Introduction:

Significant strides have been made to enhance our understanding of the impact of surgical treatment of advanced bladder, specifically in women, and how it may affect their quality of life. Increased effort has illustrated that women who have undergone anterior pelvic exenteration suffer from persistent sexual dysfunction. Consideration for organ preservation, particularly ovarian preservation, as a potential avenue for mitigating some of the long-lasting post operative sexual side effects. Our study aims to examine the effects of oophorectomy in post-menopausal women on testosterone levels and the sexual implications of this reduced hormonal state.

Methods:

In this prospective cohort study utilizing the UK Biobank, a population-based cohort of 502 682 participants, we analyzed serum hormone levels of healthy, post-menopausal women with no prior history of malignancy with and without previous oophorectomy. We examined the correlations between serum concentrations of testosterone and oestradiol and a history of oophorectomy, adjusting for confounding factors such as smoking, BMI, age at menopause and recruitment, and past hormone therapy. Additional exploratory analyses assessed the relationships between hormone levels and musculoskeletal factors, such as muscle fat infiltration, femur neck bone area, and heel bone mineral density (BMD) score, using linear regression. Furthermore, we employed analysis of variance (ANOVA) to evaluate the potential link between testosterone levels and the intensity of pain experienced during intercourse.

All analyses were performed in Python (v3.12), P<0.05 defined as statistically significant.

Results:

This study included 32,919 women of which 9207 (28.0%) underwent postmenopausal oophorectomy. When comparing women who underwent an oophorectomy, women without were more likely to exhibit higher serum testosterone level [1.2nmol/L (SD +/- 0.7) vs 0.9nmol/L (SD +/- 0.6), p<0.01]. There were no hormone specific associations between testosterone and muscle fat infiltration, femur neck bone area, and heel BMD score and estradiol level (Figure E). Compared to women with no oophorectomy, postmenopausal oophorectomy on multivariate analysis was shown to be associated with significantly lower testosterone levels (OR 3.27, p<0.0001) after adjusting for confounders (Figure A). Furthermore, women with lower testosterone reported an increased level of pain during intercourse, as compared to those with higher serum level (p=0.025, Figure C).

Conclusion:

This study demonstrated that there is a statistically significant difference in the mean testosterone in postmenopausal women who had an oophorectomy versus those who did not, and most notably, an association between lower testosterone levels and dyspareunia. These findings have the ability to alter our approach to anterior pelvic exenteration and the benefits of ovarian preservation in women who deem importance of maintaining sexual function after RC, even in post-menopausal women. Contrary to the prevailing misconception that menopause negates hormonal production, the ovaries remain significant contributors to testosterone production. Thus, ovarian preservation presents an essential quality-of-life consideration for our surgical patients.

Funding: N/A