Abstract
In hysterectomized patients, even though there is still controversy, evidence indicates that in the short term, the vaginal approach shows benefits over the laparoscopic approach, as it is less invasive, faster and less costly. However, the quality of sexual life has not been systematically reviewed in terms of the approach adopted. Through a systematic review, we analyzed (CRD42020158465 in PROSPERO) the impact of hysterectomy on sexual quality and whether there are differences according to the surgical procedure (abdominal or vaginal) for noncancer patients. MEDLINE (through PubMed), Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Scopus were reviewed to find randomized clinical trials assessing sexuality in noncancer patients undergoing total hysterectomy, comparing vaginal and abdominal (laparoscopic and/or open) surgery. Three studies that assessed the issue under study were finally included. Two of these had a low risk of bias (Cochrane risk of bias tool); one was unclear. There was significant variability in how sexuality was measured, with no differences between the two approaches considered in the review. In conclusion, no evidence was found to support one procedure (abdominal or vaginal) over another for non-oncological hysterectomized patients regarding benefits in terms of sexuality.
Highlights
Hysterectomy, whether via the open abdominal, laparoscopic, or vaginal procedure, is the most common gynecological surgery in developed countries after cesarean section.The choice of one procedure over another depends on a range of factors [1,2,3,4,5,6].Historically, the most frequently used method has been open abdominal surgery, in cases of tumors or enlarged uterus
Hysterectomy has been associated with a high rate of short- and long-term complications [7,8,9,10,11]
All the randomized clinical trials (RCTs) that compared total vaginal versus abdominal hysterectomy carried out on women requiring this type of intervention in terms of female sexuality were selected
Summary
Hysterectomy, whether via the open abdominal, laparoscopic, or vaginal procedure, is the most common gynecological surgery in developed countries after cesarean section. The most frequently used method has been open abdominal surgery, in cases of tumors or enlarged uterus. Laparoscopic surgery is increasingly used, though inhibited by the learning curve associated with its technical difficulty [5]. Hysterectomy has been associated with a high rate of short- and long-term complications [7,8,9,10,11]. Sexual dysfunction (persistent or recurrent reduction of sexual desire, arousal, orgasm, along with the presence of pain) may occur, which, not life-threatening, can significantly limit the quality of life of the patient [7,12,13]
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