Sexual function after hysterectomy according to surgical indication: a prospective cohort study

BACKGROUND: Given that patients undergo hysterectomy with the goal of improving different symptoms and concerns, it is important to consider whether sexual function differs prior to and following hysterectomy depending on preoperative surgical indications. Our aims were to describe characteristics of sexual function prior to and six months following benign hysterectomy in patients with three common surgical indications, and to identify preoperative factors that influence the magnitude and direction of change in sexual function after the procedure. METHODS: This prospective observational cohort study enrolled women (n=80) undergoing hysterectomy for benign indications at an academic tertiary care center between December 2015 to July 2017. Patients were categorised into three groups according to surgical indication: 1) pelvic pain (PP), 2) abnormal uterine bleeding (AUB), and 3) pelvic organ prolapse (POP). Primary outcome was Female Sexual Function Index (FSFI), which patients completed preoperatively and six months postoperatively. RESULTS: The study included 80 patients, of whom 25.0% (n=20) had surgical indication of PP, 46.3% (n=37) of AUB, and 28.7% (n=23) of POP. PP patients experienced a significant improvement in overall sexual function, as well as orgasm and pain domains following hysterectomy. Significant improvements were not found in AUB and POP patients. In multivariate analysis, lower baseline sexual function (p