Sexual Function After Hysterectomy

Roovers JWR, Van der Bom JG, Van der Vaart CH et al: Hysterectomy and sexual well being: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. Br Med J 2003;327:774-778.

Hysterectomy disrupts the local nerve supply and anatomical relations of the pelvic organs. Various procedures may damage the innervation and pelvic floor differently. The authors interviewed 413 women at 13 sites in the Netherlands before they underwent hysterectomy for benign disease other than symptomatic prolapse of the uterus and endometriosis. Responses about sexual pleasure, sexual activity, and problems before surgery and after 6 months were compared in 310 women who were sexually active before and after surgery.

The mean general satisfaction score before surgery was 7.0 improving to 7.4 after surgery, with no difference between procedures. In 56% of the women, at least one sexual problem before surgery was reported, and these problems persisted after surgery in over half of the women, with no difference between procedures. New problems developed in 19% to 24% of patients after hysterectomy, with no difference between procedures. The prevalence of one or more bothersome sexual problems 6 months after surgery was 43% (38/89) after vaginal hysterectomy, 41% (31/76) after subtotal abdominal hysterectomy, and 39% (57/145) after total abdominal hysterectomy (X2 test, p=0.88). The data showed a trend toward more problems with lubrication, arousal, and altered sensation in the genitals after subtotal or total abdominal hysterectomy compared to vaginal hysterectomy, but it did not reach statistical significance. Although sexual problems were common in these women, overall sexual pleasure was reported to improve after hysterectomy independent of the type of procedure. The findings need to be confirmed in a larger study.