title: Female sexual function after pure transvaginal appendectomy: a cohort study.
abstract: BACKGROUND
  The impact of transvaginal natural orifice transluminal endoscopic surgery (NOTES) on female sexual function is unknown. We therefore performed a prospective cohort study of women undergoing pure transvaginal appendectomies (TVA) versus traditional laparoscopic appendectomies (LA). Using a validated, 19-point, female sexual function index questionnaire (FSFI) assessing six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction, and pain with intercourse), pre- and postoperative sexual function was compared.
  
  
  METHODS
  Between August 2008 and August 2010, 42 patients with acute appendicitis were offered a pure TVA. Patients who did not wish to undergo a TVA underwent an LA and served as controls. Both groups were provided with an FSFI before surgery and at regular intervals for up to 1 year. Pre- and postoperative FSFI results were compared between cohorts using unpaired t tests, and between individuals within each cohort pre- and postoperatively using paired t tests.
  
  
  RESULTS
  Twenty-two underwent LA, 18 patients underwent a pure TVA, and 2 refused participation in this study. Preoperative and >60 days postoperative FSFI data were available for 21 patients (10 LA and 11 TVA). Baseline FSFI scores were not significantly different between groups (LA, 19.3 ± 0.9; TVA, 19.3 ± 0.8, p = 0.99). FSFI scores at greater than 60 days postoperatively did not differ significantly from FSFI scores preoperatively in either group (LA, 19.3 ± 0.9 to 19.7 ± 0.7; p = 0.87; TVA, 19.3 ± 0.8 to 19.4 ± 0.9; p = 0.97). No FSFI domain in either cohort was significantly changed postoperatively.
  
  
  CONCLUSIONS
  Neither LA nor TVA affected female sexual function scores. This suggests that TVA does not have negative effects on female sexual function. The results of this study may prove beneficial in consultations with patients concerning the sexual sequelae of transvaginal surgery.
authors: Department of Surgery, Section of Gastrointestinal Surgery, Yale University School of Medicine, 40 Temple Street, Suite 7B, New Haven, CT 06510, USA. D.Solomon@yale.edu
authors: Daniel
authors: D
authors: Solomon
authors: Rachel
authors: R
authors: Lentz
authors: Andrew J
authors: AJ
authors: Duffy
authors: Robert L
authors: RL
authors: Bell
authors: Kurt E
authors: KE
authors: Roberts
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001062:Appendectomy / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000009:adverse effects* / Q000379:methods; D011446:Prospective Studies; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D020018:Sexual Dysfunctions, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires; D014621:Vagina / Q000601:surgery; D055815:Young Adult