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Background <p>Hysterectomy is one of commonly performed gynaecological surgeries. Even though it is effective for treating benign conditions, it can compromise ovarian function by disrupting blood supply, potentially leading to earlier menopause and altered sexual wellbeing. Total abdominal hysterectomy (TAH) and total laparoscopic hysterectomy (TLH) are two widely used approaches; however, their long-term impact on ovarian reserve and sexual function remains debated. Internationally, the Female Sexual Function Index (FSFI) is used as a validated tool to measure sexual health, yet no Sinhala version exists. Through this study, we aimed to compare sexual function and ovarian reserve following TAH and TLH, while also developing and validating a Sinhala version of the FSFI.</p> Methods <p>Conducted in two phases, the first involved the development and validation of a Sinhala version of the FSFI in normal volunteers. The second was a prospective non-randomised cohort study at Teaching Hospital Peradeniya, including 81 patients. Ovarian reserve was assessed with Follicle-stimulating hormone (FSH) and Estradiol (E2) levels before surgery and six months later. Sexual function was measured using the validated Sinhala FSFI at the same time points. Data were analysed using SPSS version 21, with adjusted analyses performed to account for baseline sexual function and selected sociodemographic factors.</p> Results <p>Both groups showed an increase in FSH (TAH: 6.57 to 7.73 mIU/mL; TLH: 5.89 to 6.96 mIU/mL, both <i>p</i> &lt; 0.001) and a reduction in E2 (TAH: 184.05 to 157.20 pmol/L, <i>p</i> = 0.012; TLH: 163.60 to 122.17 pmol/L, <i>p</i> &lt; 0.001). FSFI scores declined in both groups (TAH: 25.77 to 24.46, <i>p</i> = 0.001; TLH: 22.87 to 21.14, <i>p</i> &lt; 0.001). Although baseline and unadjusted follow-up FSFI scores differed between groups, the magnitude of decline was similar (ΔFSFI: TAH − 1.30 vs. TLH − 1.72, <i>p</i> = 0.507). After adjustment for covariates, surgical approach was not independently associated with postoperative sexual function. Hormonal changes were not significantly associated with FSFI outcomes.</p> Conclusion <p>Both approaches were associated with comparable reductions in ovarian reserve and sexual function over a six-months period. Neither approach showed a clear advantage, highlighting the importance of preoperative counselling and individualized surgical planning to ensure that women are aware of potential hormonal and sexual health changes after surgery.</p>

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Comparison of the effects of total laparoscopic hysterectomy and total abdominal hysterectomy on ovarian reserve and sexual function: a non-randomised prospective study

  • 期刊论文

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  • 发表日期：

    2026年1月6日

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  • Sampath Gnanarathne,
  • Chaminda Kandauda,
  • U. A. Isurindi,
  • Ayodya Kariyawasam

摘要

Background

Hysterectomy is one of commonly performed gynaecological surgeries. Even though it is effective for treating benign conditions, it can compromise ovarian function by disrupting blood supply, potentially leading to earlier menopause and altered sexual wellbeing. Total abdominal hysterectomy (TAH) and total laparoscopic hysterectomy (TLH) are two widely used approaches; however, their long-term impact on ovarian reserve and sexual function remains debated. Internationally, the Female Sexual Function Index (FSFI) is used as a validated tool to measure sexual health, yet no Sinhala version exists. Through this study, we aimed to compare sexual function and ovarian reserve following TAH and TLH, while also developing and validating a Sinhala version of the FSFI.

Methods

Conducted in two phases, the first involved the development and validation of a Sinhala version of the FSFI in normal volunteers. The second was a prospective non-randomised cohort study at Teaching Hospital Peradeniya, including 81 patients. Ovarian reserve was assessed with Follicle-stimulating hormone (FSH) and Estradiol (E2) levels before surgery and six months later. Sexual function was measured using the validated Sinhala FSFI at the same time points. Data were analysed using SPSS version 21, with adjusted analyses performed to account for baseline sexual function and selected sociodemographic factors.

Results

Both groups showed an increase in FSH (TAH: 6.57 to 7.73 mIU/mL; TLH: 5.89 to 6.96 mIU/mL, both p < 0.001) and a reduction in E2 (TAH: 184.05 to 157.20 pmol/L, p = 0.012; TLH: 163.60 to 122.17 pmol/L, p < 0.001). FSFI scores declined in both groups (TAH: 25.77 to 24.46, p = 0.001; TLH: 22.87 to 21.14, p < 0.001). Although baseline and unadjusted follow-up FSFI scores differed between groups, the magnitude of decline was similar (ΔFSFI: TAH − 1.30 vs. TLH − 1.72, p = 0.507). After adjustment for covariates, surgical approach was not independently associated with postoperative sexual function. Hormonal changes were not significantly associated with FSFI outcomes.

Conclusion

Both approaches were associated with comparable reductions in ovarian reserve and sexual function over a six-months period. Neither approach showed a clear advantage, highlighting the importance of preoperative counselling and individualized surgical planning to ensure that women are aware of potential hormonal and sexual health changes after surgery.