BackgroundThe first elective hysterectomy was performed in 1813 by Conrad Langenback and was done by vaginal approach. Subtotal hysterectomy was the method of choice before antibiotics was discovered because of the lessened risk of intra-abdominal infection.Laparoscopy is a relatively new method and has since 1991 raised the question whether a total hysterectomy is necessary when the subtotal approach requires less surgical experience and less risk of damage of internal organs. After the subtotal gained popularity, researchers wanted to find which procedure was best for sexual function.Sexuality is a topic not well researched and is a subject that has been influenced by society’s cultural view throughout history. The methodology to investigate a woman’s sexuality is poor and not consistent. Masters and Johnson were pioneers in sexual research and found that a small group of women experience internal orgasm as the uterus contracts. This has raised questions whether these women will have a decreased sexual function after hysterectomy.The aim of this study was to explore whether there is any reason to conclude that removing cervix or not, during hysterectomy for a benign disease, would make a difference for women’s sexual function.
MethodsA literary search was made on Medline database on review articles on sexuality and hysterectomy. Malignancy as a medical indication for the hysterectomy (which also would include oophorectomy) was excluded as operative indication.
ResultsThe included 16 review articles could not find any significant difference between total- and subtotal hysterectomy regarding women’s self-reported sexual function. The majority of women experienced an improvement in sexual function following the hysterectomy, but a small group experienced new problems 1 and 2 years after the operation.A positive or necessary role of the cervix in female sexual response cannot be verified by current research.
ConclusionNo conclusions can be made from this literature review regarding which hysterectomy technique affects the most or the least a woman’s sexual function.The review articles seem to support that choice of hysterectomy method is probably not the most important predictor for postoperative experienced sexual function in benign diseases.The gold standard for further research is to design RCTs to compare groups who have similar benign pathology and including women with a medical reason that warrant hysterectomy. On the other hand, it is unlikely that women would like to participate in future RCTs, because women with benign conditions probably wants to choose for themselves, after consulting with their doctors, which method they would prefer.