The following is a summary of “Psychosocial predictors of change in sexual activity and sexual function after hysterectomy in women with pelvic pain,” published in the September 2023 issue of Obstetrics and Gynecology by Till, et al.

Concerns about the potential impact on sexual function are common among individuals contemplating hysterectomy. While existing research suggested that most patients experience stable or slightly improved sexual function following hysterectomy, there is a subset of patients for whom sexual function may decline post-surgery. However, the specific surgical, clinical, and psychosocial factors influencing sexual activity and changes in sexual function remain unclear. For a study, researchers sought to investigate the relationship between baseline psychosocial factors and both sexual activity and sexual function six months after hysterectomy.

As part of an observational cohort study evaluating presurgical predictors of post-hysterectomy outcomes, patients undergoing hysterectomy for benign, non-obstetric reasons were prospectively recruited. The Female Sexual Function Index was administered before and six months after the hysterectomy, alongside validated self-reported measures of depression, resilience, relationship satisfaction, emotional support, and social participation.

Among the 193 patients with complete data, 149 (77.2%) reported engaging in sexual activity at the six-month mark following hysterectomy. A binary logistic regression model that explored sexual activity at this point revealed a few significant associations. Older age (odds ratio 0.91; 95% CI 0.85–0.96; P = 0.002) was linked to a reduced likelihood of being sexually active, indicating that for each year older, the likelihood of sexual activity decreased by 9%. Conversely, higher levels of relationship satisfaction reported before the surgery (odds ratio 1.09; 95% CI 1.02–1.16; P = 0.008) were associated with an increased likelihood of sexual activity at six months post-hysterectomy. As expected, patients who were sexually active before the operation were nearly ten times more likely to remain sexually active post-hysterectomy (odds ratio 9.78; 95% CI 3.95–24.19; P < 0.001).

Further analyses focusing on the Female Sexual Function Index scores were conducted among patients who were sexually active both before and after the procedure, comprising 132 individuals (68.4% of the study population). In this group, there was no significant change in the overall Female Sexual Function Index score from baseline to the six-month mark, but there were notable alterations in specific domains of sexual function. Patients reported significant improvements in desire (P = 0.012), arousal (P = 0.023), and pain (P < 0.001) domains. In contrast, there were significant declines in the orgasm (P< 0.001) and satisfaction (p < 0.001) domains. It’s worth noting that a substantial proportion of patients met the criteria for sexual dysfunction at both baseline and six-month follow-up, with this proportion not showing a statistically significant change. In a multivariate linear regression model, the analysis found no discernible relationship between changes in sexual function score and any of the examined variables, including age, history of endometriosis, pelvic pain severity, or psychosocial measures.

Among patients with pelvic pain who underwent hysterectomy for benign indications, sexual activity, and sexual function remained relatively stable after the procedure. Factors associated with a greater likelihood of postoperative sexual activity included higher preoperative relationship satisfaction, younger age, and preoperative sexual activity. Notably, psychosocial factors, including depression, relationship satisfaction, emotional support, and a history of endometriosis, did not influence changes in sexual function among patients who were sexually active both before and after hysterectomy.

Source: ajog.org/article/S0002-9378(23)00418-0/fulltext