Does hysterectomy affect genital sensation?

https://doi.org/10.1016/j.ejogrb.2004.09.004Get rights and content

Abstract

Objectives:

To evaluate vaginal and clitoral sensation before and after hysterectomy and to assess pre- and post-surgery changes in sexual function.

Study design:

Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina and clitoris 1 day prior to and 3 months following surgery. A survey was performed 18 months following operation to evaluate long-term changes in sexual function.

Participants:

Twenty-seven women, aged 30–57 years, who were admitted for elective hysterectomy.

Main outcome measures:

Genital sensation and reported sexual function.

Results:

There was significant deterioration in sensation to cold and warm stimuli at the anterior and posterior vaginal wall after surgery. Vaginal vibratory sensation thresholds tended to increase. Clitoral thermal and vibratory sensation thresholds remained unchanged before and after surgery. Of the 22 patients who participated in the follow-up survey, 17 did not report any decline in sexual function, while 4 patients reported deterioration in genital sensation and in sexual function.

Conclusion:

The results demonstrate quantifiable sensory loss in the vagina after hysterectomy, with preservation of clitoral sensation. Only a minority of patients reported a decline in their sexual function. These findings highlight the relative importance of clitoral as compared to vaginal sensation in sexual function.

Introduction

Hysterectomy is the most frequently performed major surgical procedure in gynaecology. It is estimated that by age 64, more than 40% of women will have a hysterectomy [1]. Most hysterectomies are performed due to abnormal uterine bleeding and uterine myoma. Previous studies have shown that women undergoing hysterectomy are concerned about the potential negative effect on their sexual function (SF) [2], [3]. Two studies found that the potential for deterioration in SF after hysterectomy is one of the most frequent pre-operative causes of anxiety [3], [4].

Such concerns about sexual function after hysterectomy are not unfounded: Several reports have indicated that 13–37% of women undergoing hysterectomy report deterioration in SF [5], [6], [7], [8]. Jewett postulated that dyspareunia after hysterectomy might be attributable to shortening of the vagina [9]. Hasson suggested that internal orgasm, caused by stimulation of nerve endings at the utero-vaginal plexus, is hindered by hysterectomy with cervix removal, while external orgasm caused by clitoral stimulation does not seem to be affected [10].

Other possible aetiologies for sexual dysfunction following hysterectomy include direct surgical tissue damage, adhesion formation, and nerve injury. Tissue damage during hysterectomy, including damage to neural tissue, may explain loss of sensation, which, in turn, may be responsible for post-operative female sexual dysfunction (FSD). In addition, vaginal dryness due to oestrogen deficiency can be caused by hysterectomy with bilateral oophorectomy [11]. These symptoms may also occur as a consequence of pre-menopausal hysterectomy without oophorectomy. Research shows that hysterectomy hastens ovarian failure and increases menopausal symptoms, including vaginal dryness [12], [13]. Finally, psychosocial effects have also been described, such as depression and loss of feminine identity [14].

Conversely, other reports suggest that hysterectomy may improve female SF. A recent study by Roovers et al. (2003) found that sexual pleasure improved after vaginal hysterectomy, subtotal hysterectomy, and abdominal hysterectomy [15]. One possible reason for improvement may be the relief from dyspareunia subsequent to removal of the pelvic pathology. Freedom from anxiety concerning possible conception is another possible factor contributing to a post-surgical increase in libido [14].

Thus, despite the fact that hysterectomy is the most frequently performed operation in gynaecology, contradictory data exist in regard to the effect of this procedure on female SF. This lack of clarity may be related to methodological issues. As Farrel and Keiser [16] concluded from their review of the researches, it seems that the majority of studies evaluating the effect of hysterectomy on SF have been poorly designed. Furthermore, due to the reliance of previous studies on self-report questionnaires, there are no data available on post-operative SF.

Therefore, more basic research must be conducted in order to examine the effects of hysterectomy on physiological and sensory mechanisms related to sexual function. Our laboratory has already demonstrated that systematic, quantitative evaluation of the female genital sensory function can be achieved through the use of thermal and vibratory sensations [17]. Moreover, ongoing research in our laboratory suggests that these tests may be sensitive to neural damage related to FSD resulting from neurological disease.

The objectives of the present study were: (1) to evaluate sensory thresholds for warm, cold, and vibratory sensations in the vaginal and clitoral region, both before and after hysterectomy, and (2) to assess changes in SF pre- and post-surgery.

Section snippets

Subjects

The sample consisted of 27 women, aged 30–57 (mean 46.6), who were hospitalised for elective hysterectomy (3 vaginal, 7 transabdominal and 17 transabdominal with bilateral oophorectomy). The indications for hysterectomy included menometrorrhagia and uterine myoma (n = 19), as well as menorrhagia (n = 8). Women with endometrial, cervical or ovarian tumours, diabetes, or any neurological disorder were excluded from participation in the study. The subjects were not using any regular medications and

Results

Pre- and post-surgical sensory thresholds are provided in Table 1. As the table shows, both anterior and posterior vaginal warm thresholds significantly increased, changing from 40.1 ± 0.93 to 41 ± 1.33 °C (p = 0.004) and from 39.4 ± 0.85 °C to 40.5 ± 0.96 °C (p < 0.001), respectively. Similarly, anterior and posterior vaginal cold thresholds significantly increased, from 31.5 ± 1.73 to 30.8 ± 1.67 °C (p = 0.006) and from 32.2 ± 1.42 to 30.8 ± 1.55 °C (p < 0.001), respectively. A trend toward significant increase was also

Discussion

Our findings clearly indicate that hysterectomy results in a statistically significant diminution in the perception of thermal stimuli in the vaginal region, as well as the tendency towards such a change in the perception of vibratory stimuli. Although statistically significant, these decreases in sensitivity appear to be quite minor in absolute terms, within a degree or two for thermal thresholds, and less than a micrometer for vibration.

Of particular interest is the relative preservation of

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