Sexual Functions after Laparoscopically Assisted Vaginal Hysterectomy (LAVH) and Total Laparoscopic Hysterectomy (TLH) in preoperatively asymptomatic women

Authors: D. Kužel 1;  P. Weiss 2;  K. Kubínová 1;  L. Mašková 3;  O. Sosna 1;  L. Bartošová 1;  P. Horák 1;  D. Tóth 4;  M. Fanta 1;  M. Mára 1
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN, Praha, přednosta prof. MUDr. A. Martan, DrSc. 1;  Sexuologický ústav 1. LF UK a VFN, Praha, vedoucí doc. MUDr. J. Zvěřina, CSc. 2;  Psychiatrická léčebna Bohnice, Praha, ředitel MUDr. M. Hollý 3;  Clinique Saint-Germain, Brive La Gaillarde, France 4
Published in: Čes. Gynek.2009, 74, č. 2 s. 130-137
Category: Original Article


To find the consequences of laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH) for sexual functions in preoperatively asymptomatic women.

Prospective study.

Department of Obstetrics and Gynecology, 1st Faculty of Medicine, Charles University and General Teaching Hospital in Prague.

Material and methods:
In 100 women without subjective complaints hysterectomy was performed for benign uterine pathology. In all the women the uterus weighted less than 250 g, there were no salpingo-oophorectomies and no perioperative complications. Women were alternativelly assigned for LAVH (n=50) or TLH (n=50). Clinical documentation and questionnaires about sexual functions were evaluated in 87 women (in 40 women after LAVH and in 47 after TLH) 18 months after surgery or later.

According to our findings the type of surgery did not influence the frequency of sexual activity after surgery, there was no change in sexual manners using during coitus as well as no change in preferred way how to reach the sexual arousal (clitoridally, vaginally or combined). The type of surgery did not influence frequency, quality and duration of orgasm. From all the evaluated parameters there were only two significantly different: the presence of postoperative sexual activity (positive answer in all women from LAVH group and only in 85% women from TLH group, F test, p=0,009) and the frequency of sexual satisfaction (in terms of both increase and also decrease in TLH group χ2 8,376, p=0,015).

The type of laparoscopic hysterectomy (LAVH or TLH) does not significantly affect the sexual functions (frequency of sexual satisfaction, type of sexual arousability, intensity and duration of orgasm) in preoperatively asymptomatic women.

Key words:
sexual functions, laparoscopic hysterectomy.


1. Bancroft, J., Lotus, JL., Long, JS. Distress about sex: A national survey of women in heterosexual relationships. Arch Sexual Behavior, 2003, 23, p. 193-208.

2. Butler, RN., Lewis, MI., Hoffman, E., Whitehead, ED. Love and sex after 60: how to evaluate and treat the sexually-active woman. Geriatrics, 1994, 49, p. 33-4, 37-8, 41-2.

3. Butler-Manuel, SA., Buttery, LDK., A’Hern, RP., et al. Pelvic nerve plexus trauma at radical hysterectomy and simple hysterectomy: The nerve content of the uterine supporting ligaments. Cancer, 2000, 89, p. 834-841.

4. Carlson, KJ., Miller, BA., Fowler, FJ, Jr. The Main Women’s Health Study: I. Outcomes of hysterectomy. Obstet Gynecol, 1994, 83, p. 556–565.

5. Clark, TJ., Gupta, JK. Outpatient thermal balloon ablation of the endometrium. Fertil Steril, 2004, 82, p. 1395-1401.

6. Dennerstein, L., Wood, C., Burrows, GD. Sexual response following hysterectomy and oophorectomy. Obstet Gynecol, 1977, 49, p. 92-95.

7. Dennerstein, L., Koochaki, P., Barton, I., Graziottin, A. Hypoactive sexual desire disorder in menopausal women: A survey of Western European women. J Sex Med, 2006, 3, p. 212-222.

8. Donnez, J., Nisolle, M. Laparoscopic supracervical (subtotal) hysterectomy. J Gynecol Surg, 1993, 2, p. 91-94.

9. Falcone, T,, Walters, MD. Hysterectomy for benign disease. Obstet Gynecol, 2008, 111, p. 753-767.

10. Farrell, SA., Kieser, K. Sexuality after hysterectomy. Obstet Gynecol, 2000, 95, p. 1045-1051.

11. Flory, N., Bissonnette, F., Amsel, RT., Binik, YM. The psychosocial outcomes of total and subtotal hysterectomy: A randomized controlled trial. J Sex Med, 2006, 3, p. 483-491.

12. Garry, R., Reich, H., Liu, CY. Laparoscopic hysterectomy: Definition and indications. Gynaecol Endosc, 1994, 3, p. 1-3.

13. Garry, R. Towards evidence-based hysterectomy. Gynaecol Endosc, 1998, 7, p. 225-233.

14. Garry, R., Fountain, J., Brown, J., et al. Evaluate hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy. Health Technol Assess, 2004, 8, p. 1-154.

15. Harris, MB., Olive, DI. Changing hysterectomy patterns after introduction of laparoscpically assisted vaginal hysterectomy. Am J Obstet Gynecol, 1994, 171, p. 340-344.

16. Hartman, KE., Ma, C., Lamvu, GM., et al. Quality of life and sexual function after hysterectomy in women with preoperative pain and depression. Obstet Gynecol, 2004, 104, p. 701–709.

17. Helström, L., Lundberg, PO., Sörbom, D., Bäckstöm, T. Sexuality after hysterectomy: a factor analysis of women@s sexual lives efore and after subtotal hysterectomy. Obstet Gynecol, 1993, 81, p. 357-362.

18. Hurskainen, R., Tepeti, J., Rissanen, P., et al. Quality of life and cost-effectiveness of levonorgestrel-releasing intrauterine system versus hysterectomy for treatment of menorrhagia: a randomised trial. Lancet, 2001, 357, p. 273-277.

19. Chapron, C., Dubuisson, JB., Aubert, V., et al. Total laparoscopic hysterectomy. Preliminary results. Hum Reprod, 1994, 9, p. 2084-2089.

20. Chapron, C., Dubuisson, JB., Ansquer, Y. Hysterectomy for patients without previous vaginal delivery. Results and modalities of laparoscopic surgery. Hum Reprod, 1996, 10, p. 2112-2126.

21. Cheung, VY., Rosenthal, DM., Morton, M., Kadanka, H. Total laparoscopic hysterectomy: a five-year experience. J Obstet Gynaecol Can, 2007, 29, p. 337-343.

22. Johns, DA., Carrerra, B., Jones, J., et al. The medical and economic impact of laparoscopically assisted vaginal hysterectomy in a large, metropolitan, non-forprofit hospital. Am J Obstet Gynecol, 1995, 172, p. 1709-1719.

23. Johnson, N., Barlow, D., Lethaby, A., et al. Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. BMJ, 2005, 330, p. 1478-1481.

24. Kilkku, P. Supravaginal uterine amputation vs. hysterectomy. Effects on coital frequency and dyspareunia. Acta Obstet Gynecol Scand, 1983, 62, p. 141-145.

25. Kilkku, P., Gronroos, M., Hirvonen, T., Rauramo, L. Supravaginal uterine amputation vs. hysterectomy: Effect on libido and orgasm. Acta Obstet Gynecol Scand, 1983, 62, p. 147-152.

26. Kjerulff, KH., Langenberg, PW., Rhodes, JC., et al. Effectiveness of hysterectomy. Obstet Gynecol, 2000, 95, p. 319‑326.

27. Kuppermann, M., Summitt, FL, Jr., Verner, RE., et al. Total or Supracervical Hysterectomy Research Group. Obstet Gynecol, 2005, 105, p. 1309-1318.

28. Laumann, EO., Paik, A., Rosen, RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA, 1999, 281, p. 537-544.

29. Lethaby, A., Ivanova, V., Johnson, NP. Total versus subtotal hysterectomy for benign gynaecological conditions. Obstet Gynecol, 2007, 110, p. 705-706.

30. Levin, RJ. The physiology of female sexual function in women. Clin Obstet Gynaec. 1980, 7, p. 213-252.

31. Léonard, F., Fotso, A., Borghese, B., et al. Ureteral complications from laparoscopic hysterectomy indicated from laparoscopic hysterectomy indicated for benign uterine pathologies: a 13-year experience in continuous series of 1300 patients. Hum Reprod, 2007, 22, p. 2006-2011.

32. Liu, CY. Laparoscopic hysterectomy: A review of 72 cases. J Reprod Med, 1992, 37, p. 351-354.

33. Long, CY., Fang, JH., Chen, WC., et al. Comparison of total laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy. Gynecol Obstet Incest, 2002, 53, p. 214-219.

34. Maas, CP., DeRuiter, MC., Kenter, GG., Trimbos, JB. The inferior hypogastric plexus in gynecologic surgery. J Gynaecol Techniques, 1999, 5, p. 55-62.

35. Maas, CP., Weijenborg, PT., ter Kuile, MM. The effect of hysterectomy on sexual functioning. Annu Rev Sex Res, 2003, 14, p. 83-113.

36. Mára, M., Fučíková, Z., Mašková, J., et al. Uterine fibroid embolization versus myomectomy in women wishing to preserve fertility: preliminary results of a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol, 2006, 126, 2, p. 226-233.

37. Marana, R., Busaca, M., Zupi, E., et al. Laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy: A prospective, randomized, multicenter study. Am J Obstet Gynecol, 1999, 180, p. 270-275.

38. McPherson, K., Herbert, A., Judge, A., et al. Psychosexual health 5 years after hysterectomy: population-based comparison with endometrial ablation for dysfunctional uterine bleeding. Health Expect, 2005, 8, p. 234-243.

39. Meikle, SF., Nugent, EW., Orleans, M. Complications and recovery from laparoscopically assisted vaginal hysterectomy compared with abdominal hysterectomy. Obstet Gynecol, 1997, 89, p. 304-311.

40. Munro, MG., Parker, WH. A Classification System for Laparoscopic Hysterectomy. Obstet Gynecol, 1993, 82, p. 624-629.

41. Nationwide Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP). Available at: Retrieved December 28, 2007.

42. Nathost-Böös, J., von Schoultz, B. Psychological reactions and sexual life after hysterectomy with and without oophorectomy. Gynecol Obstet Invest, 1992, 34, p. 97-101.

43. Ng, CC., Chern, BS. Total laparoscopic hysterectomy: a 5-year experience. Arch Gynecol Obstet, 2007, 276, p. 613-618.

44. Oldenhave, A., Jaszmann, LJ., Everaerd, WT., Haspels, AA. Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age. Am J Obstet Gynecol, 1993, 168, p. 765-771.

45. Pelosi, MA. Laparoscopic supracervical hysterectomy using a single umbilical puncture: Mini-laparoscopy. J Reprod Med, 1992, 37, p. 774-784.

46. Phipps, JH., John, M., Nayak, S. Comparison of laparoscopically assisted vaginal hysterectomy and bilateral salpingo-oophorectomy with conventional abdominal hysterectomy and bilateral salpingo-oophorectomy. Br J Obstet Gynaecol, 1993, 100, p. 698-700.

47. Pinto, I., Chimeno, P., Romo, A., et al. Uterine fibroids: uterine artery embolization versus abdominal hysterectomy for treatment–a prospective, randomized, and controlled trial. Radiology, 2003, 226, p. 425-431.

48. Reich, H., DeCaprio, J., McGlyn, F. Laparoscopic Hysterectomy. J Gynecol Surg, 1989, 5, p. 213-216.

49. Reich, H., McGlynn, F., Sekel, L. Total laparoscopic hysterectomy. Gynaecol Endosc, 1993, 2, p. 59-63.

50. Reich, H., Roberts, L. Laparoscopic hysterectomy in current gynaecological practice. Rev Gynaecol Pract, 2003, 3, p. 32-40.

51. Rhodes, JC., Kjerulff, KH., Langenberg, PW., Guzinski, GM. Hysterectomy and sexual functioning. JAMA, 1999, 282, p. 1934-1941.

52. Roovers, JP., van der Bom, JG., van der Vart, CH., Heintz, AP. Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. BMJ, 2003, 327, p. 774-778.

53. Saye, WB., Espy, GB., Bischop, MR., et al. Laparoscopic Doderlein hysterectomy: A rational alternative to traditional abdominal hysterectomy. Surg Laparosc Endosc, 1993, 3, p. 88-94.

54. Shifren, JL., Braunstein, GD., Simon, JA., et al. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Engl J Med, 2000, 343, p. 682-688.

55. Siow, A., Nikam, YA., Ng, CC, Su, MC. Urological complications of laparoscopic hysterectomy: a four-year review at KK Women@s and Children@s Hospital, Singapure. Singapure Med J, 2007, 48, p. 217-221.

56. Thakar, R., Avers, S., Clarkson, P., et al. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med, 2002, 347, p. 1318-1325.

57. Thakar, R., Ayers, S., Georgakapolou, A., et al. Hysterectomy improves duality of life an decreases psychiatric symptoms: a prospective and randomised comparison of total versus subtotal hysterectomy. BJOG, 2004, 111, p. 1115-1120.

58. Vessey, MP., Villard-Mackintosh, L., McPherson, K., et al. The epidemiology of hysterectomy: Findings in a large cohort study. Br J Obstet Gynaecol, 1992, 99, p. 402-407.

59. Virtanen, H., Makinen, J., Tenho, T. Effects of abdominal hysterectomy on urinary and sexual symptoms. Br J Urol, 1993, 72, p. 868-872.

60. Wu, JM., Wechter, ME., Geller, EJ., et al. Hysterectomy rates in the United States, 2003. Obstet Gynecol, 2007, 110, p. 1091–1095.

61. Zekam, N., Oyelese, Y., Goodwin, K., et al. Total versus subtotal hysterectomy: a survey of gynecologists. Obstet Gynecol, 2003, 102, p. 301-305.

Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine

Article was published in

Czech Gynaecology

Issue 2

2009 Issue 2

Most read in this issue

This topic is also in:

Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account