Sexual activity after pelvic surgeries

Abstract

Introduction Approximately 50%–70% of women will undergo pelvic surgery at some point in their lives, including procedures such as hysterectomy, suburethral sling placement, and genital prolapse repair. These interventions are performed for indications like uterine fibroids, chronic pelvic pain, pelvic adhesions, and urinary or fecal incontinence3. Societal and cultural influences, along with the lack of comprehensive sexual education by physicians, have limited awareness and open discussion regarding the effects of pelvic surgery on sexual function. Objective The goal of this study is to demonstrate the positive impact of pelvic surgeries on sexual activity in a large percentage of women who have undergone these procedures. Methods This investigation analyzed the postoperative sexual function of hundreds of patients across two centers where 2,526 procedures were performed between the ages of 18 and 76 years. All participants were pre-screened using the Female Sexual Function Index (FSFI). Participants underwent comprehensive evaluations before and after surgical intervention. All participants who qualified for Hormone Replacement Therapy (HRT) were offered it, and those who did not decline were treated, in addition to receiving re-education for the needs of increased sexual activity. All patients were prescribed local estrogen therapy and advised to engage in self-stimulation with a dilator, particularly for those without partners. Follow-up evaluations were conducted at regular intervals up to 24 months after the surgical procedures. Results The study yielded highly promising results, with a marked improvement in sexual function observed in a vast majority of cases, exceeding 85%. Specific procedures showed high success rates, such as Total Abdominal Hysterectomy (82.4%), Laparoscopic/Robotic Hysterectomy (91.1%), and Labioplasty (94.4%). Conversely, Anterior/Posterior Repair showed a 50.0% improvement. A total of 1,120 patients (85%) reported significant improvement of their sexual function at the 24-month follow-up. Conclusions Contrary to prior reports, pelvic surgeries improved sexual activity in over 85% of cases. Most women experienced enhanced pain relief and satisfaction, particularly after prolapse repair or hysterectomy, while a minority developed new sexual dysfunction following incontinence surgery. Preoperative dyspareunia and complications increased the risk of poor outcomes. These results highlight the importance of individualized preoperative counseling, structured postoperative follow-up, the selective use of hormone replacement therapy, and sexual re-education to promote sexual activity to optimize sexual health outcomes. Disclosure No