Impact of Vaginal Cuff Closure on Postoperative Sexual Function Outcomes: VCOS Study

INTRODUCTION: Vaginal cuff closure during hysterectomy may be performed using a horizontal or vertical orientation, yet limited data exist on how closure technique influences postoperative sexual function. OBJECTIVE: The objective of this study was to assess the association between vaginal cuff closure orientation and postoperative sexual function using a validated sexual function instrument. METHODS: Design: Cross-sectional cohort study. Setting: A single tertiary academic medical center. Patients or Participants: All women who underwent hysterectomy for benign indications via robotic, laparoscopic, or vaginal routes between January 2023 and September 2024 were eligible for inclusion. Interventions: Eligible women were contacted by telephone and invited to complete the Female Sexual Function Index-6 (FSFI-6), a validated tool assessing six domains of sexual function. Total scores range from 2 to 30, with scores ≤19 indicating risk of female sexual dysfunction (FSD). FSFI-6 scores were analyzed in relation to vaginal cuff closure orientation (vertical vs horizontal) and surgical approach. RESULTS: A total of 45 women responded to the questionnaire, of whom 23 were in the vertical closure group and 22 in the horizontal closure group. Age, marital status, parity, and body mass index (BMI) were comparable between the groups. The most common indication to perform the procedure was due to abnormal uterine bleeding caused by fibroids, contributing 40% of women in both groups. 21 (91%) and 16 (73%) of the women in the vertical and the horizontal groups, respectively, indicated they were sexually active before the procedure. Interestingly, while asked about sexual activity following the procedure, a reduction was noted in the vertical group (83%) versus increase in the horizontal group (82). The change was not found to be statistically significant. The total questionnaire score was found 16 (10–18) for the vertical closure versus 18 (13–20) for the horizontal closure (p=0.37). A total score >19 was observed in 7% of the vertical group and 32% of the horizontal group, although this difference was not statistically significant. CONCLUSIONS: While no significant differences were observed, trends suggest horizontal cuff closure may be associated with more favorable sexual function outcomes post-hysterectomy. Larger, prospective studies are needed to confirm these findings and inform surgical best practices.