Sexuality after total vs. subtotal hysterectomy.
BACKGROUND
The effect of hysterectomy on sexuality is not fully elucidated and until recently total and subtotal hysterectomies have only been compared in observational studies.


OBJECTIVE
To compare total abdominal hysterectomy (TAH) to subtotal abdominal hysterectomy (SAH) regarding effects on sexuality.


METHODS
In a Danish multicenter trial 319 women were randomized to TAH (n = 158) or SAH (n = 161); 185 women had self-selected TAH (n = 80) or SAH (n = 105) in a simultaneously conducted observational study. Women were followed for 1 year by strict data collection procedures, including postal questionnaires. Results were analyzed by intention to treat (ITT) analyses.


RESULTS
No significant differences were observed between TAH and SAH at 1-year follow-up in both the randomized trial and the observational study regarding women's desire for sex, frequency of intercourse, frequency of orgasm, quality of orgasm, localization of orgasm, satisfaction with sexual life, and dyspareunia. None of these sexual variables changed significantly from entry to the 1-year follow-up, apart from dyspareunia, which was significantly (p = 0.009) reduced in both intervention groups. Significant (p < 0.05) predictors for satisfaction with sexual life after hysterectomy were the preoperative satisfaction with sexual life [odds ratio (OR) 32, 95% confidence interval (CI) 10-125], good relationship with partner (OR 50, 95% CI 9-354), physical well-being (OR 0.30, 95% CI 0.09-0.88) and hormone replacement therapy (OR 0.23, 95% CI 0.06-0.78).


CONCLUSIONS
Both TAH and SAH significantly reduce dyspareunia without having a negative effect on sexual function. The shift toward SAH seems unwarranted.
Zobbe
Vibeke
V
Department of Gynecology and Obstetrics, Roskilde County Hospital, Denmark. vibeke@zobbe.dk
Gimbel
Helga
H
Andersen
Birthe Margrethe
BM
Filtenborg
Thomas
T
Jakobsen
Kristian
K
Sørensen
Helle Christina
HC
Toftager-Larsen
Kim
K
Sidenius
Katrine
K
Møller
Nini
N
Madsen
Ellen Merete
EM
Vejtorp
Mogens
M
Clausen
Helle
H
Rosgaard
Annie
A
Gluud
Christian
C
Ottesen
Bent S
BS
Tabor
Ann
A
D002584:Cervix Uteri / Q000502:physiology; D004414:Dyspareunia / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D019529:Sexuality; D011795:Surveys and Questionnaires; D013997:Time Factors