Stefano Uccella1, Vito Andrea Capozzi2, Matteo Ricco'3, Emanuele Perrone4, Margherita Zanello5, Stefania Ferrari6, Pier Carlo Zorzato6, Renato Seracchioli5, Antonella Cromi7, Maurizio Serati7, Raffaella Ergasti4, Francesco Fanfani8, Roberto Berretta9, Mario Malzoni10, Stefano Cianci4, Enrico Vizza11, Maurizio Guido12, Francesco Legge12, Giuseppe Ciravolo13, Salvatore Gueli Alletti4, Fabio Ghezzi7, Massimo Candiani14, Giovanni Scambia4. 1. Obstetrics and Gynecology Department (Drs. Uccella, Ferrari, and Zorzato), Ospedale degli Infermi, Biella, Italy; Department of Woman and Child Health (Drs. Uccella, Capozzi, Perrone, Ergasti, Cianci, Alletti, and Scambia), Fondazione Policlinico Gemelli, IRCCS, Rome, Italy. Electronic address: stefucc@libero.it. 2. Department of Woman and Child Health (Drs. Uccella, Capozzi, Perrone, Ergasti, Cianci, Alletti, and Scambia), Fondazione Policlinico Gemelli, IRCCS, Rome, Italy; Obstetrics and Gynecology Department (Drs. Capozzi and Berretta), University of Parma, Parma, Italy. 3. Service for Health and Safety on the Workplaces (Dr. Ricco'), AUSL - I.R.C.C.S. di Reggio Emilia, Italy. 4. Department of Woman and Child Health (Drs. Uccella, Capozzi, Perrone, Ergasti, Cianci, Alletti, and Scambia), Fondazione Policlinico Gemelli, IRCCS, Rome, Italy. 5. Minimally Invasive Gynecological Surgery Unit (Drs. Zanello and Seracchioli), Sant'Orsola-Malpighi Hospital, Bologna, Italy. 6. Obstetrics and Gynecology Department (Drs. Uccella, Ferrari, and Zorzato), Ospedale degli Infermi, Biella, Italy. 7. Department of Obstetrics and Gynecology (Drs. Cromi, Serati, and Ghezzi), University of Insubria, Del Ponte Hospital, Varese, Italy. 8. Department of Medicine and Aging Sciences (Dr. Fanfani), University "Gabriele d'Annunzio" of Chieti-Pescara, Italy. 9. Obstetrics and Gynecology Department (Drs. Capozzi and Berretta), University of Parma, Parma, Italy. 10. Endoscopica Malzoni-Center for Advanced Endoscopic Gynecological Surgery (Dr. Malzoni), Avellino, Italy. 11. Department of Oncological Surgery, Gynecologic Oncologic Unit (Dr. Vizza), "Regina Elena" National Cancer Institute, IRCCS, Rome, Italy. 12. Division of Gynaecology, Department of Obstetrics and Gynaecology (Drs. Guido and Legge), "F. Miulli" General Hospital, Acquaviva delle Fonti, Bari, Italy. 13. Department of Obstetrics and Gynecology (Dr. Ciravolo), Spedali Civili di Brescia, Brescia, Italy. 14. Gynecology Department (Dr. Candiani), IRCCS San Raffaele Scientific Institute, Milan, Italy.
Abstract
STUDY OBJECTIVE: The effect of the different types of vaginal cuff closures on posthysterectomy sexual function has not been investigated in depth. We evaluated if there is a difference between transvaginal versus a laparoscopic closure after total laparoscopic hysterectomy (TLH) on female sexual function, using a validated questionnaire. DESIGN: Secondary analysis of a prospective randomized controlled trial. SETTING: Three academic research centers. PATIENTS: Women consenting to telephone interviews on their sexual life before and after undergoing TLH were included. INTERVENTIONS: Patients were randomly assigned to a laparoscopic or transvaginal approach for vaginal cuff closure at the end of TLH for benign indications. MEASUREMENTS AND MAIN RESULTS: A validated questionnaire (the Female Sexual Function Index [FSFI]) was used to explore sexuality before and after the operation. Of the 1408 patients enrolled in the primary study, 400 patients were asked to complete the questionnaire. Of them, 182 (41.4%) were eligible and accepted enrollment in the present analysis. No difference was found in terms of pre- and postoperative FSFI scores between groups. Patients with a low preoperative FSFI score (<26.55) had a significantly higher likelihood of having a postoperative sexual disorder (p <.001). Women who received bilateral adnexectomy before menopause and those with postoperative vaginal cuff hematoma had a significantly lower postoperative FSFI score (p = .001 and p = .04, respectively). After multivariable analysis, both variables maintained at least a tendency toward an association with a lower postoperative FSFI score (odds ratio, 2.696; 95% confidence interval, 1.010-7.194; p = 0.048 and p = 0.053; odds ratio, 13.2; 95% confidence interval, .966-180.5, respectively). CONCLUSION: Transvaginal and laparoscopic cuff closures after TLH have similar sexual postoperative outcomes. A patient with sexual problems before TLH is more likely to have a low FSFI score postoperatively. Premenopausal patients undergoing bilateral ovariectomy and those with postoperative vaginal cuff hematoma have a worse postoperative sexual life. (Clinicaltrials.gov, protocol number NCT02453165, registration date May 25, 2015.).
RCT Entities:
STUDY OBJECTIVE: The effect of the different types of vaginal cuff closures on posthysterectomy sexual function has not been investigated in depth. We evaluated if there is a difference between transvaginal versus a laparoscopic closure after total laparoscopic hysterectomy (TLH) on female sexual function, using a validated questionnaire. DESIGN: Secondary analysis of a prospective randomized controlled trial. SETTING: Three academic research centers. PATIENTS: Women consenting to telephone interviews on their sexual life before and after undergoing TLH were included. INTERVENTIONS:Patients were randomly assigned to a laparoscopic or transvaginal approach for vaginal cuff closure at the end of TLH for benign indications. MEASUREMENTS AND MAIN RESULTS: A validated questionnaire (the Female Sexual Function Index [FSFI]) was used to explore sexuality before and after the operation. Of the 1408 patients enrolled in the primary study, 400 patients were asked to complete the questionnaire. Of them, 182 (41.4%) were eligible and accepted enrollment in the present analysis. No difference was found in terms of pre- and postoperative FSFI scores between groups. Patients with a low preoperative FSFI score (<26.55) had a significantly higher likelihood of having a postoperative sexual disorder (p <.001). Women who received bilateral adnexectomy before menopause and those with postoperative vaginal cuff hematoma had a significantly lower postoperative FSFI score (p = .001 and p = .04, respectively). After multivariable analysis, both variables maintained at least a tendency toward an association with a lower postoperative FSFI score (odds ratio, 2.696; 95% confidence interval, 1.010-7.194; p = 0.048 and p = 0.053; odds ratio, 13.2; 95% confidence interval, .966-180.5, respectively). CONCLUSION: Transvaginal and laparoscopic cuff closures after TLH have similar sexual postoperative outcomes. A patient with sexual problems before TLH is more likely to have a low FSFI score postoperatively. Premenopausal patients undergoing bilateral ovariectomy and those with postoperative vaginal cuff hematoma have a worse postoperative sexual life. (Clinicaltrials.gov, protocol number NCT02453165, registration date May 25, 2015.).
Authors: Luigi Carlo Turco; Giuseppe Vizzielli; Virginia Vargiu; Salvatore Gueli Alletti; Maria De Ninno; Gabriella Ferrandina; Luigi Pedone Anchora; Giovanni Scambia; Francesco Cosentino Journal: Front Oncol Date: 2021-11-15 Impact factor: 6.244