Effects of genital prolapse surgery and hysterectomy on pelvic floor function

This study was aimed to evaluate the effects of hysterectomy on pelvic floor function. We conducted a prospective observational multicenter study with three-year follow-up in thirteen teaching and nonteaching hospitals in the Netherlands. Four-hundred-thirty females who underwent hysterectomy for benign disease other than symptomatic uterine prolapse were included. Validated disease-specific quality-of-life questionnaire were completed before surgery and at 6 months, 12 months and three years after surgery to assess the presence of micturition symptoms, defecation symptoms and sexual problems. Micturition symptoms at three year after surgery were more common following vaginal hysterectomy than following abdominal hysterectomy (OR 2.2, 95% CI 1.3-4.0). Micturition symptoms that more often disappeared following -abdominal hysterectomy included urgency (OR 2.4, 95% CI 1.0-5.5) and obstructive micturition (OR 2.9, 95% CI 1.0-8.2). Constipation had developed in 2% of the patients without constipation before surgery and persisted in 46% of the -patients with constipation before surgery. Sexual pleasure statistically significantly improved in all patients, independently of the performed technique of -hysterectomy. At six months after vaginal, subtotal abdominal hysterectomy and total abdominal hysterectomy, the prevalence of one or more bothersome sexual problems was 43%, 41% and 39% respectively (Chi-square test: p = 0.88). From our prospective study it can be concluded that removal of the cervix during hysterectomy does not worsen pelvic floor function. Abdominal hysterectomy might have benefits over vaginal hysterectomy with respect to micturition. Hysterectomy does not cause constipation. Sexual function following hysterectomy does not depend on the performed technique and is on average better than before surgery.