Department of Obstetrics and Gynecology, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
J Sex Med. 2014 Jun;11(6):1495-504. doi: 10.1111/jsm.12506. Epub 2014 Mar 18.
Voluntary termination of pregnancy (TOP) is a social issue; however, even if it is one of the most common procedures performed in the world, few studies evaluated sexual function changes after medical or surgical TOP.
The aim of this study was to evaluate how first trimester TOP by either surgical (group 1) or medical procedure (group 2) affects sexual function.
This prospective observational study included 211 patients (132 in group 1 and 79 in group 2) who requested first trimester TOP between September 2010 and May 2012. Medical TOP (mifepristone and misoprostol) was offered to patients up to 49 days of gestation. Surgical TOP was performed up to 12 weeks. The Female Sexual Function Index (FSFI) was used to evaluate sexual function before TOP, after 1, 3, and 6 months from TOP.
Changes in the FSFI values and number of sexual active patients after 1, 3, and 6 months from the TOP and the self-reported quality of sexual life at 6 months, with the two different procedures, were the main outcome measures.
At 4-week follow-up, 23.6% of women in group 1 did not resume sexual intercourse compared with 5.4% of women in group 2 (P = 0.003). At 6 months, 3.3% of women in the group 1 and no women in the group 2 did not resume sexual intercourses (P = 0.123). Compared with women in group 2, those in group 1 had lower FSFI score and number of sexual intercourses at 1, 3, and 6 months follow-up (P < 0.001).
This study shows that the number of sexually active women and the overall FSFI are reduced in women undergoing surgical TOP compared with those undergoing medical TOP. Counseling regarding sexual function changes should be included in the discussion of morbidity related to medical or surgical TOP.
自愿终止妊娠（TOP）是一个社会问题；然而，即使这是世界上最常见的手术之一，也很少有研究评估药物或手术性 TOP 后性功能的变化。
本研究旨在评估通过手术（第 1 组）或药物程序（第 2 组）进行的早期妊娠 TOP 如何影响性功能。
这项前瞻性观察研究纳入了 211 名患者（第 1 组 132 例，第 2 组 79 例），他们于 2010 年 9 月至 2012 年 5 月期间要求进行早期妊娠 TOP。为妊娠 49 天内的患者提供药物性 TOP（米非司酮和米索前列醇）。手术性 TOP 则在妊娠 12 周内进行。采用女性性功能指数（FSFI）评估 TOP 前、TOP 后 1、3 和 6 个月的性功能，并评估患者在 6 个月时的性生活质量。
主要观察指标为：TOP 后 1、3 和 6 个月时 FSFI 值和有性生活患者数量的变化，以及两种不同程序后 6 个月的自我报告性生活质量。
在第 4 周随访时，第 1 组中有 23.6%的女性未恢复性生活，而第 2 组中只有 5.4%的女性未恢复性生活（P=0.003）。在第 6 个月时，第 1 组中有 3.3%的女性未恢复性生活，而第 2 组中没有女性未恢复性生活（P=0.123）。与第 2 组的女性相比，第 1 组的女性在 TOP 后 1、3 和 6 个月时的 FSFI 评分和性生活次数均较低（P<0.001）。
本研究表明，与药物性 TOP 相比，手术性 TOP 后有性生活的女性数量和整体 FSFI 降低。应在讨论与药物或手术性 TOP 相关的发病率时纳入对性功能变化的咨询。
