The effect of dexamethasone on sexual function in a randomized trial in robotic hysterectomy

Background and Aim The impact of hysterectomy on women's sexual functioning is a subject of debate. Some women report improvements in sexual function post-surgery, often due to the relief of symptoms like pain or bleeding, while others experience sexual dysfunction following the procedure. Factors such as preoperative health and the type of hysterectomy performed (e.g., laparoscopic or robotic) may contribute to these variations. Robotic-assisted hysterectomy, as a minimally invasive surgical method, was well-received due to its benefits, including reduced postoperative pain, quicker recovery, and shorter hospital stays. Dexamethasone, a corticosteroid commonly used in multimodal anesthesia regimens and known for its anti-inflammatory properties, can reduce surgical stress, decrease postoperative pain, and hasten recovery. The aim of this randomized trial was to assess whether adding dexamethasone to a robotic hysterectomy procedure would further improve postoperative outcomes besides of lowering inflammatory response, particularly regarding sexual functioning. Methods The study-recruited women scheduled for robotic-assisted hysterectomy and randomized into two groups: One receiving 24 mg of dexamethasone preoperatively and the other receiving a placebo. Various measures were taken, including blood tests, pain assessments using the visual analogue scale (VAS), and reports on postoperative vomiting, nausea, and medication usage at five time points: 0, 4, 8, 12, and 24 hours postoperatively. The primary outcome included inflammatory response and, secondarily, sexual functioning measures such as urinary incontinence during sex, orgasm intensity, and frequency of sexual desire. Results A total of 112 women participated, with complete data available from all participants for blood tests, medical interventions, and VAS measures at all time points. No significant differences were found in basic characteristics between the dexamethasone and placebo groups. However, the study observed the following differences in sexual functioning: Women in the dexamethasone group had a higher frequency of wanting sex at each weekly follow-up compared to the placebo group (p = 0.018). Orgasm intensity was significantly higher in the dexamethasone group (p = 0.044). The high and better score in QoR-15 at week 4 was associated with wanting more sex (p=0.04) and less pain during intercourse (p=0.047). No differences were found in the resumption of sex within the four-week study period, pain during sex or incontinency during intercourse. Conclusion The addition of dexamethasone in robotic-assisted hysterectomy was associated with an increased frequency of sexual desire and more intense orgasms in the first four weeks postoperatively. This suggests that dexamethasone may positively affect certain aspects of sexual functioning in women undergoing this procedure. These findings highlight the potential benefits of dexamethasone in the postoperative recovery phase, but further research may be needed to understand the full scope of its effects on sexual health after hysterectomy.