Sexual Function Outcomes after Total vs Subtotal Hysterectomy: A Comparative Study in Tunisian Women

Introduction: Hysterectomy is a common gynecological procedure performed for both benign and malignant conditions worldwide. Its potential impact on female sexual function remains a concern for both physicians and patients. The surgical approach -total hysterectomy (TH) versus subtotal hysterectomy (SH)- may influence postoperative outcomes, particularly in relation to sexual function, a key component of women's well-being. In Tunisia, social and cultural factors often restrict open discussions about sexuality, making Tunisian women’s sexual health underexplored. This study aims to compare the impact of the two techniques of hysterectomy on postoperative sexual function among Tunisian women. Methods: This prospective observational study was conducted at the Maternity Center of Tunis (CMNT) from March to May 2022. Sixty sexually active women who had undergone either TH or SH were included through a consecutive sampling method among patients presenting to the emergency department. Sexual function, both before and after surgery, was evaluated using the Female Sexual Function Index (FSFI), which is available in validated Arabic and French versions. Statistical analysis was performed using the Chi-square test, with p < 0.05 considered significant. Data were collected anonymously, and written informed consent was obtained from all participants. Results: The mean age of patients was 51.2 years. TH was performed in 60% of cases (n = 36), and SH in 40% (n = 24). The overall FSFI score declined significantly following surgery, decreasing from 78.3 to 47.3. No statistically significant differences were observed between the TH and SH groups in the domains of desire, arousal, or pain (p = 0.07). SH was associated with significantly improved lubrication and more intense orgasms compared to TH (p = 0.03). Women who underwent hysterectomy with bilateral salpingo-oophorectomy (BSO) reported significantly lower sexual function and more pain during intercourse compared to those who underwent ovary-sparing hysterectomy (p < 0.05). Discussion: Some studies suggest better outcomes with SH, while many others have reported improved orgasm and satisfaction. However, some authors found no significant difference. Conclusions: SH may offer benefits over TH in terms of lubrication and orgasm, although the overall difference in postoperative sexual function was not significant. BSO appears to negatively affect sexual function, contributing to decreased libido and increased dyspareunia. These findings emphasize the importance of individual decision-making and informed patient counseling. Further research into larger simple sizes is needed to confirm these findings.