Maintaining sexual function after gynaecological surgery

obvious causes for dysfunction. However, other changes may have an equal role to play, such as altered lubrication, altered body image and neuropathic pain. Without a clear understanding of the causes of sexual dysfunction it is difficult to know how to remedy the situation. In cases of introital dyspareunia and in women with a reduction in vaginal volume, there are numerous techniques described to correct the problem. It is unclear, though, how successful these procedures are in relieving symptoms. Newer techniques aimed at understanding sexual function more accurately should allow us to study the changes that occur and by so doing attempt to prevent dysfunction, or to correct it. Much anecdote and little science inform the debate on this subject. It is true that alterations in sexual function have been described following a variety of gynaecological operations. However, the true causal relationship between the surgery and the outcome remains obscure. Unfortunately, most surgical studies have paid only very superficial attention to sexual dysfunction and it is only recently that specific questionnaires have been developed to examine the issue. Without adequate documentation of the preoperative status, it is difficult to understand the changes that may have taken place as a direct consequence of the surgery. Reductions in vaginal volume or in the introital dimensions seem to be