| Objective:By comparing the female sexual hormone levels,the peri-menopause symptoms and the changes of sexual function for patients with laparoscopic total hysterectomy preoperatively and postoperatively,we intended to investigate whether laparoscopic total hysterectomy had any effect on sexual hormones and sexual function in women of reproductive age.At the same time,the specific changes of sexual hormones and sexual stages were analyzed,and the possible causes of postoperative sexual function changes were analyzed,so as to provide guidance and treatment basis for the follow-up clinical work.Methods:We prospectively issued and collected modified Kupperman rating tables and FSFI questionnaire in women of childbearing age(30-50 years old)who were hospitalized in ZhongDa Hospital for "uterine benign lesions" from January 1,2017 to March 31,2018.The preoperative sexual hormone(on the second or third day of the menstrual cycle)was completed simultaneously.Blood samples and the questionnaires were taken 3 months,6 months and 1 year after surgery.Results:1.Initially,162 eligible patients were brought into our study.Before surgery,relevant preparation including the sexual hormone test,Kupperman scale and FSFI questionnaire were finished.After eliminating the unqualified questionnaires,only 157 remained.22 patients with FSH>25.00 mIU/mL were considered to have ovarian dysfunction.37 cases were excluded because of their preoperative sexual dysfunction indicated by the preoperative FSFI questionnaire.During the follow-up,1 case was lost due to patient’s missing visit.Therefore,97 patients finally entered the following study,with an average age of 46.52±3.44 years old and an average uterine size of 10.29±3.26 weeks.2.Sexual hormones: The FSH and LH at each time point after surgery were higher than those before surgery.During the follow-up 3 months after surgery,both FSH and LH were significantly increased,but with the extension of postoperative recovery time,the levels of FSH and LH in the patients at 1 year after surgery were decreased compared with that at 3 months after the operation.There were statistically significant differences in FSH and E2 before surgery,3 months after surgery,6 months after surgery and 1 year after surgery(P<0.05).There was no significant difference in LH between 3 months after surgery and 6 months after surgery(P>0.05).3.Kupperman scores: All patients were scored less than 6 points in Kupperman before surgery,presenting no obvious perimenopausal symptoms.The patients showed obvious perimenopausal symptoms,which were characterized by hot flashes,sweating,insomnia and pain in sexual intercourse after surgery.At the follow-up of 3 months after surgery,Kupperman score was significantly higher than that before surgery.One patient had severe perimenopausal symptoms whose Kupperman score was 18.0 3 months after surgery and 1 year after surgery,the symptoms were better,but still more obvious than that before surgery.The pairwise comparison of Kupperman scores in four time points before surgery,3 months after surgery,6 months after surgery and 1 year after surgery was of statistical significance.(P<0.05).4.The female sexual function: All of the patients scored more than 26.55 of FSFI before surgery,showing no FSD.Due to concerns about the healing of vaginal stump,53 out of 97 patients(54.64%)had no sexual life by 3 months after surgery,and 4(4.12%)had no sexual life by 6 months after surgery.The FSFI scores of the patients 3 months after the surgery,6 months after the surgery and 1 year after the surgery were significantly lower than the preoperative,showing more obvious FSD.The incidence of FSD almost reached 100% 3 months after surgery,and the incidence of FSD was about 49.48% 1 year after surgery.The most prominent dimensions of sexual dysfunction include vaginal lubrication,pain during sexual intercourse,and sexual satisfaction.There was no significant difference in sexual desire score(P > 0.05).Except that the libido level at 6 months after surgery was different from that at 3 months and 1 year after surgery(P<0.05),there was no significant difference in libido at other time points(P>0.05).There was no significant difference in the scores of sexual arousal dimensions between preoperative and 1 year after surgery(P=0.076).There was no significant difference in the scores of sexual arousal dimensions between preoperative and 1 year after surgery(P=0.549).There were no statistically significant differences in the scores of vaginal lubrication,orgasm,and coital pain between 3 months and 6 months after surgery(P=0.091,P=0.991,P=0.109),and there were statistically significant differences in pairwise comparisons at other time points(P<0.05).Conclusions:1.Laparoscopic total hysterectomy will have a certain negative impact on ovarian function of reproductive age at short notice,causing perimenopausal symptoms in a short time after surgery,and thus adversely affecting the quality of sexula life postoperatively.2.In terms of the effect of LTH on female sexual function in the younger women,except that it has no significant effect on sexual desire,sexual arousal,vaginal lubrication,orgasm,sexual satisfaction and other dimensions postoperatively were all decreased compared with that before surgery.The incidence of vaginal lubrication and sexual pain was significantly increased.3.The ovarian dysfunction and sexual function in women of childbearing age may be self-limiting,but it has not reached the preoperative level until 1 year after the operation.Postoperative attention should be paid to sexual dysfunction in the corresponding dimensions and active treatment measures should be taken to improve postoperative sexual function,including perioperative psychological education and sexual health guidance. |
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