Surgical vs. Medical Abortion on Sexual Function After Early Pregnancy Loss

Surgical Abortion for Early Pregnancy Loss is Associated With Greater Short-Term Decline in Sexual Function Compared to Medical Abortion: A Prospective Comparative Study

This study compares the medium-term effects of surgical and medical abortion on sexual function in women who have experienced early pregnancy loss (6-12 weeks gestation). A total of 86 women (45 medical abortion, 41 surgical abortion) were followed for 6 months. Sexual function was measured using the Female Sexual Function Index (FSFI) before treatment and at 6 months after the procedure. The surgical abortion group showed a significant decline in total FSFI score at 6 months compared to baseline, with decreases observed in all six domains: desire, arousal, lubrication, orgasm, satisfaction, and pain. The medical abortion group showed no significant change in total FSFI score. Between-group comparison at 6 months revealed significantly lower total FSFI scores in the surgical group compared to the medical group. These findings suggest that surgical abortion for early pregnancy loss is associated with a significant decline in sexual function that persists up to 6 months after the procedure, whereas medical abortion appears to have a neutral effect during the same period. Due to the non-randomized design, these findings should be considered hypothesis-generating.

This prospective, comparative cohort study was conducted at Harran University Faculty of Medicine between April 2025 and January 2026. Women aged 18-40 diagnosed with early pregnancy loss (6-12 weeks gestation) were allocated to surgical or medical abortion based on shared decision-making. The Female Sexual Function Index (FSFI) was used to evaluate sexual function before treatment and at 6 months follow-up. Statistical analyses were performed using non-parametric tests (Mann-Whitney U, Wilcoxon signed-rank) with Bonferroni correction. Effect sizes (r) were calculated for all primary outcomes.

Inclusion Criteria:

• - Diagnosis of early pregnancy loss (6-12 weeks gestation)
• Planned to undergo either surgical or medical abortion
• Age between 18 and 40 years
• Proficiency in speaking and reading Turkish
• Voluntary participation and provision of written informed consent

Exclusion Criteria:

• A known pre-existing diagnosis of sexual dysfunction (baseline FSFI total score ≤ 26.55)
• A documented history of severe psychiatric disorders (e.g., schizophrenia, bipolar disorder)
• History of chronic pelvic pain conditions (e.g., endometriosis, vulvodynia) or any other chronic medical condition known to significantly affect sexual function (e.g., unmanaged diabetes mellitus, multiple sclerosis)
• Current use of medications that can impact sexual function (e.g., SSRIs, SNRIs, antipsychotics, antihypertensives)
• Insufficient communication ability, defined as difficulty understanding and speaking Turkish or having cognitive/communication impairments that would prevent reliable completion of the study questionnaires