Sexual functioning after vaginal natural orifice transluminal endoscopic surgery: combined results of two randomized controlled trials

Abstract Objective To explore women’s sexual functioning and associated quality of life after vaginal natural orifice transluminal endoscopic surgery (vNOTES) as an alternative to laparoscopy. Design Two parallel group, 1:1 randomized single-centre single-blinded trials comparing the effects of vNOTES and laparoscopy. Setting Gynaecology unit of a Belgian teaching hospital. Population Women aged between 18 and 70 years with a benign indication for hysterectomy or adnexectomy. Methods After informed consent, women were randomized for vNOTES (experimental group) or laparoscopy (control group). Participants and outcome assessors were blinded. Paper and pencil questionnaires before surgery, as well as at 3 and 6 months after surgery. Main outcome measures The outcome of interest in this secondary analysis was sexual functioning at 3 and 6 months after surgery. We additionally measured quality of life. Results We studied 68 women allocated to the vNOTES (experimental) condition and 67 women allocated to the laparoscopy (control) condition. No significant effects of time, type of surgery, and surgical technique were found on patients’ sexual function. At 3 and 6 months post-surgery, an increasing number of negative associations were found between quality of life and aspects of sexual functioning. Conclusions vNOTES applied for hysterectomy and adnexectomy as compared to laparoscopy does not have a differential impact on women’s sexual functioning. Sexual function has few links to patients’ quality of life before surgery, but grows in relevance as a negative correlate of quality of life after surgery.