Hysterectomy is the most common pelvic surgery performed in women of all ages. More than half a million women undergo hysterectomy for different reasons each year in the US. The majority of women were not evaluated for sexual life after hysterectomy; of the women who were willing to report about the sexual function, 15-37% were shown to have a considerable decrease in the sexual life after the surgery.[51,52] The pathophysiology, implicated in sexual dysfunction after hysterectomy, includes lack of vaginal lubrication and loss of libido. Both of these complications are further aggravated by bilateral oophorectomy, especially following radical hysterectomy. Two most important causes of postoperative dyspareunia are vaginal dryness and short vaginal vault.
Quality of life issues are becoming significant end points in gynecological surgical patients. These issues have not been reported adequately in the literature. The introduction of cervical screening programs (annual pap smear) has resulted in early detection of cervical cancer at a younger age. This age migration can potentially make sexual function a major postoperative issue in the gynecological surgery. Although the reports of sexual function after gynecological surgeries dates back to 1980s, lack of standard questionnaire and definitions has produced wide variations in the literature reports.
In a population-based epidemiological study in Sweden, Bergmark et al. reported that reduced sexual satisfaction and dyspareunia were the primary sources of symptom-induced distress following treatment of cervical cancer. Recent studies by Jensen et al. demonstrated that patients treated with radical hysterectomy and radiotherapy suffered short-term sexual difficulties, such as dyspareunia and vaginal dryness, leading to decreased sexual satisfaction. However, some of these postoperative problems subsided 6 months after surgery. Studies involving the surgeries of ovarian malignancies report similar rates of sexual dysfunction. The data on sexual dysfunction following treatment of endometrial and vulval cancer are limited in the literature. There is definitive increase in the awareness about the impact of surgeries for gynecological cancer and its effect on female sexual function. The assessment and treatment of sexual function should become an important part of the standard care of women diagnosed and treated for gynecological cancers.
Although simple hysterectomy is the most common gynecological surgery, sexual dysfunction after this surgery has not been widely reported. The paucity of literature is a major limitation. Sexual dysfunction after hysterectomy is associated with the etiology for the hysterectomy and various preoperative conditions such as dyspareunia and dysmenorrhea. Several studies report that sexual function improves after simple hysterectomy in 30-50% of patients.[56-58] The potential explanation for improvement includes the relief from preoperative dyspareunia and dysmenorrhea. The Maryland women's health study revealed that women after simple hysterectomy had improvement in overall sexual functioning without change in the frequency of orgasm. Dragisic et al. reported no change in sexual desire, orgasm frequency or orgasm after simple hysterectomy. Questions have been raised regarding the impact of the type of hysterectomy (vaginal vs abdominal) on sexual function. However, El-Toukhy et al. in 2004 reported no significant difference in the sexual function after abdominal or vaginal simple hysterectomy. It would appear from the reported literature that simple hysterectomy does not have adverse effects on sexual function. These reports need to be confirmed from validated questionnaire that can stratify the different domains of sexual function, which include orgasm, desire and arousal, pain during the intercourse, lubrication and satisfaction.
Recently, there is a growing interest about sexual dysfunction following pelvic surgery among the gynecologists. This increased awareness will lead to development of better surgical techniques and better information on postoperative sexual dysfunction. The risk and benefits of any pelvic surgery should include in an accurate informed consent on sexual dysfunction. In the future, sexual function will soon become a routine discussion in the informed consent of gynecological surgery.