The patient-partitioning schema for the study population is shown in Figure . The proportion of responders was not significantly different between the two surgical subgroups (Table ). Forty-eight percent (n = 33) of women undergoing a SCH returned the questionnaire, while 39% (n = 27) of those undergoing a TAR chose to participate. While all respondents answered the majority of questions, not all study patients answered every question. Nonetheless, there was no question in the survey answered by fewer than 74% of the respondents. The mean time (+SD) from surgery to questionnaire was 19.2 months (± 3.4 months) in the SCH group and 19.8 months (± 3.9 months) in the TAH group (range = 14–26 months; P > 0.05).
The demographic data obtained from the chart review and from the questionnaire are summarized in Table . The data illustrate that the two groups do not differ significantly except for oophorectomy status. Significantly more women underwent bilateral salpingoophorectomy (BSO) in the TAH group than in the SCH group (63 percent versus 30 percent, respectively; P
< 0.05). Since removal of the ovaries may have a deleterious effect on sexual function [20
], the possible effects of oophorectomy on outcome measures were considered in the analysis. In addition, we considered the possible effects of hormone replacement therapy (HRT) of current users on sexual function, even though the two surgical groups showed no significant difference in reported use of HRT.
Outcome variables in which a pre-surgical subjective rating was elicited were evaluated and compared between the two groups (Table ). In the TAH group, three women reported the absence of intercourse before surgery (versus no women in the SCH group), while in the SCH group proportionately more women reported intercourse >6 times/month. Although the possible effect of this finding on our ultimate outcomes was unclear, we included it as a possible confounder in our subsequent modeling process to insure that the results were not biased. We also added consideration of prior expectations regarding the likely effect of the surgery on sexual function, in an attempt to control for as many potential confounding variables as possible.
Baseline (preoperative) sexual function & expectations
The results of our initial analysis led to the construction of a multiple stepwise logistic regression model in which type of procedure, oophorectomy, use of HRT, frequency of intercourse prior to surgery, and preoperative expectations were used to predict the various sexual function outcome measures. Since our hypothesis centered on loss of sexual function, each of the outcome measures was categorized according to a binomial classification of function relative to pre-surgical status.
The relevant findings of this modeling procedure are summarized in Table . Changes in libido, dyspareunia, and multiple orgasm frequency were not predictable based upon any of our independent variables. However, intercourse frequency, orgasm frequency, and overall sexual satisfaction were all significantly related to type of procedure (P = 0.01, 0.03, and 0.03, respectively). Regarding intercourse frequency, 42% (n = 10) of TAH patients experienced worse outcome compared with 15% (n = 5) of SCH patients. Forty-three percent (n = 9) of TAH patients experienced a decrease in the ability to achieve orgasm compared with 6% (n = 2) of SCH patients. Overall sexual satisfaction was worse for 33% (n = 8) of TAH patients compared with 6% (n = 2) of SCH patients. Only for overall sexual satisfaction did oophorectomy add significant predictive value (P = 0.02). Thirty-five percent (n = 9) of patients who had a BSO with their hysterectomy had worse overall sexual satisfaction when compared to 3% (n = 1) of patients who had hysterectomy only without BSO. With respect to HRT, there was no significant difference between sexual function of patients who were receiving hormone replacement and those who were not. Frequency of intercourse prior to surgery was not associated with postoperative change in any of the sexual variables analyzed (P < 0.05).