(Poster 38) Postoperative Pain and Sexual Function in Total vs Supracervical Hysterectomies

Objectives: There is no consensus on whether a difference exists in postoperative pain, complications, and sexual function between laparoscopic total (TLH) and supracervical hysterectomies (SCH). With the growing prevalence of minimally invasive hysterectomies, it is critical to assess whether total or supracervical hysterectomies are superior in clinical situations in which either are appropriate surgical options.

Methods: This is a retrospective study in which laparoscopic total and supracervical hysterectomies performed between January 2023 - 2024 at the Icahn School of Medicine at Mount Sinai within the Department of Obstetrics and Gynecology were compared. Postoperative complications including vaginal cuff hematoma, postoperative infection, wound disruption, and urinary retention were compared between the two groups. Immediate postoperative pain was analyzed using PACU pain scores and pain medication administration reports. Postoperative vaginal bleeding and postoperative sexual function within the first year postoperatively were assessed. Postoperative sexual function was measured by patient report of dyspareunia and enjoyment of intercourse during postoperative visits. It should be noted that a small portion of patient charts that were reviewed did not include information about postoperative sexual function. Group comparisons were carried out using the Chi-squared (χ2) test for categorical variables, or the Mann Whitney’s U test for continuous variables. A result is considered statistically significant at the p-value < 0.05 level of significance without multiple testing correction. All analyses were performed using SAS version 9.4 (SAS Institute, Cary, NC), and some visualizations were done using R version 4.4.0.

Results: A total of 54 SCH and 56 TLH cases were included. Average patient age was 48 years old. We found that patients who underwent SCH had significantly lower estimated blood loss (p < 0.0001) and lower intraoperative Surgicel use (p < 0.0001). SCH patients had a significantly lower average pain score (p=0.029) and lower averaged peak pain score (p=0.040) during the first 3 hours of PACU recovery compared to TLH patients (Figure 1).

Significantly more patients who underwent SCH found intercourse more enjoyable postoperatively than those who underwent TLH (p=0.018). Additionally, fewer SCH patients experienced worsened dyspareunia postoperatively (p=0.032). We did not observe a significant difference in intraoperative or postoperative complications or in occurrence or length of postoperative vaginal bleeding.

Conclusions: Our study found that patients who underwent SCH had significantly lower average pain scores and averaged peak pain scores in the first 3 hours of PACU recovery. Additionally, those who underwent SCH found intercourse more enjoyable postoperatively than patients who underwent TLH and fewer SCH patients experienced worsened dyspareunia post-operatively. There were no observed differences in intraoperative and postoperative complications or in length/occurrence of significant postoperative vaginal bleeding.

Figure 1. Patient pain scores and pain medications across time in PACU.