Sexual function, psychological distress, and health-related quality of life in HPV-positive women with and without LEEP: a cross-sectional comparative study.

Abstract

Objective: To compare sexual function, psychological distress, and health-related quality of life (HRQoL) between HPV-positive women with and without prior loop electrosurgical excision procedure (LEEP).

Methods: In this cross-sectional study, 226 HPV-positive women (LEEP, n = 112; no LEEP, n = 114) attending a tertiary clinic in Mersin, Türkiye, between January and June 2026 completed the FSFI (primary outcome), HADS, and SF-36. Analyzes used Mann-Whitney U and χ² tests and multivariable regression, with Holm correction within prespecified families.

Results: FSFI scores were lower in the LEEP group (median 14.6 vs 22.3; median difference -3.3, 95% CI -6.4 to -1.0; rank-biserial r = -0.23). The difference persisted after adjustment (-4.0, 95% CI -6.8 to -1.2) and among sexually active women. Desire, arousal, lubrication, and satisfaction were lower after Holm correction. Anxiety, depression, and SF-36 domains showed no significant differences. Most LEEP participants had CIN2-3, unlike controls. Time since LEEP was unrelated to outcomes.

Conclusion: Prior LEEP was associated with modestly lower sexual function, without significant differences in psychological distress or HRQoL. Differences in lesion grade and absence of pretreatment assessments preclude attributing this association to LEEP itself. Sexual-health assessment may be useful during follow-up.