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Hysterectomy and sexual function: a systematic review and meta-analysis.
Dedden, Suzanne J; Werner, Marlene A; Steinweg, Jorrit; Lissenberg-Witte, Birgit I; Huirne, Judith A F; Geomini, Peggy M A J; Maas, Jacques W M.
Afiliación
  • Dedden SJ; Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, 5504 DB, the Netherlands.
  • Werner MA; GROW-School of Oncology and Reproduction, Maastricht University, Maastricht, 6229 HZ, the Netherlands.
  • Steinweg J; Department of Sexology and Psychosomatic Gynaecology, Amsterdam Reproduction and Development, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, 1105 AZ, the Netherlands.
  • Lissenberg-Witte BI; Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, 6229 HX, the Netherlands.
  • Huirne JAF; Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, 1081 HV, the Netherlands.
  • Geomini PMAJ; Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, 1105 AZ, the Netherlands.
  • Maas JWM; Department of Obstetrics and Gynaecology, Máxima Medical Centre, Veldhoven, 5504 DB, the Netherlands.
J Sex Med ; 20(4): 447-466, 2023 03 31.
Article en En | MEDLINE | ID: mdl-36857309
BACKGROUND: Sexual function after hysterectomy can be a concern for patients, and research remains inconclusive about changes in sexual function associated with hysterectomy. AIM: We meta-analyzed studies on change in sexual function from pre- to posthysterectomy and the role of total vs subtotal hysterectomy and concomitant bilateral salpingo-oophorectomy (BSO) in differences in such change. METHODS: We searched PubMed, Embase, and Cochrane databases from inception to January 2022. Two reviewers screened and included studies if they were published in a peer-reviewed journal and reported on sexual function pre- and posthysterectomy for benign nonprolapse indication. Methodological quality was assessed with the STROBE checklist. We used random effects multilevel models to meta-analyze standardized mean differences in pre- to postoperative sexual function and the posthysterectomy Female Sexual Function Index mean across study groups in R (RStudio). OUTCOMES: Outcomes included overall sexual function, dyspareunia, desire, arousal, lubrication, and orgasm. RESULTS: Thirty-two articles were analyzed: 8 randomized controlled trials, 20 prospective studies, 2 retrospective studies, 1 cross-sectional study, and 1 secondary analysis, comprising a total of 4054 patients. Each study provided data for at least 1 outcome. 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 posthysterectomy. Cervix removal was not significantly associated with differences in magnitude of 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, arousal or overall sexual function. However, these significant differences were not replicated within studies that directly compared cases with and without BSO. CLINICAL IMPLICATIONS: Clinicians should address remaining sexual dysfunction posthysterectomy, and BSO should not be considered if not medically required. STRENGTHS AND LIMITATIONS: We analyzed a comprehensive number of trials and studied clinically relevant factors that might relate to differences in change in sexual function. Conclusions need to be interpreted with caution since many studies showed moderate methodological quality and large effect size heterogeneity. CONCLUSION: 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 posthysterectomy. Hysterectomy without BSO was associated with significantly stronger improvement in lubrication and orgasm than hysterectomy with BSO. Future research on hysterectomy should analyze predictors of sexual function change trajectories, such as different indications.
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Texto completo: 1 Base de datos: MEDLINE Asunto principal: Disfunciones Sexuales Fisiológicas / Histerectomía Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Female / Humans Idioma: En Revista: J Sex Med Asunto de la revista: GINECOLOGIA / MEDICINA REPRODUTIVA / UROLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Países Bajos

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Disfunciones Sexuales Fisiológicas / Histerectomía Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies / Systematic_reviews Límite: Female / Humans Idioma: En Revista: J Sex Med Asunto de la revista: GINECOLOGIA / MEDICINA REPRODUTIVA / UROLOGIA Año: 2023 Tipo del documento: Article País de afiliación: Países Bajos