Sexual Function and Psychological Distress Across Surveillance, Colposcopy, and LEEP in Women with a History of High-Risk HPV Positivity: A Cross-Sectional Study

Background/Objectives: High-risk human papillomavirus (hrHPV) positivity and its management may affect sexual function and psychological well-being, yet whether this burden differs across the successive steps of cervical management is unclear. We compared sexual function, quality of life, and psychological distress across three management steps—surveillance, colposcopy, and loop electrosurgical excision procedure (LEEP). Methods: In this single-center cross-sectional study, 302 reproductive-age women with a history of hrHPV positivity (surveillance, n = 50; colposcopy, n = 177; LEEP, n = 75) completed the Female Sexual Function Index (FSFI), WHOQOL-BREF, and Hospital Anxiety and Depression Scale (HADS). Groups were compared with Kruskal–Wallis and chi-square tests; FSFI total was modelled by multivariable linear regression and FSFI-defined dysfunction by logistic regression. Results: No statistically significant between-group differences were observed in FSFI total (medians 23.8/25.2/24.5; p = 0.897), FSFI subdomains, HADS, or WHOQOL domains; FSFI-defined dysfunction was frequent across groups, with no statistically significant between-group difference (59–67%). No statistically significant association between management pathway and FSFI was observed in the adjusted models (LEEP vs. surveillance B = −0.63, 95% CI −4.68 to +3.42). Depressive symptoms—but not anxiety—were associated with FSFI-defined dysfunction (per HADS-D point, OR = 1.14, 95% CI 1.03–1.26, p = 0.009), whereas the association with continuous FSFI was not significant (B = −0.37, p = 0.064). Marital status was the strongest overall correlate. Conclusions: Across surveillance, colposcopy, and LEEP, sexual function did not differ significantly between management groups at the time of assessment, and, in exploratory analyses, depressive symptoms showed the most consistent association with sexual dysfunction. These findings highlight the potential relevance of psychosocial and relational context in the psychosexual care of women with a history of hrHPV positivity, although prospective studies are needed before specific screening or counselling recommendations can be made.