Female Sexual Dysfunction After High-Intensity Focused Ultrasound versus Laparoscopic Total Hysterectomy for Adenomyosis: Associations with Anxiety and Depression

Background: Direct comparative data on postoperative sexual function between laparoscopic total hysterectomy (LTH) and high-intensity focused ultrasound (HIFU) in adenomyosis (AM) remain limited; therefore, this retrospective study compared sexual outcomes and their associations with psychological factors. Methods and Materials: Medical records of 193 AM patients who underwent either LTH (n=102) or HIFU (n=91) and completed six-month follow-up were retrospectively reviewed. Sexual function was evaluated using the Female Sexual Function Index (FSFI), while psychological status was assessed using the Hamilton Anxiety Rating Scale (HAMA) and the Hamilton Depression Rating Scale (HAMD). Results: HIFU group demonstrated significantly higher total FSFI scores when compared with LTH group at 6 months post-treatment (27.3 vs 23.8, p< 0.001). Significant improvements were found in sexual desire (4.2 vs 3.6, p< 0.001), lubrication (4.0 vs 3.5, p< 0.05), orgasm (3.8 vs 3.2, p< 0.001), and satisfaction (3.3 vs 2.7, p< 0.001), while similar trend was observed in pain scores. It was further demonstrated that elevated anxiety and depression scores were negatively correlated with FSFI scores (r=− 0.39 and − 0.37, both p< 0.001). Conclusion: HIFU was associated with better sexual function compared to LTH in AM women, suggesting that HIFU may be a better strategy to preserve postoperative sexual function than LTH. Keywords: adenomyosis, sexual dysfunction, HIFU, LTH, psychological factors