title: Cervix removal at the time of hysterectomy: factors affecting patients' choice and effect on subsequent sexual function.
abstract: OBJECTIVE
  To identify factors that influence the decision-making process on the type of hysterectomy (total or supracervical) and the impact of surgery of subsequent sexual function.
  
  
  METHODS
  A cross-sectional survey was undertaken on 212 women who underwent total laparoscopic hysterectomy (TLH) or laparoscopic supracervical hysterectomy (LSH) for benign conditions at the Division of Minimally Invasive Gynecology at Brigham and Women's Hospital in Boston, MA, USA. We analyzed the factors that patients considered in their decision-making process, their sexual function after surgery and their satisfaction with the surgery overall. Demographic and perioperative outcomes were also collected.
  
  
  RESULTS
  A total of 115 women answered the survey, for a response rate of 54.24%. The patients who underwent LSH (n=54) and TLH (n=61) were overall similar in terms of baseline factors and perioperative outcomes. Patients reported that the physician was the main source of information regarding decision to remove or retain the cervix (79.13%). The physicians' recommendation was viewed as very or extremely important (83.68%) to the decision-making process, followed by concerns regarding their future sex life (51.09%). Almost half of the women reported that hysterectomy had no impact on sexual function. No statistically significant differences were seen between groups regarding satisfaction with sexual function (p=.822), impact on sexual function (p=.753) or recommendation of this surgery to other women (p=.505).
  
  
  CONCLUSIONS
  Concerns about sexual health were important to women when considering the type of hysterectomy to undergo. Cervix removal or retention at the time of hysterectomy did not impact women's sexual function after mean follow-up of 15.2 months.
authors.affiliation: Minimally Invasive Gynecological Surgery Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Nieck S A
authors.initials: NSA
authors.lastname: Pouwels
authors.affiliation: Minimally Invasive Gynecological Surgery Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Luiz G O
authors.initials: LGO
authors.lastname: Brito
authors.affiliation: Minimally Invasive Gynecological Surgery Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: jeinarsson@partners.org.
authors.forename: Jon I
authors.initials: JI
authors.lastname: Einarsson
authors.affiliation: Minimally Invasive Gynecological Surgery Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Goggins
authors.affiliation: Minimally Invasive Gynecological Surgery Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Wang
authors.affiliation: Minimally Invasive Gynecological Surgery Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Cohen
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000601:surgery*; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery; D008796:Metrorrhagia / Q000601:surgery; D008875:Middle Aged; D010052:Ovariectomy / Q000379:methods; D057240:Patient Preference; D011183:Postoperative Complications; D060728:Reproductive Health; D012735:Sexual Dysfunction, Physiological; D011795:Surveys and Questionnaires; D000069339:Trachelectomy / Q000379:methods*; D014591:Uterine Diseases / Q000601:surgery*; D014594:Uterine Neoplasms / Q000601:surgery
keywords: Cross sectional study; Decision-making process; Sexual function; Subtotal hysterectomy; Total hysterectomy