Sexual Function following Laparoscopic versus Transvaginal Closure of the Vaginal Vault after Laparoscopic Hysterectomy: Secondary Analysis of a Randomized Trial by the Italian Society of Gynecological Endoscopy Using a Validated Questionnaire

Stefano Uccella, Vito Andrea Capozzi, Matteo Ricco’, Emanuele Perrone, Margherita Zanello, Stefania Ferrari, Pier Carlo Zorzato, Renato Seracchioli, Antonella Cromi, Maurizio Serati, Raffaella Ergasti, Francesco Fanfani, Roberto Berretta, Mario Malzoni, Stefano Cianci, Enrico Vizza, Maurizio Guido, Francesco Legge, Giuseppe Ciravolo, Salvatore Gueli AllettiFabio Ghezzi, Massimo Candiani, Giovanni Scambia

Research output: Contribution to journalArticle

Abstract

Study Objective: The effect of the different types of vaginal cuff closures on posthysterectomy sexual function has not been investigated in depth. We evaluated if there is a difference between transvaginal versus 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 centers. Patients: Women consenting to telephone interviews on their sexual life before and after undergoing TLH were included. Interventions: Patients were randomly assigned to a laparoscopic or transvaginal approach for vaginal cuff closure at the end of TLH for benign indications. Measurements and Main Results: A validated questionnaire (the Female Sexual Function Index [FSFI]) was used to explore sexuality before and after the operation. Of the 1408 patients enrolled in the primary study, 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 postoperative FSFI scores between groups. Patients with a low preoperative FSFI score (<26.55) had a significantly higher likelihood of having a postoperative sexual disorder (p <.001). Women who received bilateral adnexectomy before menopause and those with postoperative vaginal cuff hematoma had a significantly lower postoperative FSFI score (p = .001 and p = .04, respectively). After multivariable analysis, both variables maintained at least a tendency toward an association with a lower postoperative FSFI score (odds ratio, 2.696; 95% confidence interval, 1.010–7.194; p = 0.048 and p = 0.053; odds ratio, 13.2; 95% confidence interval, .966–180.5, respectively). Conclusion: Transvaginal and laparoscopic cuff closures after TLH have similar sexual postoperative outcomes. A patient with sexual problems before TLH is more likely to have a low FSFI score postoperatively. Premenopausal patients undergoing bilateral ovariectomy and those with postoperative vaginal cuff hematoma have a worse postoperative sexual life. (Clinicaltrials.gov, protocol number NCT02453165, registration date May 25, 2015.)

Original languageEnglish
Pages (from-to)186-194
Number of pages9
JournalJournal of Minimally Invasive Gynecology
Volume27
Issue number1
DOIs
Publication statusPublished - Jan 1 2019

Keywords

  • FSFI
  • Laparoscopic hysterectomy
  • Sexual outcome
  • Vaginal cuff closure
  • Vaginal cuff dehiscence

ASJC Scopus subject areas

  • Obstetrics and Gynaecology

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