Sexual Function There is considerable debate in the lay literature about the effect of hysterectomy on sexual function, although evidence consistently suggests that the majority of women have unchanged or improved sexual function 1 to 2 years after hysterectomy (13,64). Few women who had a hysterectomy had a measurable worsening in sexual function during this time period. The long-term effects of hysterectomy on sexual function remain largely unknown. Studies have addressed the short-term effects of hysterectomy on dyspareunia, frequency of intercourse, orgasm, libido or sexual interest, vaginal dryness, and overall sexual function. The Maine Women’s Health Study demonstrated a significant decrease in the number of women who reported dyspareunia 12 and 24 months after hysterectomy compared to the preoperative period (13). Eighty-one percent of the women who experienced dyspareunia preoperatively had an improvement in this symptom at 24 months after hysterectomy, while only 1.9% of women without preoperative dyspareunia developed it by 24 months after surgery. In this study, 39% of women reported dyspareunia preoperatively, and only 8% had this complaint 12 months after hysterectomy. Women who were managed nonsurgically showed no decline in the mean frequency of dyspareunia (13).
Most studies report that hysterectomy has little impact on the frequency of intercourse, libido, and sexual interest. Orgasmic function before and after hysterectomy is somewhat more controversial, but the largest study by Carlson et al. reported a slight increase in the proportion of women who experienced orgasms after a hysterectomy (13). It is plausible that removal of the uterus and/or cervix (especially if the ovaries are also removed) may adversely affect sexual function in some women, but this may be offset by the improvement in sexual function that could result from cessation of abnormal or heavy vaginal bleeding, dysmenorrhea, or symptoms of prolapse. It is likely that vaginal dryness is not affected by hysterectomy and depends more on age and postoperative hormonal status. Body image and sexual function are improved after vaginal, abdominal, and laparoscopic hysterectomy, but no differences were found between the three routes (13,63).
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