Cervix removal at the time of hysterectomy: factors affecting patients' choice and effect on subsequent sexual function

Objectives: To identify factors that influence the decision-making process on the type of hysterectomy (total or supracervical) and the impact of surgery of subsequent sexual function. Study design: A cross-sectional survey was undertaken on 212 women who underwent total laparoscopic hysterectomy (TLH) or laparoscopic supracervical hysterectomy (LSH) for benign conditions at the Division of Minimally Invasive Gynecology at Brigham and Women's Hospital in Boston, MA, USA. We analyzed the factors that patients considered in their decision-making process, their sexual function after surgery and their satisfaction with the surgery overall. Demographic and perioperative outcomes were also collected. Results: A total of 115 women answered the survey, for a response rate of 54.24%. The patients who underwent LSH (n = 54) and TLH (n = 61) were overall similar in terms of baseline factors and perioperative outcomes. Patients reported that the physician was the main source of information regarding decision to remove or retain the cervix (79.13%). The physicians' recommendation was viewed as very or extremely important (83.68%) to the decision-making process, followed by concerns regarding their future sex life (51.09%). Almost half of the women reported that hysterectomy had no impact on sexual function. No statistically significant differences were seen between groups regarding satisfaction with sexual function (p = .822), impact on sexual function (p = .753) or recommendation of this surgery to other women (p = .505). Conclusion: Concerns about sexual health were important to women when considering the type of hysterectomy to undergo. Cervix removal or retention at the time of hysterectomy did not impact women's sexual function after mean follow-up of 15.2 months. (C) 2015 Elsevier Ireland Ltd. All rights reserved. (AU)