Skip to main content

Evaluation of Changes in Sexual Function Related to Uterine Fibroid Embolization (UFE): Results of the EFUZEN Study

Abstract

Objectives

The main goal of the study was to evaluate sexual function before and one year after UFE. The secondary goals were to evaluate the quality of life before and one year after UFE and to determine the relation of imaging findings (MRI data) before and 3–6 months after UFE to changes in sexual function and quality of life.

Materials and Methods

Study design: a prospective, multicenter (25 centers) observational study was conducted. Patients: a total of 264 consecutive symptomatic women undergoing UFE using Embozene® (Celonova) from March 2012 to May 2013 were enrolled. Clinical data: the sexual function score and the quality of life score were calculated using the previously validated Female Sexual Function Index (FSFI) by Rosen and UFS-QOL by Spies, respectively, before and one year after UFE. Imaging data: MRI were performed before and 3–6 months after UFE. Data recorded were uterine and main fibroid volume, percentage of fibroid enhancement after injection of gadolinium. Impact of imaging data before and after UFE FSFS scores and QOL scores after UFE was searched.

Results

Complete FSFI study and QOL study were obtained in 170 and 192 women, respectively. At 1 year post-UFE, improvement of FSFI score was seen in 134/170 women (78.8%), QOL scores were improved in 183/203 women (90.2%) and symptoms severity in 163/192 (84.9%). The relation between main fibroid reduction, decrease of fibroid enhancement and global UFS-QOL and FSFI scores was not established.

Conclusion

At one year post-embolization, UFE significantly improves all aspects of sexual function and quality of life.

This is a preview of subscription content, access via your institution.

References

  1. Ryan GL, Syrop CH, Van Voorhis BJ. Role, epidemiology, and natural history of benign uterine mass lesions. Clin Obstet Gynecol. 2005;48(2):312–24.

    Article  PubMed  Google Scholar 

  2. Edozien LC. Hysterectomy for benign conditions. BMJ. 2005;330(7506):1457–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Verkauf BS. Myomectomy for fertility enhancement and preservation. Fertil Steril. 1992;58(1):1–15.

    CAS  Article  PubMed  Google Scholar 

  4. Ravina JH, Herbreteau D, Ciraru-Vigneron N, Bouret JM, Houdart E, Aymard A, Merland J. Arterial embolisation to treat uterine myomata. Lancet. 1995;346(8976):671–2.

    CAS  Article  PubMed  Google Scholar 

  5. Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007;356(4):360–70.

    CAS  Article  PubMed  Google Scholar 

  6. Spies JB, Coyne K, Guaou Guaou N, Boyle D, Skyrnarz-Murphy K, Gonzalves SM. The UFS-QOL, a new disease-specific symptom and health-related quality of life questionnaire for leiomyomata. Obstet Gynecol. 2002;99(2):290–300.

    PubMed  Google Scholar 

  7. Hehenkamp WJ, Volkers NA, Birnie E, Reekers JA, Ankum WM. Symptomatic uterine fibroids: treatment with uterine artery embolization or hysterectomy—results from the randomized clinical embolisation versus hysterectomy (EMMY) Trial. Radiology. 2008;246(3):823–32.

    Article  PubMed  Google Scholar 

  8. Voogt M, De Vries J, Fonteijn W, Lohl P, Boekkooi P. Sexual functioning and psychological well-being after uterine artery embolization in women with symptomatic uterine fibroids. Fertil Steril. 2009;92(2):756–61.

    Article  PubMed  Google Scholar 

  9. Mara M, Fucikova Z, Maskova J, Kuzel D, Haakova L. Uterine fibroid embolization versus myomectomy in women wishing to preserve fertility: preliminary results of a randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2006;126(2):226–33.

    Article  PubMed  Google Scholar 

  10. Scheurig C, Gauruder-Burmester A, Kluner C, Kurzeja R, Lembcke A, Zimmermann E, et al. Uterine artery embolization for symptomatic fibroids: short-term versus mid-term changes in disease-specific symptoms, quality of life and magnetic resonance imaging results. Hum Reprod. 2006;21(12):3270–7.

    CAS  Article  PubMed  Google Scholar 

  11. Rosen R, Brown C, Heiman J, Leiblum S, Meston C, Shabsigh R, et al. The female sexual function index (FSFI): a multidimensional self-report instrument for the assessment of female sexual function. J Sex Marital Ther. 2000;26:191–208.

    CAS  Article  PubMed  Google Scholar 

  12. Hehenkamp WJ, Volkers NA, Bartholomeus W, de Blok S, Birnie E, Reekers JA, Ankum WM. Sexuality and body image after uterine artery embolization and hysterectomy in the treatment of uterine fibroids: a randomized comparison. Cardiovasc Interv Radiol. 2007;30(5):866–75.

    Article  Google Scholar 

  13. Lippman SA, Warner M, Samuels S, Olive D, Vercellini P, Eskenazi B. Uterine fibroids and gynecologic pain symptoms in a population-based study. Fertil Steril. 2003;80(6):1488–94.

    Article  PubMed  Google Scholar 

  14. Okolo SO, Gentry CC, Perrett CW, Maclean AB. Familial prevalence of uterine fibroids is associated with distinct clinical and molecular features. Hum Reprod. 2005;20(8):2321–4.

    CAS  Article  PubMed  Google Scholar 

  15. Lonnée-Hoffmann R, Pinas I. Effects of hysterectomy on sexual function. Curr Sex Health Rep. 2014;6(4):244–51.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Danesh M, Hamzehgardeshi Z, Moosazadeh M, Shabani-Asrami F. The effect of hysterectomy on women’s sexual function: a narrative review. Med Arch. 2015;69(6):387–92.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Yeagley TJ, Goldberg J, Klein TA, Bonn J. Labial necrosis after uterine artery embolization for leiomyomata. Obstet Gynecol. 2002;100(5 Pt 1):881–2.

    PubMed  Google Scholar 

  18. El-Shalakany AH, Nasr El-Din MH, Wafa GA, Azzam ME, El-Dorry A. Massive vault necrosis with bladder fistula after uterine artery embolisation. BJOG. 2003;110(2):215–6.

    Article  PubMed  Google Scholar 

  19. Lai AC, Goodwin SC, Bonilla SM, Lai AP, Yegul T, Vott S, DeLeon M. Sexual dysfunction after uterine artery embolization. J Vasc Interv Radiol. 2000;11(6):755–8.

    CAS  Article  PubMed  Google Scholar 

  20. Arleo EK, Masheb RM, Pollak J, McCarthy S, Tal MG. Fibroid volume, location and symptoms in women undergoing uterine artery embolization: does size or position matter? Int J Fertil Womens Med. 2007;52(2–3):111–20.

    PubMed  Google Scholar 

  21. Kovacsik HV, Herbreteau D, Sapoval M, Beregi JP, Bommart S, Bartoli JM. Evaluation of change in sexual function related to uterine fibroid embolization (UFE): final results of the french SFICV EFUZEN study. JVIR. 2016;supp3(27):518.

    Google Scholar 

Download references

Centers Included in SFICV Study

H Vernhet-Kovacsik, CHU Arnaud de Villeneuve, Montpellier; J M Bartoli, AP-HM Hôpital Timone, CHU Marseille; J P Beregi, CHU Carémeau, Nîmes; F Boudghene, CH Gaston Ramon, Sens; P Chabrot, CHU Gabriel Montpied, Clermont-Ferrand; J C Brichaux, Clinique St Etienne, Bayonne; P Chevallier, Hôpital Archet II, CHU Nice; F Cotton, HCL, CHU Lyon Sud; M C Delchier, Hôpital Rangueil, CHU Toulouse; D Herbreteau, CHU Bretonneau, Tours; D Higue, CH Côte Basque, Bayonne; X Kos, Clinique Aressy, Bizanos; D Krause, Hôpital Bocage, CHU Dijon; J C Lasalarie, CHU Sud Réunion; M Lebbadi, CHU Fort de France; J Massonnat, Clinique Axium, Aix-en-Provence; C Poey, Clinique St Paul, Fort de France; P Romy, Clinique Pasteur, Guilherand Granges; G Roumieux, CH Henri Duffaut, Avignon; M Sapoval, AP-HP HEGP, CHU Paris; C Sengel, Hôpital Michallon, CHU Grenoble; F Thouveny, Hôpital Larrey, CHU Angers; H Trillaud, Hôpital St André, CHU Bordeaux; E Uzan, CHP Beauregard, Marseille; O Vignaux, AP-HP Hôpital Cochin, CHU Paris.

Author information

Authors and Affiliations

Authors

Consortia

Corresponding author

Correspondence to Hélène Vernhet Kovacsik.

Ethics declarations

Conflict of interest

None.

Appendix: Calculation of the FSFI and QOL Scores

Appendix: Calculation of the FSFI and QOL Scores

Calculation of FSFI scores The sexual function was evaluated using FSFI by computing 6 subscale scores and a total FSFI score. Subscale scores were calculated by adding the score of the individual items (questions) that comprise the subscale. Each subscale score was then multiplied by a subscale factor. Overall score of the FSFI was obtained by adding the 6 subscale scores. The minimum score of the FSFI is 2, and the maximum score is 36. A high FSFI score is better than a low score Missing data on the FSFI questionnaire. When a patient had not answered all items (questions) on a certain subscale (desire, arousal, lubrication, etc.) but had answered more than 50% of the items, the missing data were imputed (replaced) by the mean subscale score of the items present. When a patient had answered 50% or less of the items on a subscale, the subscale score was considered missing. When a subscale score was missing, the total FSFI score could not be calculated and was thus considered missing FSFI scores at inclusion after imputation of missing data.

Calculation of UFS-QOL scores The UFS-QOL is divided in symptom severity and health-related quality of life (HRQL). The Symptom severity scale score is based on the sum of question 1–8 in the UFS-QOL questionnaire. The HRQL comprised 6 subscales. Subscale scores were calculated by adding the score of the items that comprise the subscale. Each subscale score was then multiplied by a subscale factor. Total score of the HRQL was obtained by adding the 6 subscale scores. A low Symptom severity score is better than a high. A high HRQL score is better than a low. Concerning missing data on the UFS-QOL questionnaire: Symptom severity, when a patient had not answered all items (questions) on symptom severity, but had answered more than 50% of the items, the missing data were imputed (replaced) by the mean symptom severity score of the items present. When a patient had answered 50% or less of the items, the symptom severity score was considered missing. Concerning missing data on the UFS-QOL questionnaire: HRQL, when a patient had not answered all items (questions) on a certain subscale (concern, activities, energy/mood etc.) but had answered more than 50% of the items, the missing data were imputed (replaced) by the mean subscale score of the items present. When a patient had answered 50% or less of the items on a subscale, the subscale score was considered missing. When a subscale score was missing, the total HRQL was not calculated and considered missing.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kovacsik, H.V., Herbreteau, D., Bommart, S. et al. Evaluation of Changes in Sexual Function Related to Uterine Fibroid Embolization (UFE): Results of the EFUZEN Study. Cardiovasc Intervent Radiol 40, 1169–1175 (2017). https://doi.org/10.1007/s00270-017-1615-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-017-1615-3

Keywords

  • Uterine fibroid embolization
  • Quality of life
  • Uterine arteries