Laparoscopic versus vaginal cuff closure in laparoscopic hysterectomy: does it affect female sexuality?

Objectives: To investigate the effect of vaginal cuff closure technique in laparoscopic hysterectomy on vaginal length and female sexual functions.

Material And Methods: This study was conducted at a tertiary research hospital. Women who underwent laparoscopic hysterectomy were included and classified according to vaginal cuff closure technique as laparoscopic (n = 75) and vaginal route (n = 25). Vaginal lengths were measured preoperatively and at 6th month postoperatively. Golombok-Rust Inventory of Sexual Satisfaction (GRISS) was used to evaluate female sexual functions. SPSS was used for statistical analysis and the level of significance was p = 0.05.

Results: Preoperative GRISS scores and vaginal lengths were similar in two groups. The shortening of vaginal length and the worsening of GRISS scores were more prominent in vaginal cuff closure group (p = 0.002, p < 0.001). The alteration in vaginal length was positively correlated with the alteration in GRISS score in vaginal and laparoscopic route groups (r = 0.800, p < 0.001; r = 0.680, p < 0.001). The risk of female sexual dysfunction increases 69.88 fold for each 1 cm shortening of vaginal length (p = 0.039). Discriminative value of postoperative vaginal length for female sexual dysfunction in patients who underwent laparoscopic hysterectomy was investigated and a cut-off value of 7.4 cm (p < 0.001) was found.

Conclusions: Laparoscopic route instead of vaginal route in laparoscopic hysterectomy is preferable to preserve a better vaginal length, which may be an important factor for female sexual functions.