Sexual function and surgical outcomes after vaginal natural orifice transluminal endoscopic surgery versus total laparoscopic hysterectomy.

OBJECTIVE

To examine whether vaginal natural orifice transluminal endoscopic surgery (vNOTES) and total laparoscopic hysterectomy (TLH) differ in postoperative sexual health, patient-reported recovery measures, and perioperative outcomes.

MATERIALS AND

METHODS

Sexually active women treated with vNOTES or TLH for benign gynaecological indications between January 2023 and January 2026 were included in this ambispective cohort. Clinical and operative information was retrieved retrospectively, while patient-reported postoperative data were obtained prospectively a minimum of six months after surgery. Sexual function was measured with the Female Sexual Function Index (FSFI). Additional outcomes included dyspareunia, time to resumption of sexual intercourse, return to work, postoperative satisfaction, and willingness to undergo the same procedure again. Selected outcomes were further examined using multivariable regression models incorporating clinically relevant confounding variables.

RESULTS

The analysis comprised 159 women, of whom 105 underwent TLH and 54 underwent vNOTES. Compared with TLH, vNOTES was associated with a shorter operative duration [160 (60) vs. 198 (90) minutes, p<0.01], earlier return to sexual intercourse [8 (3) vs. 9 (4) weeks, p<0.01], and higher postoperative satisfaction [10 (9-10) vs. 9 (8-10), p<0.01]. In adjusted analyses, the associations with shorter operative time [β=-27.24, 95% confidence interval (CI): -50.62 to -3.86; p=0.02] and earlier resumption of intercourse (β=-1.60 weeks, 95% CI: -2.93 to -0.27; p=0.01) persisted. No significant differences were identified in FSFI-based sexual function, dyspareunia, time to return to work, or composite adverse events.

CONCLUSION

vNOTES and TLH showed comparable postoperative sexual function and dyspareunia outcomes. vNOTES was associated with an earlier return to sexual intercourse, greater postoperative satisfaction, and shorter operative duration. Further prospective multicentre research is required to clarify longer-term sexual outcomes after these procedures.