Abstract
Abstract Objectives We meta-analyzed change in sexual function from pre-hysterectomy to post-hysterectomy and the role of cervix removal and bilateral salpingo-oophorectomy (BSO) in differences in such change. Methods We searched PubMed, Embase, and Cochrane from inception-January 2022. Two reviewers screened and included studies if they were published in a peer-reviewed journal and reported on sexual function pre-hysterectomy and post-hysterectomy for benign, non-prolapse indication. Methodological quality was assessed using the STROBE-checklist. We used random-effects multilevel-models to meta-analyze standardized mean-differences in preoperative to postoperative sexual function and the post-hysterectomy FSFI-mean across study groups in R(-Studio). Results We analyzed 32 articles: eight randomized-controlled-trials, 20 prospective studies, two retrospective studies, one cross-sectional study, and one secondary analysis compromising 4054 patients. Study quality was moderate and effect-sizes showed large between-study heterogeneity. Hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route with patients tending to report (potentially remaining) sexual dysfunction post-hysterectomy. Cervix removal was not significantly associated with differences in change. Hysterectomy without (-)BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with (+)BSO which was not the case for desire and arousal nor overall sexual function. However, these significant differences were not replicated within studies that directly compared +/-BSO. Conclusions (Subtotal and total) hysterectomy was not associated with significant change in overall sexual function irrespective of surgical route with patients tending to report (potentially remaining) sexual dysfunction post-hysterectomy. Hysterectomy-BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy+BSO, but not for desire and arousal, nor overall sexual function. Conclusions need to be interpreted with caution due to the moderate methodological study quality and large heterogeneity. Future research should study predictors of different sexual function change-trajectories associated with hysterectomy, such as different indications. Clinicians should address (remaining) sexual dysfunction post-hysterectomy and BSO should not be considered if not medically required. Conflicts of Interest J.A.F. Huirne received various research grants (Samsung, NWO/TTW/ZonMw), participated in an international course sponsored by Samsung, and a congress on surgical treatment by Olympus for which she received compensation for travel expenses, all of which were not related to the studied subject. She is chair of the niche working group of the ESGE (European Society of Gynaecological Endoscopy) and chair of the research committee of the NVOG (Dutch Society for Obstetrics and Gynaecology). The other authors have nothing to disclose.
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