Many studies affirm that any type of hysterectomy can result in more pelvic floor symptoms [1-3].This systematic review aims to describe the prevalence of urinary and sexual symptoms between women after hysterectomy for benign conditions.

A systematic search in six electronic databases (MEDLINE/PubMed, SCIELO, LILACS, CINAHL, SCOPUS and WEB OF SCIENCE) was carried out from September 1 to 7, 2019 by two researchers to retrieve all the manuscripts that contained information on the prevalence of urinary disorders and sexual symptoms in women after hysterectomy for benign conditions, in accordance with the PRISMA checklist. For search strategies, combinations of terms, only in English, were used: (hysterectomy OR "hysterectomy, vaginal") AND AND ("pelvic floor disorders" OR "pelvic floor") AND AND ("Diurnal Enuresis" OR "Nocturnal Enuresis" OR urina) AND ("Sexual dysfunction" OR Dyspareunia OR "Sexual Behavior" OR libido OR Orgasm). The text search was limited to the investigation of prevalence or occurrence of lower urinary tract symptoms and sexual dysfunctions in women after hysterectomy for benign conditions. There were no limits regarding the publication period and articles were excluded if they were duplicates, reviews or commentaries. Included study designs were randomized controlled trials (RCT) and observational studies and inclusion was determined by the PICO criteria: study participants required to be adults aged 18 to 65 years, submitted to hysterectomy for benign conditions and which measured urinary and sexual symptoms. For comparison, studies comparing surgical techniques for treating benign conditions for assessing the onset of voiding or sexual dysfunctions were also included. The JBI Critical Appraisal Checklist for Studies Reporting Prevalence Data was used for bias risk evaluation of the studies selected.

A total of nine studies, published between 2001 and 2017, were included in the sample. The average age of the participants ranged from 41 to 60 years and the dysfunctions predominantly investigated by the articles were urinary symptoms, related in 7 studies. Two studies reported, in addition to data related to voiding dysfunction, female sexual dysfunction. The articles were analyzed, according to the type of study, through the JBI critical appraisal checklist, within the sample of this review. All 9 articles had a low risk of bias. It was not possible to carry out a meta-analysis in this systematic review due to the methodological heterogeneity of the studies. Urinary incontinence’s rate for abdominal hysterectomy ranged from 17.6% to 39.6%. The stress incontinence rates (33 to 51%) and urge incontinence (12 to 34%) were related to vaginal hysterectomy. Otherwise, stress incontinence rates (0.9 to 45%), urge incontinence rates (5 to 22%), intermittency (20.7 to 24.4%), incomplete emptying (13.7 to 20.7%) and frequency (19.8 to 38.2%) were related for abdominal hysterectomy. Superficial and deep dyspareunia were found in the postoperative period of abdominal hysterectomy due to benign pathologies (6.6% to 16.5%). For vaginal hysterectomy that rate ranged from 11,3 to 24,4%.

Hysterectomy is one of the most common gynecological surgery in women. Although effective for noncancerous gynecological conditions, the hysterectomy might adversely affect pelvic floor functions, which may result in several disorders for these patients. The main dysfunctions reported were urinary incontinence and dyspareunia. However, some authors evidence the existence of these symptoms before surgery. Most results refer to abdominal hysterectomy including voiding symptoms, such as intermittency and incomplete emptying.

Based on the results obtained through this systematic review, it is important to highlight that urinary and sexual dysfunctions in hysterectomized women are frequent events. The main reported disorders were urinary incontinence and dyspareunia. Additional research is needed in order to investigate the impact of these symptoms on the patients’ work productivity and also the causality between dysfunctions and their occupation.

Selcuk S, Cam C, Asoglu MR, Kucukbas M, Arinkan A, Cikman MS, et al. Effect of simple and radical hysterectomy on quality of life – analysis of all aspects of pelvic floor dysfunction. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2016; 198: 84-8
Lakeman MME, Vaart CH, Roovers JPWR. A long-term prospective study to compare the effects of vaginal and abdominal hysterectomy on micturition and defecation. BJOG. 2011;118: 1511-17
Kocaay AF, Oztuna D, Su FA, Elhan AH, Kuzu MA. Effects of hysterectomy on pelvic floor disorders: a longitudinal study. Diseases of the colon and rectum. 2017; 60(3): 303-10.