}\\pm \\text{2,8}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,9}\\pm \\text{0,7}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,4}\\pm\\)\u003c/span\u003e\u003c/span\u003e 0,6\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{5,1}\\pm\\)\u003c/span\u003e\u003c/span\u003e0,6\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,5}\\pm \\text{0,6}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{4,6}\\pm \\text{0,8}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{5,5}\\pm \\text{0,5}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\text{29,3}\\pm \\text{2,8}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0308\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;2.235\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;5.620\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;5.512\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;5.240\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;5.419\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;=\u0026thinsp;0.0034\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;3.104\u003c/p\u003e\n \u003cp\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\n \u003cp\u003et\u0026thinsp;=\u0026thinsp;10.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003eLub:Lubrication; Orgas:Orgasmic; Func:Function; Satis:Satisfaction;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003e* \u0026quot;Independent Sample-t\u0026quot; test (t-table value) when comparing the measurement values of two independent groups in normally distributed data; \u0026ldquo;Paired Sample-t\u0026rdquo; test (t-table value) statistics were used to compare two dependent groups.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eWhen compared before and after the operation, the decrease in FSFI scores in the total hysterectomy group was significantly greater than in the subtotal hysterectomy group.\u003c/p\u003e\n\u003cp\u003eIn the IIEF scale applied to the spouses of the total hysterectomy group, no statistical difference was observed between pre- and post-operative erection function and orgasmic function (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). A significant decrease was noted in sexual satisfaction scores after the operation (mean\u0026thinsp;=\u0026thinsp;8.7) compared to before (mean\u0026thinsp;=\u0026thinsp;11.2) (t\u0026thinsp;=\u0026thinsp;11.80, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). A significant decrease was noted in sexual desire scores after the operation (mean\u0026thinsp;=\u0026thinsp;8.1) compared to before (mean\u0026thinsp;=\u0026thinsp;9.2) (t\u0026thinsp;=\u0026thinsp;8.979, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). A significant decrease was detected in general satisfaction scores after the operation (mean\u0026thinsp;=\u0026thinsp;6.6) compared to before the operation (mean\u0026thinsp;=\u0026thinsp;8.5) (t\u0026thinsp;=\u0026thinsp;9.299, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001).\u003c/p\u003e\n\u003cp\u003eIn the IIEF scale applied to the spouses of the subtotal hysterectomy group, no statistical difference was observed in terms of erectile function and orgasmic function before and after the operation (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). A significant decrease was noted in sexual satisfaction scores after the operation (mean\u0026thinsp;=\u0026thinsp;10.9) compared to before (mean\u0026thinsp;=\u0026thinsp;11.4) (t\u0026thinsp;=\u0026thinsp;3.975, p\u0026thinsp;=\u0026thinsp;0.0003). A significant decrease was noted in sexual desire scores after the operation (mean\u0026thinsp;=\u0026thinsp;9.1) compared to before (mean\u0026thinsp;=\u0026thinsp;9.3) (t\u0026thinsp;=\u0026thinsp;2.468, p\u0026thinsp;=\u0026thinsp;0.0178). A significant decrease was detected in general satisfaction scores after the operation (mean\u0026thinsp;=\u0026thinsp;8.6) compared to before the operation (mean\u0026thinsp;=\u0026thinsp;8.8) (t\u0026thinsp;=\u0026thinsp;2.351, p\u0026thinsp;=\u0026thinsp;0.0235).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe impact of vaginal tissue loss on sexual functions remains unclear. Previous studies have not found a direct connection between vaginal length and sexual function [12,13]. Although Cruz et al. found that the vaginal length was shorter in vaginal hysterectomy compared to robotic hysterectomy, they could not show a significant difference in terms of sexual function [14]. However, disruption of the autonomic and somatic neuronal network of the upper vagina may cause decreased lubrication, negatively affecting orgasm. In addition to vaginal tissue loss and nerve damage, scar formation secondary to the operation is also one of the postoperative problems. Parys et al. suggested that the closely related plexus may be damaged when the cervix is removed [15]. Similarly, Hasson et al. emphasized that the cervix may be associated with sexual arousal and orgasm through the uterovaginal nerves via the Frankenhauser plexus, and therefore the cervix should be protected in appropriate cases to avoid nerve damage [16]. Another study comparing vaginal hysterectomy with abdominal hysterectomy associated the dyspareunia seen after vaginal hysterectomy with vaginal shortening [17]. In this study, increased vaginal tissue loss was detected in the patient group that underwent total hysteretomy compared to the subtotal hysterectomy group. This tissue loss, when evaluated together with the significant decrease in FSFI scores observed in the total hysterectomy group compared to the subtotal hysterectomy group, may be related to the loss of erogenous zones in the vagina and nerve damage previously suggested in the literature.\u003c/p\u003e\n\u003cp\u003eConflicting results in studies investigating sexual functions after hysterectomy increase the need to elucidate the relationship between vaginal anatomy and sexual function. Radosa et al. suggested that regardless of the surgical technique used, hytrectomy has a positive effect on sexual functions because it eliminates the organic cause that negatively affects sexual functions [21]. Likewise, Dedden et al. found a significant increase in the FSFI scores of patients after hysterectomy [22]. Flory et al., however, could not detect a significant difference between subtotal hysterectomy and total hysterectomy in terms of sexual function[23]. In these studies, patient groups that could seriously negatively affect sexual function, such as endometriosis and chronic pelvic pain, were included in the study, and the sexual dysfunctions of the patients were determined by pre-operative FSFI scores. Elimination of the negative effects of these diseases on sexual function through hysterectomy; It may have positively affected sexual functions despite the loss of vaginal tissue. In this study, the existing diseases of the patients did not have a significant negative effect on sexual functions, and no sexual dysfunction was observed in any patient before the operation. In addition, thanks to the IIEF scoring applied to the spouses of the patients, sexual dysfunction of the sexual partner, which could cause confusion, was excluded.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eKilkko et al. While they found that the frequency of orgasm was significantly reduced in the 1st year after total hysterectomy compared to the pre-operative period, they did not encounter such a problem in supravaginal hysterectomy [18]. Kiremitli et al., who investigated the effect of hysterectomy types on vaginal length and sexual functions, also found that FSFI scores were significantly reduced in patients with high vaginal tissue loss [19]. Kiyak et al., who used a uterine manipulator during abdominal hysterectomy, suggested that this technique protected vaginal tissue and sexual functions [20]. In this study, although a uterine manipulator was not used during abdominal hysterectomy, the decrease in FSFI scores in the subtotal hysterectomy group, which was not accompanied by vaginal tissue loss, was significantly less than the total hysterectomy group.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe decrease observed in FSFI scores in both groups shows that sexual functions are negatively affected by the operation, regardless of the protection of the cervix. However, the reason why the FSFI scores of patients who underwent total hysterectomy decreased significantly compared to the subtotal hysterectomy group may be related to the neural damage that occurs due to the loss of erogenous zones along with the cervix. However, controversial results in the literature reveal that more studies are needed on this subject.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study shows that vaginal tissue loss has a direct negative impact on sexual functions. Regardless of the type of hysterectomy chosen, sexual functions of patients are negatively affected. However, the lower FSFI values of patients who underwent total hysterectomy may be associated with the loss of erogenous zones and neural damage identified in previous studies. For this reason, the subtotal approach should be evaluated in appropriate patients to protect them from loss of sexual function.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthorship Credits: \u0026nbsp;\u003c/strong\u003eThe authors declare that are qualified for authorship and have participated sufficiently in the work to take public responsibility for appropriate portions of the content. The authors declare that; the authors made a substantial contribution to the concept or design of the work; or acquisition, analysis or interpretation of data, drafted article or revised it critically for important intellectual content, approved the version to be published and each author have participated sufficiently in the work and take public responsibility for appropriate portions of the content.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflict of interest. Authors declare that no funding or any type of sponsorships was received.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure Statement\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo potential conflict of interest was reported by the author(s). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNo financial assistance was received.\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWu JM, Wechter ME, Geller EJ, Nguyen T V., Visco AG. Hysterectomy rates in the United States, 2003. Obstetrics and Gynecology. 2007;110(5). \u003c/li\u003e\n\u003cli\u003eFarquhar CM, Steiner CA. Hysterectomy rates in the United States 1990-1997. Obstetrics and Gynecology. 2002;99(2). \u003c/li\u003e\n\u003cli\u003eNeis F, Reisenauer C, Kraemer B, Wagner P, Brucker S. Retrospective analysis of secondary resection of the cervical stump after subtotal hysterectomy: why and when? Arch Gynecol Obstet. 2021;304(6). \u003c/li\u003e\n\u003cli\u003eJohnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methods of hysterectomy: Systematic review and meta-analysis of randomised controlled trials. Vol. 330, British Medical Journal. 2005. \u003c/li\u003e\n\u003cli\u003eEngh MAE, Jerhamre K, Junskog K. A randomized trial comparing changes in sexual health and psychological well-being after subtotal and total hysterectomies. Acta Obstet Gynecol Scand. 2010;89(1). \u003c/li\u003e\n\u003cli\u003eThakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after Total versus Subtotal Abdominal Hysterectomy. New England Journal of Medicine. 2002;347(17). \u003c/li\u003e\n\u003cli\u003eLethaby A, Mukhopadhyay A, Naik R. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database of Systematic Reviews. 2012; \u003c/li\u003e\n\u003cli\u003eThakar R, Manyonda I, Stanton SL, Clarkson P, Robinson G. Bladder, bowel and sexual function after hysterectomy for benign conditions. Vol. 104, BJOG: An International Journal of Obstetrics and Gynaecology. 1997. \u003c/li\u003e\n\u003cli\u003eLuo J, Betschart C, Ashton-Miller JA, DeLancey JOL. Quantitative analyses of variability in normal vaginal shape and dimension on MR images. Int Urogynecol J. 2016;27(7). \u003c/li\u003e\n\u003cli\u003eErcan \u0026Ouml;, \u0026Ouml;zer A, K\u0026ouml;st\u0026uuml; B, Bakacak M, Kiran G, Avci F. Comparison of postoperative vaginal length and sexual function after abdominal, vaginal, and laparoscopic hysterectomy. International Journal of Gynecology and Obstetrics. 2016;132(1). \u003c/li\u003e\n\u003cli\u003eTill SR, Schrepf A, Pierce J, Moser S, Kolarik E, Brummett C, As-Sanie S. Sexual function after hysterectomy according to surgical indication: a prospective cohort study. Sex Health. 2022 Mar;19(1):46-54. doi: 10.1071/SH21153. PMID: 35226836; PMCID: PMC9297198.\u003c/li\u003e\n\u003cli\u003eMweber A, Dwalters M, Rschover L, Mıtchınson A. Vaginal anatomy and sexual function. Obstetrics \u0026amp; Gynecology. 1995 Dec;86(6):946\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eSchimpf MO, Harvie HS, Omotosho TB, Epstein LB, Jean-Michel M, Olivera CK, et al. Does vaginal size impact sexual activity and function? Int Urogynecol J. 2010;21(4). \u003c/li\u003e\n\u003cli\u003eDe La Cruz JF, Myers EM, Geller EJ. Vaginal versus robotic hysterectomy and concomitant pelvic support surgery: A comparison of postoperative vaginal length and sexual function. J Minim Invasive Gynecol. 2014;21(6). \u003c/li\u003e\n\u003cli\u003eLong CY. The effect of simple hysterectomy on lower urinary tract function. In: Hysterectomies: Prevalence, Methods and Postoperative Complications. 2015. \u003c/li\u003e\n\u003cli\u003eHasson HM. Cervical removal at hysterectomy for benign disease: Risks and benefits. 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Journal of Investigative Surgery. 2021;34(10). \u003c/li\u003e\n\u003cli\u003eRadosa JC, Meyberg-Solomayer G, Kastl C, Radosa CG, Mavrova R, Gr\u0026auml;ber S, et al. Influences of Different Hysterectomy Techniques on Patients\u0026rsquo; Postoperative Sexual Function and Quality of Life. Journal of Sexual Medicine. 2014;11(9). \u003c/li\u003e\n\u003cli\u003eDedden SJ, van Ditshuizen MAE, Theunissen M, Maas JWM. Hysterectomy and sexual (dys)function: An analysis of sexual dysfunction after hysterectomy and a search for predictive factors. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2020;247. \u003c/li\u003e\n\u003cli\u003eFlory N, Bissonnette F, Amsel RT, Binik YM. The psychosocial outcomes of total and subtotal hysterectomy: A randomized controlled trial. Journal of Sexual Medicine. 2006;3(3). \u003c/li\u003e\n\u003c/ol\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":true,"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":"Sexual Function, subtotal hysterectomy, Vaginal lengths, hysterectomy, FSFI, IIEF","lastPublishedDoi":"10.21203/rs.3.rs-3818818/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3818818/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e It was aimed to evaluate the vaginal length in patients who underwent total or subtotal hysterectomy and to reveal its effects on the sexual functions of the patients depending on the choice of surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterials and Methods:\u003c/strong\u003e 85 patients who were decided to undergo hysterectomy for benign reasons were included in the study. Vaginal lengths of all patients and cervical lengths of patients who underwent subtotal hysterectomy were recorded before and after the operation. In addition, the Female Sexual Function Index (FSFI) questionnaire was administered to the patients before and 24 months after the operation, and the International Index of Erectile Function (IIEF) questionnaire was administered to their spouses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e While there was no significant change in the vaginal length of women who underwent subtotal hysterectomy after the operation (p\u0026gt;0.05), a significant shortening was detected in the total hysterectomy group (p:\u0026lt;0.0001). There was a decrease in the total FSFI scores of the patients after the operation in both groups (p\u0026lt;0.0001). However, the decrease in FSFI scores in the subtotal hysterectomy group was significantly less than that in the total hysterectomy group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The decreasing FSFI scores of the patients after the operation show that both operations have negative effects on sexual functions. However, due to the vaginal tissue loss seen in the total hysterectomy group, the sexual functions of the patients were more negatively affected than the subtotal hysterectomy group.\u003c/p\u003e","manuscriptTitle":"Vaginal Length Measurement and Examination of Sexual Functions in Patients Who Had Total or Subtotal Hysterectomy for Benign Reasons","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-14 19:51:40","doi":"10.21203/rs.3.rs-3818818/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":"79cc9f51-c8ff-498c-a70a-46f96a3d67e5","owner":[],"postedDate":"February 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-02-24T17:30:22+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-14 19:51:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3818818","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3818818","identity":"rs-3818818","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}