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Vaginal blood flow after radical hysterectomy with and without nerve sparing. A preliminary report
  1. Q. D. PIETERSE*,
  2. M. M. TER KUILE*,
  3. M. C. DERUITER,
  4. J. B.M.Z. TRIMBOS*,
  5. G. G KENTER* and
  6. C. P MAAS*
  1. Departments of *Gynaecology
  2. Anatomy and Embryology, Leiden University Medical Centre, Leiden, The Netherlands
  1. Address correspondence and reprint requests to: Quirine Dionne Pieterse, MD, Department of Gynaecology, Leiden University Medical Centre, K6-P, P.O Box 9600, 2300 RC Leiden, The Netherlands. Email: q.d.pieterse{at}


Radical hysterectomy with pelvic lymphadenectomy (RHL) for cervical cancer causes damage to the autonomic nerves, which are responsible for increased vaginal blood flow during sexual arousal. The aim of the study of which we now report preliminary data was to determine whether a nerve-sparing technique leads to an objectively less disturbed vaginal blood flow response during sexual stimulation. Photoplethysmographic assessment of vaginal pulse amplitude (VPA) during sexual stimulation by erotic films was performed. Subjective sexual arousal was assessed after each stimulus. Thirteen women after conventional RHL, 10 women after nerve-sparing RHL, and 14 healthy premenopausal women participated. Data were collected between January and August 2006. The main outcome measure was the logarithmically transformed mean VPA. To detect statistically significant differences in mean VPA levels between the three groups, a univariate analysis of variance was used. Mean VPA differed between the three groups (P= 0.014). The conventional group had a lower vaginal blood flow response than the control group (P= 0.016), which tended also to be lower than that of the nerve-sparing group (P= 0.097). These differences were critically dependent on baseline vaginal blood flow differences between the groups. The conventional group follows a vaginal blood flow pattern similar to postmenopausal women. Conventional RHL is associated with an overall disturbed vaginal blood flow response compared with healthy controls. Because it is not observed to the same extent after nerve-sparing RHL, it seems that the nerve-sparing technique leads to a better overall vaginal blood flow caused by less denervation of the vagina.

  • cervical carcinoma
  • menopause
  • nerve-sparing
  • photoplethysmography
  • radical hysterectomy

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