Effect of Hysterectomy due to Benign Diseases on Female Sexual Function: A Systematic Review and Meta-analysis

Kazemi, Farideh; Alimoradi, Zainab; Tavakolian, Samira

doi:10.1016/j.jmig.2021.10.012

Cited by 8 publications

(4 citation statements)

References 32 publications

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“…Similarly, concomitant hysterectomy was not associated with sexual dysfunction in studies of BRCA pathogenic variant carriers undergoing risk-reducing BSO [ 111 , 112 ]. In our review, hysterectomy (without BSO) was not associated with high rates of de novo impaired sexual function or satisfaction, a finding supported by a recent systematic review and meta-analysis [ 113 ]. For women having RRH with BSO, adequate pre-operative counselling about any potential impact on sexual function and HRT options is associated with improved satisfaction and reduced sexual problems [ 114 ].…”

Section: Discussionsupporting

confidence: 83%

Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review

Oxley

Xiong

Xia

et al. 2022

Cancers

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Background: Risk-reducing hysterectomy (RRH) is the gold-standard prevention for endometrial cancer (EC). Knowledge of the impact on quality-of-life (QoL) is crucial for decision-making. This systematic review aims to summarise the evidence. Methods: We searched major databases until July 2022 (CRD42022347631). Given the paucity of data on RRH, we also included hysterectomy as treatment for benign disease. We used validated quality-assessment tools, and performed qualitative synthesis of QoL outcomes. Results: Four studies (64 patients) reported on RRH, 25 studies (1268 patients) on hysterectomy as treatment for uterine bleeding. There was moderate risk-of-bias in many studies. Following RRH, three qualitative studies found substantially lowered cancer-worry, with no decision-regret. Oophorectomy (for ovarian cancer prevention) severely impaired menopause-specific QoL and sexual-function, particularly without hormone-replacement. Quantitative studies supported these results, finding low distress and generally high satisfaction. Hysterectomy as treatment of bleeding improved QoL, resulted in high satisfaction, and no change or improvements in sexual and urinary function, although small numbers reported worsening. Conclusions: There is very limited evidence on QoL after RRH. Whilst there are benefits, most adverse consequences arise from oophorectomy. Benign hysterectomy allows for some limited comparison; however, more research is needed for outcomes in the population of women at increased EC-risk.

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Section: Discussionsupporting

confidence: 83%

Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review

Oxley

Xiong

Xia

et al. 2022

Cancers

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“…In a recent meta‐analysis of sexual function after hysterectomy on benign indication, an improvement was seen in the meta‐regression analysis after 3–12 months, but the authors conclude that these results are unstable, and requires more studies 28 . Our first results from this cohort also showed an improvement in FSFI‐scores after 6 months which might be due to the removal of a bulky uterus and cessation of bleeding discomforts 11 .…”

Section: Discussionmentioning

confidence: 67%

Pelvic floor and sexual function 3 years after hysterectomy – A prospective cohort study

Johannesson,

Amato,

Forsgren

2023

Acta Obstet Gynecol Scand

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IntroductionLong term effects after hysterectomy, such as a worsening of pelvic floor and sexual function, have been studied with diverse results. Therefore, we investigated the long‐term effects of hysterectomy for benign indication on pelvic floor and sexual function as well as differences in outcome depending on mode of hysterectomy.Material and methodsIn a prospective clinical cohort study, we included 260 women scheduled for hysterectomy who answered validated questionnaires; pelvic floor impact questionnaire (PFIQ‐7), pelvic floor distress inventory (PFDI‐20) and female sexual function index (FSFI). Participants were followed up to 3 years after surgery. Nonparametric statistics and mixed effect models were used in analyses of the data.ResultsAfter exclusions, 242 women remained in the study, with a response rate at the 3‐year follow‐up of 154/242 (63.6%) for all questionnaires. There was an improvement of pelvic floor function with a mean score of PFIQ‐7 at baseline of 42.5 (SD 51.7) and at 3 years 22.7 (SD 49.4), (p < 0.001) and mean score of PFDI‐20 at baseline was 69.6 (SD 51.1) and at 3 years 56.2 (SD 54.6), (p = 0.001). A deterioration of sexual function was seen among the sexually active women after 3 years with a mean score of FSFI at baseline 25.2 (SD 6.6) and after 3 years 21.6 (SD 10.1), (p < 0.001). However, this was not consistent with the unaltered sexual function for the whole cohort. No difference in pelvic floor or sexual function was detected when comparing robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy.ConclusionsThree years after surgery robotic assisted laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent. Among the sexually active women, a decline of sexual function was seen after 3 years, not consistent with the entire cohort and independent of surgical methods. Whether this is a trend associated with aging or menopausal transition remains to be studied.

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“…The impact of hysterectomy itself on sexual function remains unclear [3 ]. In addition, many studies are limited by short term follow up of 1-2 years.…”

Section: Lack Of Conclusive Evidencementioning

confidence: 99%

Beyond the cuff: a consideration of factors that affect sexual function after benign hysterectomy

Cohen,

Young,

Lin

et al. 2024

Current Opinion in Obstetrics &Amp; Gynecology

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Purpose of review Hysterectomy is the most common gynecologic surgical procedure performed on women in the United States. While there are data supporting that hysterectomy for benign indication often does not reduce sexual function and may in fact improve sexual function as fibroids and endometriosis are resected, it remains unclear if there are factors within the perioperative period that affect sexual function in the years following surgery. To date, there is no consensus on what factors can optimize patients’ sexual function after hysterectomy. Recent findings We present the current literature that assesses factors which may contribute to sexual function after hysterectomy. Preoperative demographic factors, including increasing age, pelvic pain, and preoperative sexual dysfunction, play a large role in postoperative sexual function. Perioperatively, there is a growing amount of data suggesting that premenopausal salpingo-oophorectomy at the time of hysterectomy may increase the risk of sexual dysfunction after hysterectomy, and no conclusive evidence that subtotal hysterectomy improves sexual function. The route of hysterectomy and technique of cuff closure can impact sexual function after hysterectomy due to the risk of shortening the vaginal length. Summary There is a lack of high-quality evidence that can provide a consensus on factors to optimize sexual function after hysterectomy. A growing area of research in the excision of endometriosis procedures is the consideration of nerve-sparing surgery. Considering the many variables that exist when counseling a patient on benign hysterectomy and its effects on sexual function, it is critical to understand the current research that exists with regards to these factors.

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Effect of Hysterectomy due to Benign Diseases on Female Sexual Function: A Systematic Review and Meta-analysis

Cited by 8 publications

References 32 publications

Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review

Quality of Life after Risk-Reducing Hysterectomy for Endometrial Cancer Prevention: A Systematic Review

Pelvic floor and sexual function 3 years after hysterectomy – A prospective cohort study

Beyond the cuff: a consideration of factors that affect sexual function after benign hysterectomy

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