Sexual function may decline following surgical menopause

Risk-reducing salpingo-oophorectomy has the potential to exert an adverse effect on sexual function and to contribute to sexual distress, according to a study.

The study included 104 premenopausal women who were undergoing risk-reducing salpingo-oophorectomy and 102 age-matched women who retained their ovaries (control).

The primary outcome of sexual function at 24 months was measured using the Female Sexual Function Index (FSFI). Secondary outcomes included the Fallowfield Sexual Activity Questionnaire (SAQ) and Female Sexual Distress Scale-Revised (FSDS-R).

Of the women, 86 (82.7 percent) in the surgical menopause group and 92 (90.2 percent) in the control group completed the 24-month follow-up. Baseline sexual function was similar between groups. Most women (61 percent) in the surgical group started hormone replacement therapy (HRT) after their procedure.

At 24 months, the percentage of women who had sexual dysfunction increased from 19 percent to 42 percent in the surgical menopause group vs 24 percent to 29 percent in the control group, although the difference did not reach significance (odds ratio [OR], 1.9, 95 percent confidence interval [CI], 0.7–5.1; p=0.21).

Compared with the control group, the surgical menopause group experienced substantial decline in all aspects of sexual function, namely desire (−0.4, p=0.02), arousal (−0.7, p<0.001), lubrication (−0.6, p=0.01), and satisfaction (−0.6, p<0.001). It also contributed to a significant increase in sexual pain (−0.5, p=0.05) and discomfort (−1.0, p<0.001). Sexual habit remained unchanged.

Notably, surgical menopause was associated with a nearly fourfold increase in the odds of sexual distress (OR, 3.7, 95 percent CI, 1.6–9.0; p=0.003). HRT use did not modify sexual function, activity, or distress.

The findings highlight the need for women considering surgical menopause to be informed of the procedure’s likely adverse effects on sexual function and that this issue may not be fully resolved by HRT. As such, clinicians should consider offering vaginal oestrogen, even for those using systemic HRT.