Abstract
Objective
To evaluate postoperative sexual function outcomes following minimally invasive uterus-preserving treatments for uterine fibroids and to quantitatively synthesize the available evidence using validated patient-reported outcome measures, while narratively summarizing other patient-reported outcomes, including pelvic pain.Data sources
A systematic literature search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar from database inception to the final search date. The review was conducted in accordance with the PRISMA 2020 guidelines and prospectively registered in PROSPERO (CRD420261392260).Methods of study selection
Studies including reproductive-age women undergoing minimally invasive uterus-preserving fibroid treatment and reporting postoperative sexual function and/or other patient-reported outcomes, including pelvic pain, using validated instruments were eligible. Studies without extractable quantitative data for sexual function outcomes were excluded. Two reviewers independently screened studies and extracted data.Tabulation, integration and results
Sixty-seven records were identified, and 11 full-text articles were assessed for eligibility. Four studies involving 382 women met the inclusion criteria and were included in the quantitative synthesis. Sexual function was primarily assessed using the Female Sexual Function Index (FSFI) and the Brief Index of Sexual Functioning for Women (BISF-W). Random-effects meta-analysis suggested an improvement in postoperative sexual function following treatment (standardized mean difference [SMD] 0.65; 95% confidence interval [CI], 0.28-1.03; p = 0.001). However, these findings should be interpreted cautiously because only four studies were included, most of which were observational, and substantial heterogeneity was present (I² = 90.3%). Publication bias could not be reliably assessed because of the limited number of included studies.Conclusion
The available evidence suggests that minimally invasive uterus-preserving fibroid treatments may be associated with improved postoperative sexual function. However, these findings should be interpreted as exploratory, given the limited number of included studies, the predominance of observational evidence, and substantial heterogeneity. Larger prospective studies with standardized outcome reporting are needed to confirm these findings.