title: Evaluation of sexual function in sexually active women 1 year after transvaginal NOTES: a prospective cohort study of 106 patients.
abstract: OBJECTIVE
  The primary objective of this prospective cohort study was to investigate sexual function, quality of life and patient satisfaction in sexually active women 1 year after transvaginal hybrid natural orifice transluminal endoscopic surgery (NOTES).
  
  
  METHODS
  This prospective single-centre cohort study included sexually active female patients after transvaginal hybrid NOTES cholecystectomy or anterior resection. Sexual life impairment and quality of life were assessed by the Gastrointestinal Quality of Life Index (GIQLI) prior and 1 year after surgery. Patient satisfaction was assessed as well as the sexual function 1 year postoperatively using the validated German version of the Female Sexual Function Index (FSFI-D).
  
  
  RESULTS
  Between September 2008 and December 2009, 106 sexually active women after transvaginal hybrid NOTES cholecystectomy or anterior resection were identified. Sexual life significantly improved (GIQLI scores 3.2 ± 1.0 preoperatively vs. 3.7 ± 0.7 1 year postoperatively, P < 0.001), and painful sexual intercourse (3.3 ± 1.0 vs. 3.6 ± 0.7, P = 0.008) decreased post-surgery. The mean FSFI-D total score after transvaginal NOTES was 28.1 ± 4.6, exceeding the cutoff for sexual dysfunction defined as 26. Four (4.5 %) out of 88 patients who answered this question were not satisfied with the transvaginal hybrid NOTES procedure.
  
  
  CONCLUSIONS
  This prospective cohort study of female sexual function after transvaginal NOTES provides compelling evidence that the transvaginal access is safe and associated with high satisfaction rate.
authors.affiliation: Department of General, Abdominal and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
authors.forename: Georg R
authors.initials: GR
authors.lastname: Linke
authors.forename: Stephanie
authors.initials: S
authors.lastname: Luz
authors.forename: Joanna
authors.initials: J
authors.lastname: Janczak
authors.forename: Andreas
authors.initials: A
authors.lastname: Zerz
authors.forename: Bruno M
authors.initials: BM
authors.lastname: Schmied
authors.forename: Ikbale
authors.initials: I
authors.lastname: Siercks
authors.forename: René
authors.initials: R
authors.lastname: Warschkow
authors.forename: Ulrich
authors.initials: U
authors.lastname: Beutner
authors.forename: Ignazio
authors.initials: I
authors.lastname: Tarantino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy / Q000523:psychology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000523:psychology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology* / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D012735:Sexual Dysfunction, Physiological / Q000209:etiology* / Q000523:psychology; D014621:Vagina / Q000601:surgery*; D055815:Young Adult