Discussion
sexual pain, vaginal innervation
VAGINA
This study was designed to assess the effect of vNOTES on female sexual function. Our results revealed no significant difference in sexual function before and after surgery in patients undergoing vNOTES, and also no significant difference in sexual function after surgery between patients receiving vNOTES and transabdominal laparoscopy. However, the time of starting sexual life after vNOTES is later than that after transabdominal laparoscopy.vNOTES is a novel surgical approach emerging in recent years. Gettman MT et al. [The current studies relevant to vNOTES have reported its feasibility and effectiveness, but its long-term safety and impact on the quality of life of patients have not been deeply discussed. This study used the validated FSFI questionnaire to evaluate six dimensions of sexual function (sexual desire, arousal, vaginal lubrication, orgasm, satisfaction, and sexual pain) and found that there was no significant difference in sexual function before and after surgery in the vNOTES group. This may be related to the anatomical structure and nerve distribution of the female lower genital tract. The vaginal innervation is concentrated to the far and front along the vaginal wall, leaving sparse sensory innervation of the posterior fornix, while the incision of vNOTES is just located at the posterior fornix of the vagina, so it has little impact on it [There is currently no randomized controlled study on the optimal time to start sexual life after vNOTES. According to previous studies, the suggested time of starting sexual life is 2 weeks after surgery [However, this study has a limitation. We only assessed changes in women’s sexual function after surgery. The sexual life is mutual, and male sexual satisfaction should also be valued. For example, the Arizona sexual experiences scale (ASEX) can be used to assess the sexual function of both partners. Therefore, in the future more large sample randomized controlled studies are needed to further evaluate the impact of vNOTES on the sexual satisfaction of both sexual partner.