Functional Outcomes After Vaginal Natural Orifice Transluminal Endoscopic Surgery Hysterectomy: A Systematic Review of Sexual Function and Pelvic Floor Integrity

Vaginal hysterectomy is guideline-preferred for benign disease, yet uptake is declining. Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) offers enhanced visualisation while optimising recovery; however, impact on functional outcomes remains unclear.

To evaluate sexual function and pelvic floor outcomes following vNOTES hysterectomy compared with minimally invasive alternatives.

A systematic review was conducted per PRISMA 2020 and Cochrane guidelines (PROSPERO CRD420251247524). MEDLINE, Embase, Cochrane and Scopus were searched to February 2026. Comparative studies (≥ 25 vNOTES patients) reporting functional outcomes (Female Sexual Function Index [FSFI], Pelvic Floor Distress Inventory [PFDI], International Consultation on Incontinence Questionnaire [ICIQ], Pelvic Organ Prolapse Quantification [POP-Q]) were included. Non-comparative studies and those without validated measures were excluded. Risk of bias was assessed using RoB2 and Newcastle-Ottawa Scale. Results were synthesised narratively (SWiM).