Psychosexual outcomes in HPV-positive women with abnormal cervical cytology: a prospective comparison of clinical surveillance and excisional treatment

Human papillomavirus(HPV)-positivity is recognized as a condition associated with psychosocial burden.It remains unclear whether adverse psychosexual outcomes are primarily driven by HPV-positivity or by excisional treatment of abnormal cervical cytology. This observational study included 128 HPV-positive women with abnormal cervical cytology managed with clinical surveillance( n = 80) or excisional treatment( n = 48).Sexual function and depressive symptoms were assessed using the Female Sexual Function Index-6(FSFI-6) and the Beck Depression Inventory(BDI) at baseline and six months. Longitudinal changes and between-group differences were analyzed. Baseline sexual dysfunction was high and didn’t differ between the two groups(75% vs. 81%, p = 0.515).Over six months, women managed with clinical surveillance demonstrated greater improvement in depressive symptoms compared with those undergoing excisional treatment(median ΔBDI − 3 vs. 0, p = 0.008).Worsening sexual dysfunction occurred frequently in surveillance group than in excisional treatment group(45%vs27.1%, p = 0.044),despite a lower sexual dysfunction at follow-up.Patients with low-grade histopathological findings showed greater improvement in depressive symptoms than those with high-grade disease( p = 0.002; p < 0.001,respectively). Psychosocial outcomes among HPV-positive women differ.Clinical surveillance is associated with greater improvement in depressive symptoms but a higher risk of worsening sexual dysfunction, whereas excisional treatment is associated with more stable sexual function changes over six months.These findings highlight the importance of individualized counseling and routine assessment of psychological and sexual well-being in HPV-related care.