Design: Prospective clinical cohort study, 5-year follow-up. Participants will be followed up to 10 years after surgery

Setting: In an academic affiliated district general hospital

Patients or Participants: 260 patients undergoing hysterectomy on benign indication between 2016 and 2018 at Danderyd Hospital.

Interventions: A comparison of robotic assisted total laparoscopic hysterectomy with traditional techniques of surgery regarding pelvic floor function and sexual function.

Measurements and Main Results: All women going through hysterectomy filled in validated questionnaires (Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20), Female Sexual Function Index (FSFI)) on pelvic organ and sexual function before surgery, at six months, 1, 3 and 5 years after surgery. Response rate was at the 5-year follow-up was 154/242 (63.6%) for all questionnaires. Data were analyzed using nonparametric statistics and mixed effect models. Symptoms of urinary, bladder and pelvic floor dysfunction were significantly reduced. The improvement of sexual function after six months (mean score of FSFI at baseline 17.9 (SD 11.7), at six months 21.0 (SD 11.7)) (P<0.001) was not persistent after five years 19.0 (SD 11.3)) and there was a decline in sexual function among the sexually active women (mean score of FSFI baseline 25.2 (6.6SD) and at 5 years 21.6 (10.1 SD, p<0.001).

Conclusion: Five years after surgery robotic-assisted total laparoscopic hysterectomy, total laparoscopic hysterectomy and total abdominal hysterectomy improve pelvic floor function to the same extent. An overall improvement of sexual function six months after hysterectomy, was not persistent after five years and among the sexually active women there was a decrease in FSFI scores. Correlations between pelvic floor function and sexual function after hysterectomy will be discussed.