Postoperative vaginal anatomy and dyspareunia after vNOTES hysterectomy without apical suspension: a comparative study
- 1Department of Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Research and Training Hospital , ,
- 2Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Research and Training Hospital , ,
- 3Department of Obstetrics and Gynecology, Perinatology Clinic, Health Sciences University Ankara Bilkent City Hospital , ,
Abstract
Objective: This study compared postoperative vaginal length, apical support, dyspareunia, and sexual function outcomes among vNOTES, laparoscopic, and abdominal hysterectomy in patients who did not undergo concomitant apical suspension.
Methods: This retrospective comparative study included 140 women aged 40–55 years who underwent hysterectomy for benign indications between June 2018 and June 2024. Patients were allocated to three groups according to the surgical approach: vNOTES (n = 60), total laparoscopic hysterectomy (TLH; n = 40), and total abdominal hysterectomy (TAH; n = 40). None of the included patients had undergone concomitant apical suspension at the time of hysterectomy. The primary anatomical outcomes were vaginal length (VL) and apical support, assessed using the Pelvic Organ Prolapse Quantification (POP-Q) C-point, at 6 months postoperatively. Sexual function was assessed using the Female Sexual Function Index (FSFI), and dyspareunia severity was evaluated using a 10-cm visual analog scale (VAS).
Results: Postoperative vaginal length was shortest in the vNOTES group (7.2 ± 0.6 cm), compared with the TLH (7.9 ± 0.7 cm) and TAH (8.4 ± 0.8 cm) groups (p < 0.001). Similarly, the C-point was located more caudally in the vNOTES group (−4.5 ± 1.0 cm) than in the TLH (−6.1 ± 0.9 cm) and TAH (−6.8 ± 1.0 cm) groups (p < 0.001). Significant differences in FSFI and dyspareunia scores were observed at 6 months, with lower FSFI and higher dyspareunia scores in the vNOTES group (p < 0.001).
Conclusion: The surgical approach was associated with differences in postoperative vaginal anatomy and dyspareunia. Compared with TLH and TAH, vNOTES without apical suspension was associated with shorter vaginal length, a more caudal apical position, and higher dyspareunia scores. Because apical suspension was not directly evaluated, whether concomitant apical support would modify these outcomes remains unknown and warrants prospective investigation.
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BibTeX
@article{tunc2026postoperative,
title = {{Postoperative vaginal anatomy and dyspareunia after vNOTES hysterectomy without apical suspension: a comparative study}},
author = {Seyhmus Tunc and Kevser Arkan and Huseyin Kayaalp and Ali Deniz Erkmen and Gul Cavusoglu Colak and Sedat Akgöl},
journal = {Frontiers in surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1934636},
url = {https://europepmc.org/article/PMC/PMC13724623},
note = {CC BY},
}
RIS
TY - JOUR
TI - Postoperative vaginal anatomy and dyspareunia after vNOTES hysterectomy without apical suspension: a comparative study
AU - Seyhmus Tunc
AU - Kevser Arkan
AU - Huseyin Kayaalp
AU - Ali Deniz Erkmen
AU - Gul Cavusoglu Colak
AU - Sedat Akgöl
PY - 2026
DA - 2026/10/19
JO - Frontiers in surgery
DO - 10.3389/fsurg.2026.1934636
UR - https://europepmc.org/article/PMC/PMC13724623
AB - Objective: This study compared postoperative vaginal length, apical support, dyspareunia, and sexual function outcomes among vNOTES, laparoscopic, and abdominal hysterectomy in patients who did not undergo concomitant apical suspension. Methods: This retrospective comparative study included 140 women aged 40–55 years who underwent hysterectomy for benign indications between June 2018 and June 2024. Patients were allocated to three groups according to the surgical approach: vNOTES (n = 60), total laparoscopic hysterectomy (TLH; n = 40), and total abdominal hysterectomy (TAH; n = 40). None of the included patients had undergone concomitant apical suspension at the time of hysterectomy. The primary anatomical outcomes were vaginal length (VL) and apical support, assessed using the Pelvic Organ Prolapse Quantification (POP-Q) C-point, at 6 months postoperatively. Sexual function was assessed using the Female Sexual Function Index (FSFI), and dyspareunia severity was evaluated using a 10-cm visual analog scale (VAS). Results: Postoperative vaginal length was shortest in the vNOTES group (7.2 ± 0.6 cm), compared with the TLH (7.9 ± 0.7 cm) and TAH (8.4 ± 0.8 cm) groups (p < 0.001). Similarly, the C-point was located more caudally in the vNOTES group (−4.5 ± 1.0 cm) than in the TLH (−6.1 ± 0.9 cm) and TAH (−6.8 ± 1.0 cm) groups (p < 0.001). Significant differences in FSFI and dyspareunia scores were observed at 6 months, with lower FSFI and higher dyspareunia scores in the vNOTES group (p < 0.001). Conclusion: The surgical approach was associated with differences in postoperative vaginal anatomy and dyspareunia. Compared with TLH and TAH, vNOTES without apical suspension was associated with shorter vaginal length, a more caudal apical position, and higher dyspareunia scores. Because apical suspension was not directly evaluated, whether concomitant apical support would modify these outcomes remains unknown and warrants prospective investigation.
SN - 2296-875X
ER -