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

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

Risultato della ricerca: Contributo in rivistaArticolo in rivista

6 Citazioni (Scopus)

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.)
Lingua originaleEnglish
pagine (da-a)186-194
Numero di pagine9
RivistaJournal of Minimally Invasive Gynecology
Volume27
DOI
Stato di pubblicazionePubblicato - 2020

Keywords

  • Adult
  • FSFI
  • Female
  • Follow-Up Studies
  • Humans
  • Hysterectomy
  • Hysterectomy, Vaginal
  • Italy
  • Laparoscopic hysterectomy
  • Laparoscopy
  • Middle Aged
  • Postoperative Complications
  • Postoperative Period
  • Reproducibility of Results
  • Sexual Behavior
  • Sexual Dysfunction, Physiological
  • Sexual outcome
  • Surgically-Created Structures
  • Surveys and Questionnaires
  • Treatment Outcome
  • Uterine Diseases
  • Vagina
  • Vaginal cuff closure
  • Vaginal cuff dehiscence

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