OBJECTIVE: The effect of the different types of vaginal cuff closures on post-hysterectomy sexual function has not been investigated in depth. We evaluated if there is a difference between transvaginal vs. a laparoscopic closure after total laparoscopic hysterectomy (TLH) on female sexual function, using a validated questionnaire. DESIGN: Secondary analysis of a prospective randomized controlled trial. SETTING: Three academic research center. PATIENT(S): Women consenting telephone interviews on their sexual life before and after undergoing TLH were included. INTERVENTION(S): Patients were randomly assigned to laparoscopic or transvaginal approach for vaginal cuff closure at the end of TLH for benign indications. MAIN OUTCOME MEASURE(S): A validated questionnaire (the female sexual function index - FSFI), was used to explore sexuality before and after the operation. RESULTS: Of the 1408 patients enrolled in the primary study, a total of 400 patients were asked to complete the questionnaire. Of them, 182 (41.4%) were eligible and accepted enrollment in the present analysis. No difference was found in terms of pre- and post-operative FSFI scores between groups. Patients with a low pre-operative FSFI (<26.55) had a significantly higher likelihood of having a post-operative sexual disorder (p <0.001). Women who received bilateral adnexectomy before menopause and those with post-operative vaginal cuff hematoma had a significantly lower postoperative FSFI (p= 0.001 and p=0.04, respectively). After multivariable analysis, both variables maintained at least a tendency towards an association with a lower post-operative FSFI (OR:2.696; 95%CI: 1.010-7.194; p=0.048 and p=0.053, OR:13.2, 95%CI 0.966-180.5). CONCLUSIONS: Transvaginal and laparoscopic cuff closure after TLH have similar sexual post-operative outcomes. A patient with sexual problems before TLH is more likely to have a low FSFI post-operatively. Pre-menopausal patients undergoing bilateral ovariectomy and those with post-operative vaginal cuff hematoma have a worse post-operative sexual life.
SEXUAL FUNCTION AFTER LAPAROSCOPIC VS. TRANSVAGINAL CLOSURE OF THE VAGINAL VAULT AFTER LAPAROSCOPIC HYSTERECTOMY: A SECONDARY ANALYSIS OF A RANDOMIZED TRIAL BY THE ITALIAN SOCIETY OF GYNECOLOGICAL ENDOSCOPY, USING A VALIDATED QUESTIONNAIRE
Guido M;
2019-01-01
Abstract
OBJECTIVE: The effect of the different types of vaginal cuff closures on post-hysterectomy sexual function has not been investigated in depth. We evaluated if there is a difference between transvaginal vs. a laparoscopic closure after total laparoscopic hysterectomy (TLH) on female sexual function, using a validated questionnaire. DESIGN: Secondary analysis of a prospective randomized controlled trial. SETTING: Three academic research center. PATIENT(S): Women consenting telephone interviews on their sexual life before and after undergoing TLH were included. INTERVENTION(S): Patients were randomly assigned to laparoscopic or transvaginal approach for vaginal cuff closure at the end of TLH for benign indications. MAIN OUTCOME MEASURE(S): A validated questionnaire (the female sexual function index - FSFI), was used to explore sexuality before and after the operation. RESULTS: Of the 1408 patients enrolled in the primary study, a total of 400 patients were asked to complete the questionnaire. Of them, 182 (41.4%) were eligible and accepted enrollment in the present analysis. No difference was found in terms of pre- and post-operative FSFI scores between groups. Patients with a low pre-operative FSFI (<26.55) had a significantly higher likelihood of having a post-operative sexual disorder (p <0.001). Women who received bilateral adnexectomy before menopause and those with post-operative vaginal cuff hematoma had a significantly lower postoperative FSFI (p= 0.001 and p=0.04, respectively). After multivariable analysis, both variables maintained at least a tendency towards an association with a lower post-operative FSFI (OR:2.696; 95%CI: 1.010-7.194; p=0.048 and p=0.053, OR:13.2, 95%CI 0.966-180.5). CONCLUSIONS: Transvaginal and laparoscopic cuff closure after TLH have similar sexual post-operative outcomes. A patient with sexual problems before TLH is more likely to have a low FSFI post-operatively. Pre-menopausal patients undergoing bilateral ovariectomy and those with post-operative vaginal cuff hematoma have a worse post-operative sexual life.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
