Nerve-Sparing Approach Reduces Sexual Dysfunction in Patients Undergoing Laparoscopic Radical Hysterectomy

IntroductionAlthough growing evidence suggests the beneficial effects of a nerve-sparing (NS) approach to surgery in cervical cancer patients, only limited data on NS laparoscopic radical hysterectomy (LRH) are available, and no studies have investigated the effects of NS-LRH on sexual function. AimThis study aims to determine whether the implementation of NS-LRH impacts on sexual function in cervical cancer patients. MethodsSexually active cervical cancer patients undergoing type C (class III) LRH between 2004 and 2013 were enrolled in this prospective study. Main Outcome MeasuresPreoperative and postoperative sexual function were assessed using a validated questionnaire, the Female Sexual Function Index (FSFI). The FSFI evaluates desire, arousal, lubrication, orgasm, satisfaction, and pain. ResultsForty patients undergoing radical hysterectomy (20 conventional LRH vs. 20 NS-LRH) represented the study group. Baseline characteristics were similar between groups (P>0.05). No differences in preoperative FSFI scores were recorded (P>0.05). We observed that both LRH and NS-LRH worsened postoperative FSFI scores (P<0.001). However, patients undergoing NS-LRH had higher postoperative FSFI scores than patients undergoing LRH (21.39.4 vs. 14.2 +/- 12.5; P=0.04). Considering postoperative domain scores, we observed that desire, arousal, orgasm, and pain scores were similar between groups (P>0.05), while patients undergoing NS-LRH experienced higher lubrication (3.4 +/- 2.3 vs. 1.7 +/- 2.2; P=0.02) and satisfaction (4.6 +/- 3.9 vs. 2.8 +/- 2.2; P=0.004) scores in comparison with patients undergoing conventional LRH. No between-group differences in survival outcomes were found. ConclusionsBoth conventional LRH and NS-LRH impact negatively on patients' sexual function. However, the NS approach impairs sexual function less, minimizing the effects of radical surgery. Bogani G, Serati M, Nappi R, Cromi A, di Naro E, and Ghezzi F. Nerve-sparing approach reduces sexual dysfunction in patients undergoing laparoscopic radical hysterectomy. J Sex Med 2014;11:3012-3020.