The aim of this study is to investigate the rate of postoperative dyspareunia and sexual dysfunction following transvaginal tissue extraction or Natural Orifice Transluminal Endoscopic Surgery (NOTES) procedures.

A systematic review was conducted using the EBSCOhost, MEDLINE, EMBASE, Cochrane, and PubMed databases to identify eligible studies. The search was performed on seven of May 2025 and included all available publications up to that date. Study quality was independently assessed by three reviewers using the Cochrane Collaboration Risk of Bias tool (RoB-2) for randomized controlled trials and the Risk of Bias in Non-Randomized Studies of Exposure (ROBINS-E) tool. Included studies were originated from different specialties, therefore, it was subsequently divided into three subgroups: General Surgery, Urology, and Gynecology.

Thirty studies including 2,488 sexually active women were analyzed across three surgical specialties. In general surgery (1,062 patients), most procedures involved transvaginal specimen extraction during hybrid NOTES cholecystectomy. Postoperative dyspareunia and sexual dysfunction were uncommon, and validated questionnaire scores showed no clinically meaningful decline in sexual function. In gynecology (1,361 patients), posterior colpotomy for adnexal mass or myomectomy specimen retrieval was associated with very low rates of postoperative dyspareunia, and studies using validated sexual-function scales demonstrated no significant difference compared with conventional laparoscopic approaches. In urology (65 patients), transvaginal extraction following nephrectomy or renal cyst surgery was not associated with postoperative dyspareunia, and postoperative sexual-function scores remained stable.

Vaginal tissue extraction or NOTES surgery can be performed with a low risk of sexual dysfunction or dyspareunia.