Sexual function and pelvic floor function five years after hysterectomy

The effects of benign hysterectomy on sexual function and pelvic floor remain uncertain. Our objective was to investigate the effects of hysterectomy on pelvic floor and sexual function 5 years postoperatively.

We conducted a prospective cohort study involving 260 women scheduled for hysterectomy, who were followed for 5 years' post-surgery. Participants completed three validated questionnaires: Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20) and Female Sexual Function Index (FSFI). Nonparametric statistics and mixed effect models were used to analyze the data.

After exclusion, 242 women were included, with a response rate of 145/242 (60%) for all questionnaires at the five-year follow-up. There was an overall reduction of more than 50% in pelvic floor symptoms after 5 years (mean PFIQ-7 score 42.5) (SD 51.7) to 20.3 (SD 40.7) (p < 0.001). The degree of bother and distress caused by pelvic floor symptoms also significantly decreased (mean PFDI-20 score 69.6) (SD 51.1) to 58.2 (SD 53.2) (p < 0.01). No significant change in overall sexual function was observed 5 years' post-hysterectomy (mean FSFI score 17.9) (SD 11.7) to 18.1 (SD 11.6) (p = 0.73). However, participants who were sexually active at the time of hysterectomy, reported a decline in sexual function over time, (mean FSFI 25.2) (SD 6.6) to 19.6 (SD 10.8) (p < 0.001). In contrast, women non-sexually active at the time of hysterectomy reported an improvement of sexual function. Additionally, there was an association before surgery, between pelvic floor dysfunction (mean PFDI-20 score) and low sexual function (mean FSFI score) (p < 0.05). The route of hysterectomy (robotic assisted total laparoscopic hysterectomy, total laparoscopic hysterectomy and abdominal hysterectomy), age at surgery, and the number of vaginal deliveries had no impact on pelvic floor function or sexual function (mean PFIQ-7, PFDI-20, FSFI scores).

Five years after hysterectomy, women experienced less pelvic floor symptoms compared to preoperatively. Women reported no change in overall sexual function, nevertheless there was a decline of sexual function among those who were sexually active before surgery. In contrast, non-sexually active women recognized improved sexual function after 5 years, indicating a plausible surgery-related symptom relief.