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Assessment of Sexual Function Following Hysterectomy: A Systematic Review and Meta-Analysis
Ákos Molnár-Csendom1, Balázs Vida1, Ferenc Bánhidy1
1Department of Obstetrics and Gynecology, Semmelweis University, 1082 Budapest, Hungary.
Background:
Hysterectomy is one of the most frequently performed major gynecological procedures, yet its effect on sexual quality of life remains unclear.
Objective:
To evaluate changes in sexual quality of life following hysterectomy and to determine whether cervical preservation is associated with improved postoperative sexual function.
Methods:
Five databases were systematically searched from inception to February 2026. Eligible studies reported pre- and postoperative sexual quality-of-life outcomes after hysterectomy using validated or non-validated questionnaires. All surgical indications, approaches, and study designs were included. Risk of bias was assessed using RoB 2 and ROBINS-I. Mean score differences were pooled using random-effects meta-analysis and meta-regression within a frequentist framework. Heterogeneity was assessed with τ2, cluster-robust standard errors were applied, and certainty of evidence was evaluated using GRADE.
Results:
Thirty-four studies were included in the systematic review, among them sixteen studies comprising 2341 patients were included in the statistical synthesis comprising three randomized controlled trials and thirteen observational studies. The Female Sexual Function Index (FSFI) was the most commonly reported outcome. Across all hysterectomy types, including total, abdominal, laparoscopic, and vaginal approaches, no clinically or statistically significant improvement in postoperative sexual function was observed compared with baseline. Subtotal hysterectomy did not demonstrate a meaningful advantage over total hysterectomy. FSFI total scores were consistent with sexual dysfunction at baseline and remained below the established cutoff (≤26.55) during follow-up across all surgical routes. No hysterectomy approach was associated with a clinically relevant change in sexual quality of life.
Conclusions:
Postoperative changes in sexual function after hysterectomy were small and non-significant overall. Cervical preservation did not provide measurable benefit. Surgical approach selection should therefore not be based on expectations of improved sexual outcomes.
