Sexual Functioning After Total Compared With Supracervical Hysterectomy: A Randomized Trial

TLDR

The study compared sexual functioning and quality‑of‑life after total versus supracervical hysterectomy in women with uterine leiomyomata or bleeding unresponsive to hormones. 135 women undergoing abdominal hysterectomy were randomized to total or supracervical surgery, with sexual functioning measured at 2 years using the Medical Outcomes Study Sexual Problems Scale and additional quality‑of‑life outcomes assessed at 6 months and 2 years. Both groups experienced marked improvement in sexual functioning and quality‑of‑life, with similar scores at 2 years (SCH 82 vs TAH 80, difference +2, 95 % CI –8 to +11) and no significant differences between procedures.

Abstract

In Brief OBJECTIVE: To compare sexual functioning and health-related quality-of-life outcomes of total abdominal hysterectomy (TAH) and supracervical hysterectomy (SCH) among women with symptomatic uterine leiomyomata or abnormal uterine bleeding refractory to hormonal management. METHODS: We randomly assigned 135 women scheduled to undergo abdominal hysterectomy in 4 U.S. clinical centers to either a total or supracervical procedure. The primary outcome was sexual functioning at 2 years, as assessed by the Medical Outcomes Study Sexual Problems Scale. Secondary outcomes included specific aspects of sexual functioning and health-related quality-of-life at 6 months and 2 years. RESULTS: Sexual problems improved dramatically in both randomized groups during the first 6 months and plateaued by 1 year. Health-related quality-of-life scores also improved in both groups. At 2 years, both groups reported few problems with sexual functioning (mean score on the Sexual Problems Scale for SCH group 82, TAH group 80, on a 0-to-100 scale with 100 indicating an absence of problems; difference = +2, 95% confidence interval –8 to + 11), and there were no significant differences between groups. CONCLUSION: Supracervical and total abdominal hysterectomy result in similar sexual functioning and health-related quality of life during 2 years of follow-up. This information can help guide physicians as they discuss surgical options with their patients. LEVEL OF EVIDENCE: I Sexual functioning and health-related quality-of-life outcomes are similar in a randomized comparison of supracervical compared with total hysterectomy.