title: Objective assessment of sexual arousal in women with a history of hysterectomy.
abstract: OBJECTIVE
  The potential contribution of psychological and anatomical changes to sexual dysfunction following hysterectomy is not clear. Radical hysterectomy for cervical cancer causes surgical damage to the autonomic nerves which are responsible for the increased vaginal blood flow during sexual arousal. Simple hysterectomy causes more limited nerve disruption. Photoplethysmographic assessment of vaginal pulse amplitude objectively measures vaginal blood flow during sexual arousal. We hypothesised that damage of the autonomic nerves results in a disrupted vaginal blood flow response during sexual stimulation.
  
  
  METHODS
  Between-groups comparison of vaginal pulse amplitude.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Twelve women with a history of radical hysterectomy, 12 women with a history of simple abdomonal hysterectomy and 17 aged-matched controls.
  
  
  METHODS
  Photoplethysmographic assessment of vaginal pulse amplitude during sexual stimulation by erotic films. Self-reported ratings of subjective sexual arousal were collected after each erotic stimulus condition.
  
  
  METHODS
  Maximum vaginal pulse amplitude.
  
  
  RESULTS
  Maximum vaginal pulse amplitude differed between the three groups (P= 0.043). Women with a history of radical hysterectomy had a lower response than controls (P= 0.015). Women in the radical hysterectomy group and controls reported an equally strong subjective arousal. Women with a history of simple hysterectomy showed an intermediate maximum vaginal pulse amplitude.
  
  
  CONCLUSIONS
  Radical hysterectomy seems associated with a disturbed vaginal blood flow response during sexual arousal. This cannot be explained solely by uteric extirpation, since it was not observed to the same extent after simple hysterectomy, but might be related to a denervation of the vagina which increases with increasing radicality of surgery.
authors.affiliation: Department of Gynaecology, Leiden University Medical Center, The Netherlands.
authors.forename: C P
authors.initials: CP
authors.lastname: Maas
authors.forename: M M
authors.initials: MM
authors.lastname: ter Kuile
authors.forename: E
authors.initials: E
authors.lastname: Laan
authors.forename: C C
authors.initials: CC
authors.lastname: Tuijnman
authors.forename: Ph Th M
authors.initials: PT
authors.lastname: Weijenborg
authors.forename: J B
authors.initials: JB
authors.lastname: Trimbos
authors.forename: G G
authors.initials: GG
authors.lastname: Kenter
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001143:Arousal / Q000502:physiology*; D016022:Case-Control Studies; D003248:Constipation / Q000209:etiology; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000523:psychology*; D007989:Libido / Q000502:physiology*; D008875:Middle Aged; D012735:Sexual Dysfunction, Physiological / Q000523:psychology*; D014549:Urinary Incontinence / Q000209:etiology; D002583:Uterine Cervical Neoplasms / Q000523:psychology / Q000601:surgery*; D014621:Vagina / Q000502:physiology