Sexual Function, Activity and Distress 24 Months After Surgical Menopause: What Happens After Menopause ( WHAM )—A Prospective Controlled Study

ABSTRACT Objective To determine the effect of surgical menopause (risk‐reducing salpingo‐oophorectomy, RRSO) on sexual function and the modifying effects of HRT. Design Prospective observational study of women undergoing RRSO and age‐matched comparison group who retained their ovaries. Setting High‐risk clinics and general population. Methods Sexual function was measured at baseline, 3, 6, 12 and 24 months. Main Outcome Measures Primary outcome was sexual function at 24 months using the Female Sexual Function Index (FSFI). Secondary outcomes included the Fallowfield Sexual Activity Questionnaire (SAQ) and Female Sexual Distress Scale‐Revised (FSDS‐R). Results Baseline sexual function was similar between groups. At 24 months, sexual dysfunction increased from 19% to 42% after RRSO versus 24% to 29% in comparisons (Odds Ratio (OR) 1.9, 95% CI 0.7–5.1; p = 0.21). Compared to comparisons, sexual desire (−0.4, p = 0.02), arousal (−0.7, p < 0.001), lubrication (−0.6, p = 0.01) and satisfaction (−0.6, p < 0.001) were significantly reduced in the RRSO group. Sexual pain (−0.5, p = 0.05) and discomfort (−1.0, p < 0.001) increased after RRSO; sexual habit was unchanged. Sexual distress nearly quadrupled in the RRSO group (OR 3.7, 95% CI 1.6–9.0; p = 0.003). After RRSO, 61% commenced HRT. HRT was not associated with sexual function, activity or distress. Conclusions Sexual dysfunction and distress increased after RRSO. Use of HRT was not associated with better sexual function.