Comparison of sexual function outcomes after vNOTES and laparoscopic tubal sterilization.

OBJECTIVE: To compare postoperative sexual function outcomes following vaginal natural orifice transluminal endoscopic surgery (vNOTES) and laparoscopic tubal sterilization (LTS). MATERIAL AND METHODS: This retrospective comparative cohort analysis included 64 women with prospectively collected routine clinical data who underwent permanent surgical sterilization using vNOTES (n = 31) or laparoscopy (n = 33). Dyspareunia VAS, QSES, and FSFI scores were assessed preoperatively and at 6 months. Six-month outcomes were compared using ANCOVA adjusted for the corresponding baseline scores. Adjusted mean differences, 95% confidence intervals, and partial eta squared (partial η2) were reported. RESULTS: After adjustment for baseline scores, the 6-month dyspareunia VAS score was significantly higher in the vNOTES group than in the LTS group (AMD, 0.44; 95% CI, 0.22 to 0.66; unadjusted p < 0.001; Holm-adjusted p < 0.002; partial η2 = 0.210). No significant differences were observed in the primary outcome, total FSFI (AMD, -1.00; 95% CI, -2.70 to 0.70; p = 0.240), or in QSES (AMD, -0.40; 95% CI, -2.10 to 1.30; Holm-adjusted p = 0.640). Among the exploratory FSFI domains, only satisfaction remained significantly lower in the vNOTES group after Holm correction (AMD, -0.39; 95% CI, -0.61 to -0.17; Holm-adjusted p < 0.006). The unadjusted difference in lubrication did not remain significant after correction (Holm-adjusted p = 0.055). CONCLUSION: vNOTES was associated with higher dyspareunia scores and lower satisfaction-domain scores at 6 months; however, no significant between-group differences were observed in total FSFI or QSES scores. These findings should be interpreted cautiously because of the retrospective, nonrandomized design and small sample size.