SEXUAL FUNCTIONING AND HEALTH-RELATED QUALITY OF LIFE AFTER TOTAL VERSUS SUPRACERVICAL HYSTERECTOMY: A RANDOMIZED TRIAL

M. Kuppermann, R. Summitt, Jr., R.E. Varner, G. McNeeley, D. Goodman-Gruen, L. Learman, C. Ireland, E. Vittinghoff, F. Lin, H. Richter, J. Showstack, E. Washington, for the Total or Supracervical Hysterectomy (TOSH) Research Group

San Francisco General Hospital, San Francisco, CA

OBJECTIVE: To compare sexual functioning and health-related quality-of-life outcomes of total abdominal hysterectomy (TAH) and supracervical hysterectomy (SCH) among women with symptomatic uterine leiomyomata and/or abnormal uterine bleeding refractory to hormonal management.

MATERIALS AND METHODS:  We randomized 135 women scheduled to undergo abdominal hysterectomy in four US clinical centers to either a total or supracervical procedure.  The primary outcome was sexual functioning at 2 years, as assessed by the Medical Outcomes Study sexual problems scale.  Secondary outcomes included specific aspects of sexual functioning and health-related quality-of-life at 6 months and 2 years.

RESULTS:  Sexual problems improved dramatically in both randomized groups during the first 6 months, and plateaued by 1 year. Health-related quality-of-life scores also improved in both groups.  The only statistically significant difference between groups during follow-up was at 6 months, when women randomized to SCH reported higher orgasm frequency and quality scores than women randomized to TAH (73 vs. 64, p=.05). Both groups reported few problems with sexual functioning at 2 years (mean score on the sexual problems scale for SCH group 82, TAH group 80, on a 0-to-100 scale with 100 indicating an absence of problems). 

CONCLUSIONS: Supracervical and total abdominal hysterectomy result in similar sexual functioning and health-related quality of life during 2 years of follow-up.  This information can help guide physicians as they discuss surgical options with their patients.

Key Words: supracervical (subtotal) hysterectomy, quality-of-life 

Disclosure – Speakers Bureau: R.E. Varner, Pfizer, Gynecare; H. Richter, Pfizer, Novartis; Consultant: C. Ireland, Berlex.