Sexual Quality of Life After vNOTES Surgery: A Systematic Literature Review

To systematically review the literature on women's sexual quality of life after transvaginal natural orifice endoscopic surgery (vNOTES) for gynecological and nongynecological procedures, and to assess women's perceptions of vNOTES, the recommended duration of postoperative sexual abstinence (medically advised pelvic rest), the actual rate and timing of postoperative resumption of sexual activity (proportion of women resuming intercourse after surgery), and overall satisfaction.

PubMed, Google Scholar, and the Cochrane Central Register of Controlled Trials (CENTRAL).

We searched the 3 databases for studies published between 2010 and January 5, 2026, using the terms "transvaginal natural orifice transluminal endoscopic surgery," "transvaginal laparoscopic surgery," and "vnotes" combined with "sexual function," "sexual quality of life," and "dyspareunia." We included studies evaluating women's sexual quality of life pre and postoperatively. Exclusion criteria were vaginal surgery without vNOTES, vNOTES not used for the main procedure, hysterectomy, urogynecology and endometriosis surgeries, missing pre or postoperative sexual function evaluation, full text unavailable in English or French, missing or unclear methodology, literature reviews, meta-analyses, and protocols.

We included 28 articles in the final systematic review: five randomized controlled trials, 17 prospective cohort studies, and 6 retrospective cohort studies, covering 9 gynecologic and 19 nongynecologic indications (urology, gastrointestinal, and endocrine surgery). Screening and data extraction were performed independently at all stages by 2 reviewers. Across all studies, over 1240 procedures were performed using vNOTES or hybrid vNOTES, several compared with conventional laparoscopy. Overall, vNOTES did not significantly impair female sexual function, except in 2 studies conducted in an oncologic context. Younger and nulliparous women expressed greater concerns regarding fertility and sexual outcomes, while postoperative sexual abstinence recommendation-highly variable across studies-was a key source of concern. Reduced morbidity and a high satisfaction rate favored acceptance, whereas the cosmetic advantage of scarless surgery showed variable influence.

The transvaginal approach, in pure or hybrid vNOTES, across both gynecologic and nongynecologic surgeries, appears to be safe regarding sexual function, with no meaningful difference compared with CL.

Transvaginal NOTES appear to preserve sexual function across procedures, with rare exceptions in oncologic settings. Fertility-related concerns (including infertility, pregnancy, and childbirth) and recommended sexual abstinence influence perceptions, while reduced morbidity and high satisfaction promote acceptance.