Effects of hysterectomy on pelvic floor function and sexual function-A prospective cohort study

Abstract

Introduction: Hysterectomy is one of the most common major surgical procedures in women. The effects of hysterectomy on pelvic floor and sexual function are uncertain. Our objective was to investigate the effects of hysterectomy for benign indications on pelvic floor and sexual function and to compare different modes of surgery.

Material and methods: We performed a prospective clinical cohort study. In all, 260 women scheduled for hysterectomy answered validated questionnaires (Pelvic Floor Impact Questionnaire, Pelvic Floor Distress Inventory and Female Sexual Function Index). Participants were followed 6 months and 1 year after surgery. Data were analyzed using nonparametric statistics and mixed effect models.

Results: Women with subtotal hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy, and previous prolapse/incontinence surgery were excluded from further analysis, leaving the remaining cohort to 242 patients. The response rate at 6 months and 1 year follow-up was 180/242 (74.3%) and 169/242 (69.8%), respectively. There was an improvement of pelvic floor function at both follow-ups; mean score of Pelvic Floor Impact Questionnaire at baseline was 42.5 (51.7), at 6 months 19.9 (42.2) and at 1 year 23.7 (50.3) (p < 0.001). The mean score of Pelvic Floor Distress Inventory at baseline was 69.6 (51.1), at 6 months 49 (43.2) and at 1 year 49 (43.2) (p < 0.001). There was an improvement of sexual function after 6 months (mean score of Female Sexual Function Index at baseline 17.9 [SD 11.7] and at 6 months 21.0 [SD 11.7]) (p < 0.001). There was no difference in pelvic floor or sexual function when comparing surgical techniques.

Conclusions: Robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent at 6 months and 1 year after surgery. There was an overall improvement of sexual function 6 months after hysterectomy, but this did not persist after 1 year.

Keywords: abdominal hysterectomy; female sexual function; laparoscopic hysterectomy; minimally invasive surgery; pelvic floor function; robotic assisted laparoscopic hysterectomy.

FIGURE 1

Flow chart showing the original cohort of 260 women and the cohort of 242 women remaining for analysis of Pelvic Floor Impact Questionnaire, Pelvic Floor Distress Inventory and Female Sexual Function Index after excluding subtotal hysterectomy, previous incontinence or prolapse surgery, vaginal hysterectomy and laparoscopic assisted vaginal hysterectomy.

FIGURE 2

Mean score of Pelvic Floor Impact Questionnaire‐7 (PFIQ‐7), Urinary Impact Questionnaire (UIQ‐7), Colorectal‐Anal Impact Questionnaire (CRAIQ‐7), Pelvic Organ Prolapse Impact Questionnaire (POPIQ‐7), Pelvic Floor Distress Inventory (PFDI‐20), Pelvic Organ Prolapse Distress Inventory (POPDI‐6), Colorectal‐Anal Distress Inventory (CRAD‐8) and Urinary Distress Inventory (UDI‐6) at baseline, 6 months and 12 months follow‐up (mean score with 95% confidence interval).

FIGURE 3

Mean score of Pelvic Floor Impact Questionnaire‐7 (PFIQ‐7), Urinary Impact Questionnaire (UIQ‐7), Colorectal‐Anal Impact Questionnaire (CRAIQ‐7), Pelvic Organ Prolapse Impact Questionnaire (POPIQ‐7), Pelvic Floor Distress Inventory (PFDI‐20), Pelvic Organ Prolapse Distress Inventory (POPDI‐6), Colorectal‐Anal Distress Inventory (CRAD‐8) and Urinary Distress Inventory (UDI‐6) at baseline, 6 months and 12 months follow‐up (mean score with 95% confidence interval). Operation type: Robotic = robotic assisted total laparoscopic hysterectomy; Laparoscopic = total laparoscopic hysterectomy; Abdominal = abdominal hysterectomy.

FIGURE 4

(A) Female Sexual Function Index (FSFI) score and domains in all women (n = 242) at baseline (before hysterectomy) at 6 months and 12 months follow‐up (median score with 95% confidence interval). (B) Female Sexual Function Index (FSFI) score and domains in sexually active women (n = 162) at baseline (before hysterectomy) at 6 months and 12 months follow‐up (median score with 95% confidence interval).