Impact of cervical preservation on vaginal length and female sexual function after hysterectomy for benign conditions: a retrospective cohort study

Objective: To evaluate how preserving the cervix and maintaining vaginal length influenced sexual function in patients undergoing hysterectomy for benign disorders. Material and Methods: This retrospective analysis included patients who had either total or subtotal hysterectomy for benign disorders between 2020 and 2022, with vaginal lengths recorded both before and after surgery. The female sexual function index (FSFI) was completed by the patients before surger y and again 24 months postoperatively, while their partners were given the International Index of Erectile Function. Results: Eighty-five patients were included, with 42 (49%) in the total hysterectomy group and the remainder in the sub-total group. While no significant change in vaginal length was observed in women who underwent subtotal hysterectomy (p>0.05), the total hysterectomy group showed a marked reduction in vaginal length postoperatively (10±1 cm vs. 6.6±1.1 cm, p<0.001). The reduction in FSFI scores for the subtotal hysterectomy group was notably lower compared to the total hysterectomy group 1.4 (0.8-2.1) vs. 9.2 (8.2-10.1), p<0.001. Conclusion: While both total and subtotal hysterectomy procedures were associated with decreased sexual function, patients who underwent total hysterectomy showed lower FSFI scores. Previous research has suggested this may be due to lack of cervical ring protection and loss of erogenous zones in the posterior vagina through nerve damage.