Objective assessment of sexual arousal in women with a history of hysterectomy

Objective: The potential contribution of psychological and anatomical changes to sexual dysfunction following hysterectomy is not clear. Radical hysterectomy for cervical cancer causes surgical damage to the autonomic nerves which are responsible for the increased vaginal blood flow during sexual arousal. Simple hysterectomy causes more limited nerve disruption. Photoplethysmographic assessment of vaginal pulse amplitude objectively measures vaginal blood flow during sexual arousal. We hypothesised that damage of the autonomic nerves results in a disrupted vaginal blood flow response during sexual stimulation. Design: Between-groups comparison of vaginal pulse amplitude. Setting: University hospital. Sample: Twelve women with a history of radical hysterectomy, 12 women with a history of simple abdominal hysterectomy and 17 age-matched controls. Methods: Photoplethysmographic assessment of vaginal pulse amplitude during sexual stimulation by erotic films. Self-reported ratings of subjective sexual arousal were collected after each erotic stimulus condition. Main outcome measure: Maximum vaginal pulse amplitude. Results: Maximum vaginal pulse amplitude differed between the three groups (P = 0.043). Women with a history of radical hysterectomy had a lower response than controls (P = 0.015). Women in the radical hysterectomy group and controls reported an equally strong subjective arousal. Women with a history of simple hysterectomy showed an intermediate maximum vaginal pulse amplitude. Conclusions: Radical hysterectomy seems associated with a disturbed vaginal blood flow response during sexual arousal. This cannot be explained solely by uteric extirpation, since it was not observed to the same extent after simple hysterectomy, but might be related to a denervation of the vagina which increases with increasing radicality of surgery.