Surgical management is associated with sexual dysfunction in gynecologic cancer

Abstract

Introduction: This study aims to assess the role of route of hysterectomy, operative times, and lymphadenectomy on sexual function using the female sexual function index (FSFI) questionnaire. Methods/materials: The FSFI, a survey of validated instruments, was used to assess sexual dysfunction in 171 women with gynecologic cancer in this cross-sectional study. A sub-analysis was performed for patients who underwent hysterectomy. A significant decline in sexual function was determined to be a decrease of 5.8 points from pre-diagnosis to post-treatment scores using a Reliable Change Index Statistic. Statistical analysis included chi-square, Student’s t-tests, and logistic regression. The primary outcome was determination if surgical route is associated with sexual dysfunction. Secondary outcomes were effect of operative time, lymphadenectomy, and lymph nodes removed on postoperative sexual function. Results: Hysterectomy was performed in 123 patients; 67% (n = 82) had total abdominal hysterectomy (TAH) and 33% (n = 41) had minimally invasive surgery (MIS). Women with TAH reported greater sexual dysfunction (50% vs. 22%; OR: 3.6; 95% CI 1.5–8.4), were more likely to be age < 50 (36.6% vs. 14.6%; OR: 3.4; 95% CI 1.3–8.9), have longer operating times (270 min ± 108 vs. 230 min ± 49; p = 0.02), and have more lymph nodes removed (15.9 ± 6.2 vs. 12.2 ± 9.8; p = 0.05). In logistic regression, TAH and age < 50 were independent predictors of sexual dysfunction, while operative time and lymphadenectomy were not. Conclusions: TAH and age < 50 are risk factors for sexual dysfunction following hysterectomy for gynecologic cancer.

Keywords

• female sexual dysfunction
• female sexual function index (fsfi)
• genital neoplasms
• adult sexuality
• cancer