Deciding between total and subtotal surgery remains a significant challenge for many gynaecologists today. Specifically, patients often express concern about the impact of laparoscopic hysterectomy sexual function on their long-term intimate well-being. A recent longitudinal study tracked 74 patients over an average of seven years to compare Total Laparoscopic Hysterectomy (TLH) with Laparoscopic Supracervical Hysterectomy (LASH). Furthermore, the median follow-up period extended well beyond 90 months for both surgical groups, providing a rare window into very long-term outcomes.

Comparing Long-term Sexual Outcomes

The research team utilized the validated Female Sexual Function Index (FSFI) to meticulously assess postoperative outcomes. Notably, the study found no statistically significant difference in the total FSFI scores between the TLH and LASH cohorts. However, the LASH group experienced a significant deterioration in their scores over the follow-up period. Specifically, lubrication scores declined significantly in women who underwent the supracervical procedure where the cervix is preserved. In contrast, the TLH group maintained remarkably stable sexual function throughout the entire seven-year period. Therefore, the common belief that preserving the cervix ensures better sexual health was not supported by this long-term evidence.

Implications for Laparoscopic Hysterectomy Sexual Function

These findings suggest that TLH might offer superior stability for certain domains of sexual health compared to LASH. While many surgeons theoretically preserve the cervix to benefit sexual pleasure, this data indicates that such preservation might actually lead to decreased lubrication over time. Moreover, clinicians must integrate these long-term results into their preoperative surgical consultations. Consequently, choosing TLH could potentially prevent future issues related to vaginal dryness and sexual dissatisfaction. Additionally, gynaecologists in India should consider these results when managing patients with benign indications to ensure the highest quality of life post-surgery.

Frequently Asked Questions

Is total hysterectomy better than subtotal for sexual health?

Recent research suggests that total laparoscopic hysterectomy provides more stable long-term sexual function. While overall satisfaction scores are similar between both methods, subtotal hysterectomy may lead to a significant decrease in lubrication over a seven-year period.

Does removing the cervix affect sexual pleasure?

Studies indicate that removing the cervix during a total laparoscopic hysterectomy does not negatively impact long-term sexual pleasure or function. In fact, patients who underwent total hysterectomy reported more stable scores in domains like lubrication compared to those who had a subtotal procedure.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional relationship. Refer to the latest local and national guidelines for clinical practice.

References

Brodkorb T et al. Sexual functioning after total versus subtotal laparoscopic hysterectomy-long term follow up results after 7 years. Arch Gynecol Obstet. 2026 Jun 07. doi: undefined. PMID: 42251612.

Sarkar A et al. Comparison of Sexual Function in Patients Undergoing Hysterectomy through Laparoscopic versus Abdominal Method: A Systematic Review. J Midlife Health. 2026 Jan-Mar;17(1):31-41.

Aleixo EF et al. Hysterectomy and sexual function: a systematic review and meta-analysis. J Sex Med. 2023 Mar;20(3):320-334.