Evaluation of Sexual Function, Menopausal Symptoms and Quality of Life in Women Undergoing Surgery for Endometrial and Cervical Cancer Vs Spontaneous Postmenopausal Controls: a Prospective Cohort Study
Year: 2025
Type: article
Study design: Observational Study
Abstract: Objectives Patients with gynecological cancers experience difficulties in sexual health due to cancer treatments. Surgery for endometrial cancer (EC) and cervical cancer (CC) frequently leads to Female Sexual Dysfunction (FSD), affecting up to 78% of this population. For EC, standard treatment involves type A radical hysterectomy with bilateral salpingo-oophorectomy. In CC either a type B or C1/2 radical hysterectomy is performed, which includes parametrial and vaginal resection, compromising nerve fibers crucial for sensory and autonomic innervation of the vagina via the pelvic plexus and hypogastric nerve. This can lead to dyspareunia, reduced arousal and impaired orgasm, especially for women who experience vaginally activated orgasms. Methods Prospective, observational 3 cohort study: 1) EC undergoing type A hysterectomy 2) CC undergoing type B or C1/2 hysterectomy 3) spontaneous menopause healthy controls (M).Validated questionnaires for quality of life (QoL) and FSD include female sexual function and distress (FSFI, FSDS), Menopause Quality of Life (MENQOL), Vulvovaginal Symptoms (VSQ), Sexual QoL SQoL-F, and and oncology-specific assessments (EORTC C30, CX24, EN24). Clitoral doppler ultrasound is performed to assess vascular pulsatility and resistance indexes (PI, RI) as markers of endothelial dysfunction in FSD. Inclusion Criteria: Women aged 30-50 who underwent surgery at least six months before enrollment. Exclusion Criteria: Metastatic disease or ongoing cancer treatments. Results Tab. 1 All questionaries for sexual function and distress indicate a worsening trend in the oncological groups vs controls. Menopausal symptoms are significantly more severe in EC and CC groups, and Sexual QoL differs significantly across the 3groups and between the EC and M groups. With limited/no data on mean PI values in clitoral arteries among menopausal women, we chose a reference PI of 1.5 to represent the general pre-/post-menopausal population. In this study, PI was elevated in both CC (median PI: 1.92, range: 1.45–2.80) and EC(median PI: 1.76, range: 0.76–2.80) groups. Conclusions Patients treated for EC and CC report poorer QoL and higher FSD rates than healthy controls. Clitoral Doppler confirms FSD, showing increased blood flow resistance, particularly in younger CC pts likely due to the extent of surgical radicality and parametrial resection. Conflicts of Interest none.
Source: The Journal of Sexual Medicine
Authors: A Logoteta, V Bruno, E Vizza, E A Jannini
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4410232555