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Annan JJK, Konney TO, Sam-Awortwi W, Darkwa KA. Emergency hysterectomy in a tertiary care hospital: indications, surgical outcomes and challenges: a 2-year retrospective descriptive cross-sectional study. Pan Afr Med J 2020; 37:106. [PMID: 33425139 PMCID: PMC7757309 DOI: 10.11604/pamj.2020.37.106.25393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/27/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction emergency hysterectomy (EH) remains a life-saving procedure in cases of life-threatening obstetric hemorrhage and other gynaecological emergencies. We aim to determine the indications, surgical outcomes and challenges of EH in our tertiary centre. Methods an ethically approved retrospective descriptive cross-sectional study on all EHs performed at a tertiary hospital during the period of 1st January 2018 to 31st December 2019 was conducted. Medical records of eligible patients were retrieved, reviewed and analysed using frequencies and percentages and then summarized in tables. Results there were 146 EHs over the two year period. The age of participants ranged from 19 to 59 years, with a mean of 34.3 years (SD = 6.06). SD: standard deviation.The main indication for EH was primary postpartum haemorrhage (PPH): 73.28% (n = 110/146). The other indications were uterine perforation with necrosis: 8.9% (n = 13/146), secondary postpartum haemorrhage: 4.8% (n = 7/146), choriocarcinoma and pelvic abscess: 2.74% (n = 4/146) each and broad ligament haematoma: 2.06% (n = 3/146). There were 3.42% (n = 5/146) which were classified as 'others **': two cases of ovarian cyst torsion; one case of placental site tumour; one case of incomplete septic abortion; one case of bulky multinodular fibroid uterus with severe unremitting lower abdominal pain.The most common indication for the subgroup of hysterectomy due to PPH was uterine atony 54.20% (n = 60/110), followed by ruptured uterus20.56% (n = 23/110) and then, morbidly adherent placenta 14.95% (n = 16/110). Placenta accreta constituted 62.5% (n = 10/16) of the morbidly adherent placenta.There were 91.78% (n=134/146) total abdominal hysterectomies and 8.22% (n = 12/146) subtotalhysterectomies. About eighty percent 79.45% (n = 116/146) of the surgeries required general anaesthesia, 15.07% (n = 22/146) required regional anaesthesia whilst 5.48% (n = 8/146) were started as regional anaesthesia but were converted to general anaesthesia.There were no associated intraoperative complications in 96.60% (141/146) of the cases. The most frequent intraoperative complications included bowel injury 2.04% (3/146), bladder injury 0.68% (1/146) and maternal death 0.68% (1/146).Twoof the three bowel injuries required bowel resection and anastomosis. Most of the surgeries 89.73% (n = 131/146) were performed by skilled doctors above the level of a Specialist. Major challenges faced include delayed referral of patients to the tertiary centre for prompt management and lack of quick access to blood products. Conclusion emergency hysterectomy is performed in women who are relatively young with primary postpartum haemorrhage as the commonest indication but there are other non-obstetric indications for this emergency surgery. Though a challenging procedure, it is safe in the hands of a skilled surgical team.
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Affiliation(s)
- John Jude Kweku Annan
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Thomas Opkoti Konney
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Wilfred Sam-Awortwi
- Department of Anaesthesiology and Intensive Care, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kwasi Ampem Darkwa
- Directorate of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
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¿Cambia la función sexual tras la histerectomía? CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2020. [DOI: 10.1016/j.gine.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Female Sexual Orgasmic Dysfunction and Genital Sensation Deficiency. J Sex Med 2019; 17:273-278. [PMID: 31859236 DOI: 10.1016/j.jsxm.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 10/30/2019] [Accepted: 11/01/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Most studies on female sexual dysfunction (FSD), and female sexual orgasmic disorder (FSOD) in particular, have qualitatively examined cultural and educational factors; only few have quantitatively examined physiological factors. AIM The aim of this study was to compare quantitative sensory testing (QST) between women for whom FSOD was their primary complaint and other women with FSD. METHODS In this retrospective study of women who visited a sexual dysfunction clinic, the study group comprised women for whom FSOD was their primary complaint, and the control group comprised other women with FSD. Sexual dysfunction was assessed by the Female Sexual Function Index (FSFI). QST was performed with a thermal and vibration Genito-Sensory Analyzer (GSA; Medoc Ltd, Israel) aimed at the clitoral and vaginal areas. MAIN OUTCOME MEASURE The main outcome was clitoral and vibratory sensory thresholds in accordance with the presence of FSOD. RESULTS The study group comprised 89 (45%) women, with a mean age of 37.6 ± 1.9 years; and the control group comprised 110 (55%) women, with a mean age of 37.5 ± 11.3 years. Both mean FSFI-FSOD and total FSFI scores were significantly lower in the study group than in the control group (0.97 ± 0.94 vs 1.91 ± 1.3, P < 0.001) and (11.9 ± 3.2 vs 15.6 ± 3.6, P < 0.001), respectively. Mean clitoral vibratory sensory thresholds were higher in the study group than in the control group: 2.02 confidence interval (CI) 1.12-2.64 vs 1.55 CI 1.12-2.41, P < 0.001. No statistically significant difference was found between the groups in vaginal vibratory thresholds: 3.7 CI 2.6-6.6 vs 3.4 CI 1.9-5.4, P = 0.14. CLINICAL IMPLICATIONS The findings support the role of the clitoris in obtaining sexual orgasm, thus inferring a possible physiologic cause of FSOD in otherwise healthy women, beyond established psychological causes. STRENGTH & LIMITATIONS Assessments using an objective quantitative measure (QST) and a subjective tool (FSFI) in both the FSOD and control groups are strengths of this study. The retrospective design is a limitation. CONCLUSION QST showed a direct correlation between vibratory clitoral stimulation and FSOD; Compared with the control group, women with FSOD are relatively insensitive to clitoral stimulation, but not to vaginal stimulation. Gruenwald I, Lauterbach R, Gartman I, et al. Female Sexual Orgasmic Dysfunction and Genital Sensation Deficiency. J Sex Med 2020; 17:273-278.
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Doğanay M, Kokanalı D, Kokanalı MK, Cavkaytar S, Aksakal OS. Comparison of female sexual function in women who underwent abdominal or vaginal hysterectomy with or without bilateral salpingo-oophorectomy. J Gynecol Obstet Hum Reprod 2019; 48:29-32. [DOI: 10.1016/j.jogoh.2018.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/30/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022]
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Danesh M, Hamzehgardeshi Z, Moosazadeh M, Shabani-Asrami F. The Effect of Hysterectomy on Women's Sexual Function: a Narrative Review. Med Arch 2018; 69:387-92. [PMID: 26843731 PMCID: PMC4720466 DOI: 10.5455/medarh.2015.69.387-392] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Regarding the contradictions about positive and negative effects of hysterectomy on women's sexual functioning, this study was conducted to review the studies on the effect of hysterectomy on postoperative women's sexual function. METHOD This study was a narrative review and performed in 5 steps: a) Determining the research questions, b) Search methods for identification of relevant studies, c) Choosing the studies, d) Classifying, sorting out, and summarizing the data, and e) reporting the results. FINDINGS The review of the studies yielded 5 main categories of results as follows: The effect of hysterectomy on Sexual desire, the effect of hysterectomy on sexual arousal, the effect of hysterectomy on orgasm, the effect of hysterectomy on dyspareunia, and the effect of hysterectomy on sexual satisfaction. CONCLUSION According to the studies reviewed in this study, most of the sexual disorders improve after hysterectomy for uterine benign diseases, and most of the patients who were sexually active before the surgery experienced the same or better sexual functioning after the surgery. An important solution for making these women ready to face with postoperative sexual complications is to train them on the basis of needs assessment in order that the patients undergoing hysterectomy be ready and capable of coping with the complications, and their sexual functioning improves after the surgery.
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Affiliation(s)
- Mahmonier Danesh
- Nasibeh Nursing and Midwifery Faculty, MazandaranUniversity of Medical Sciences, Sari, Iran
| | - Zeinab Hamzehgardeshi
- Department of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran; Traditional and Complementary Medicine Research Centre, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fereshteh Shabani-Asrami
- Department of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran; Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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Levin RJ, Both S, Georgiadis J, Kukkonen T, Park K, Yang CC. The Physiology of Female Sexual Function and the Pathophysiology of Female Sexual Dysfunction (Committee 13A). J Sex Med 2017; 13:733-59. [PMID: 27114190 DOI: 10.1016/j.jsxm.2016.02.172] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The article consists of six sections written by separate authors that review female genital anatomy, the physiology of female sexual function, and the pathophysiology of female sexual dysfunction but excluding hormonal aspects. AIM To review the physiology of female sexual function and the pathophysiology of female sexual dysfunction especially since 2010 and to make specific recommendations according to the Oxford Centre for evidence based medicine (2009) "levels of evidence" wherever relevant. CONCLUSION Recommendations were made for particular studies to be undertaken especially in controversial aspects in all six sections of the reviewed topics. Despite numerous laboratory assessments of female sexual function, genital assessments alone appear insufficient to characterise fully the complete sexual response.
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Affiliation(s)
- Roy J Levin
- Reader in Physiology (Retired), Department of Biomedical Science, University of Sheffield, Sheffield, UK: Section 2.
| | - Stephanie Both
- Department of Psychosomatic Gynecology and Sexology, Leiden University Medical Center, Leiden, The Netherlands: Section 3
| | - Janniko Georgiadis
- Department of Neuroscience, University Medical Center, Groningen, University of Groningen, The Netherlands: Section 4
| | - Tuuli Kukkonen
- College of Social and Applied Human Science, University of Guelph, Guelph, ON, Canada: Section 6
| | - Kwangsung Park
- Department of Urology, Chonnan National University Medical School, Gwangju, Korea: Section 5
| | - Claire C Yang
- Department of Urology, University of Washington, Seattle, WA, USA: Section 1
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Lowenstein L, Mustafa S, Gartman I, Gruenwald I. Effect of Midurethral Sling Surgery on Vaginal Sensation. J Sex Med 2016; 13:389-92. [PMID: 26944464 DOI: 10.1016/j.jsxm.2016.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/05/2015] [Accepted: 01/10/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Previous studies have reported changes in the sensory functioning of the vagina in women with pelvic floor disorder. AIM To evaluate vaginal and clitoral sensation before and after surgery with trans-obturator tape (TVT-O, Ethicon Johnson & Johnson). METHODS Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina and clitoris 1 day before and 12 ± 4 months after surgery. MAIN OUTCOME MEASURES Differences in thresholds to warm, cold, and vibratory sensations at a predetermined anatomic area of the genital region. RESULTS Twenty-two women were admitted for midurethral sling surgery, and four were lost to follow-up. For the remaining 18 (mean age = 52 years, range = 37-65), we found a significant sensory decrease at the clitoral region to cold, warm, and vibratory stimuli after surgery. In contrast, in the anterior vaginal wall, there was a significant decrease only to warm stimuli after surgery. CONCLUSION TVT-O can cause sensory loss in the clitoral and anterior vaginal wall region that can be measured and quantified. The effect of such sensory loss on sexual function and quality of sexual life needs further investigation.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Susana Mustafa
- Department of Obstetrics and Gynecology, Rambam Medical Center, Haifa, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Irena Gartman
- Neurourology Division, Department of Urology, Rambam Medical Center, Haifa, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ilan Gruenwald
- Neurourology Division, Department of Urology, Rambam Medical Center, Haifa, Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Burke YZ, Lowenstein L. Current Practice in Hysterectomy for Benign Reasons and Its Effect on Sexual Function. J Sex Med 2016; 13:1289-1291. [DOI: 10.1016/j.jsxm.2016.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 11/16/2022]
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Burke YZ, Lowenstein L. Value of Quantitative Sensory Testing in the Evaluation of Genital Sensation: Its Application to Female Sexual Dysfunction. Sex Med Rev 2016; 4:121-5. [DOI: 10.1016/j.sxmr.2015.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/08/2015] [Indexed: 11/30/2022]
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Lowenstein L, Mustafa-Mikhail S, Gartman I, Gruenwald I. The effect of pelvic organ prolapse repair on vaginal sensation. Int Urogynecol J 2016; 27:915-8. [PMID: 26740196 DOI: 10.1007/s00192-015-2910-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate vaginal and clitoral sensation before and after robotic sacrocolpopexy for the repair of pelvic organ prolapse. METHODS Twenty-two women, mean age 63 years (range 41-77), were admitted for robotic sacrocolpopexy repair of pelvic organ prolapse; 4 were lost to follow-up. Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina (anterior and posterior areas) and clitoris 1 day before and a mean of 12 ± 4 months following surgery. Student's paired t test was used to compare sensory thresholds before and after surgery. RESULTS For the 18 women who completed follow-up, sensitivity was significantly higher after surgery (sensory threshold decreased) at the clitoral and vaginal regions, to cold and warm stimuli. In contrast, the vaginal and clitoral vibratory sensory thresholds did not change significantly following surgery. CONCLUSION The repair of pelvic organ prolapse by robotic sacrocolpopexy could potentially play a role in restoring clitoral and vaginal wall sensation. The effects of these sensory changes on sexual function and the quality of sexual life need further investigation.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics & Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel.,Department of Urology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel
| | - Susana Mustafa-Mikhail
- Department of Obstetrics & Gynecology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel. .,Department of Urology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel.
| | - Irena Gartman
- Division of Neurourology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel
| | - Ilan Gruenwald
- Division of Neurourology, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa, Israel
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Genital sensation in women with pelvic organ prolapse. Int Urogynecol J 2015; 26:981-4. [PMID: 25715930 DOI: 10.1007/s00192-015-2637-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/21/2015] [Indexed: 10/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to compare vaginal and clitoral sensory thresholds in women with pelvic organ prolapse and women with normal pelvic anatomy. METHODS Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina and clitoral area of women with pelvic organ prolapse, pelvic organ prolapse quantification (POP-Q) stage II or higher (study group) and of women without prolapse, POP-Q stage ≤ I (control group). The quantitative sensory tests were performed with a thermal and vibration Genito-Sensory Analyzer, at the distal third of the anterior and posterior vaginal wall and at the clitoral area. Warm stimuli were used to evaluate unmyelinated C-fibers; cold stimuli for thinly myelinated A-delta; and vibratory stimuli for large A-beta fibers. Independent Student's t test and Chi-squared test of association were used for analysis of continuous and categorical parameters respectively. RESULTS Overall, 66 women, 22 with median POP-Q stage III (range: II-IV) and 44 with POP-Q stage I (range: 0-I), participated in the study. There were no statistically significant differences between the two groups regarding the characteristics examined (health status, medical history, and age). In all regions examined, mean thresholds for vibratory and warm stimuli were significantly higher and mean thresholds for cold stimuli significantly lower in the group with prolapse. CONCLUSION Women with pelvic organ prolapse exhibited lower sensitivity in the genital area to vibratory and thermal stimuli than did women without prolapse. Our findings suggest that a neuropathic sensory deficit in the area of the genitalia might be associated with prolapse.
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Abstract
Hysterectomy remains the most common major gynecological surgery. Postoperative sexual function is a concern for many women and their partners. In this respect, a beneficial effect of hysterectomy for benign disease independent of surgical techniques or removal of the cervix has been demonstrated in the past decade by the majority of studies. For about 20 % of women, deteriorated sexual function has been reported and current research is attempting to identify mechanisms and predictive factors explaining these postoperative changes. Alternative treatments of benign uterine disorders or uterus preserving surgery for genital prolapse appeared to have similar outcomes in terms of sexual function. Concomitant oophorectomy had negative effects on sexual function and long-term health, particularly in premenopausal women. This may not be reversed by estrogen replacement. Hysterectomy performed for malignancy had a detrimental effect on sexual function. Individualized risk assessment and information should be aimed at during preoperative decision making.
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Psychological outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013; 174:5-19. [PMID: 24398028 DOI: 10.1016/j.ejogrb.2013.12.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 08/27/2013] [Accepted: 12/06/2013] [Indexed: 11/23/2022]
Abstract
Hysterectomy is one of the commonest operative procedures in the developed world, mostly occurring among premenopausal women, with contradictory results regarding post-operative psychological wellbeing. This review aims to inform practice by examining whether hysterectomy predicts depression or anxiety outcomes. We searched PubMed, EMBASE, and PsycINFO electronic databases for articles published before November 2012. Reference lists of relevant articles were hand searched, and expert opinions were sought. Refereed studies investigating an association between hysterectomy for benign (non-cancerous) conditions and post-operative symptoms of depression or anxiety were chosen for this review. Two authors independently abstracted data from original articles. Authors of relevant studies were contacted for data that could not be extracted from the published articles. Review Manager 5.1 was used throughout the meta-analysis to calculate the summary relative risks (RRs), and the weighted standardized mean difference (WstdMD), and their corresponding 95% confidence intervals (CI). A random effects model was used in data analysis and verified using a fixed effect model. Overall, hysterectomy was associated with a decreased risk of clinically relevant depression (RR=1.69, 95% CI 1.19-2.38). Additionally, hysterectomy was associated with a decrease in standardized depression outcomes (standardized mean difference (SMD) 0.38 (95% CI 0.27-0.49)). Conversely, there was no significant association between hysterectomy and risk of clinically relevant anxiety (RR=1.41, 95% CI 0.72-2.75). In conclusion, data from before and after studies suggest that hysterectomy for benign gynecological conditions is not adversely associated with anxiety and may be positively rather than adversely associated with depression.
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North CE, Creighton SM, Smith ARB. A comparison of genital sensory and motor innervation in women with pelvic organ prolapse and normal controls including a pilot study on the effect of vaginal prolapse surgery on genital sensation: a prospective study. BJOG 2012; 120:193-199. [DOI: 10.1111/1471-0528.12083] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2012] [Indexed: 11/27/2022]
Affiliation(s)
- CE North
- Warrell Unit; St Mary's Hospital; Manchester UK
| | - SM Creighton
- Institute of Women's Health; University College; London UK
| | - ARB Smith
- Warrell Unit; St Mary's Hospital; Manchester UK
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Sexuality after hysterectomy at University of Jordan Hospital: a teaching hospital experience. Arch Gynecol Obstet 2012; 287:703-8. [DOI: 10.1007/s00404-012-2601-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 10/09/2012] [Indexed: 10/27/2022]
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Histopathology diagnosis in women who underwent a hysterectomy for a benign condition. Arch Gynecol Obstet 2011; 285:1339-43. [DOI: 10.1007/s00404-011-2152-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 11/15/2011] [Indexed: 11/27/2022]
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Komisaruk BR, Frangos E, Whipple B. Hysterectomy improves sexual response? Addressing a crucial omission in the literature. J Minim Invasive Gynecol 2011; 18:288-95. [PMID: 21545957 DOI: 10.1016/j.jmig.2011.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 01/13/2011] [Accepted: 01/21/2011] [Indexed: 10/18/2022]
Abstract
The prevailing view in the literature is that hysterectomy improves the quality of life. This is based on claims that hysterectomy alleviates pain (dyspareunia and abnormal bleeding) and improves sexual response. Because hysterectomy requires cutting the sensory nerves that supply the cervix and uterus, it is surprising that the reports of deleterious effects on sexual response are so limited. However, almost all articles that we encountered report that some of the women in the studies claim that hysterectomy is detrimental to their sexual response. It is likely that the degree to which a woman's sexual response and pleasure are affected by hysterectomy depends not only on which nerves were severed by the surgery, but also the genital regions whose stimulation the woman enjoys for eliciting sexual response. Because clitoral sensation (via pudendal and genitofemoral nerves) should not be affected by hysterectomy, this surgery would not diminish sexual response in women who prefer clitoral stimulation. However, women whose preferred source of stimulation is vaginal or cervical would be more likely to experience a decrement in sensation and consequently sexual response after hysterectomy because the nerves that innervate those organs, that is, the pelvic, hypogastric, and vagus nerves, are more likely to be damaged or severed in the course of hysterectomy. However, all published reports of the effects of hysterectomy on sexual response that we encountered fail to specify the women's preferred sources of genital stimulation. As discussed in the present review, we believe that the critical lack of information as to women's preferred sources of genital stimulation is key to accounting for the discrepancies in the literature as to whether hysterectomy improves or attenuates sexual pleasure.
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Affiliation(s)
- Barry R Komisaruk
- Department of Psychology, Rutgers, The State University of New Jersey, Newark, New Jersey 07102, USA.
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Abstract
Controlled tissue cooling, or hypothermia, has been used therapeutically for decades to mitigate the negative effects of traumatic, ischemic, and surgical insults. When applied systemically, moderate hypothermia can attenuate or prevent the extent of neurologic sequelae. Localized hypothermia, on the other hand, has the capacity to reduce tissue edema, suppress inflammation, and minimize the severity of peripheral nerve injury. Therapeutic hypothermia has been used in critical care, neurosurgery, ophthalmology, otolaryngology, cardiothoracic surgery and most recently in urology. Nerve injury during radical pelvic surgery can result in urinary incontinence or retention, impotence and bowel dysfunction. Localized hypothermia during radical prostatectomy has demonstrated improved recovery of urinary continence and erectile function, and similar benefits might be observed in other types of radical pelvic surgery.
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Affiliation(s)
- David S Finley
- Institute of Urologic Oncology, David Geffen School of Medicine, University of California Los Angeles, 924 Westwood Boulevard, Suite 1050, Los Angeles, CA 90095, USA.
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Lee M, Morgan M, Rapkin A. Clitoral and Vulvar Vestibular Sensation in Women Taking 20 mcg Ethinyl Estradiol Combined Oral Contraceptives: A Preliminary Study. J Sex Med 2011; 8:213-8. [DOI: 10.1111/j.1743-6109.2010.02074.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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21
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Abdelmonem AM. Vaginal length and incidence of dyspareunia after total abdominal versus vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol 2010; 151:190-2. [PMID: 20427116 DOI: 10.1016/j.ejogrb.2010.03.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 12/26/2009] [Accepted: 03/31/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Allam M Abdelmonem
- Department of OB/GYN, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt.
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Abstract
Sexual function is complex and involves interaction of many factors, including emotional connection, body image, intact physical response and partner sexual function. Disease processes such as abnormal uterine bleeding, endometriosis, urinary incontinence and pelvic organ prolapse may have a negative impact on various parameters of sexual health. Gynecological surgery to address these common complaints may correct the pathological process. However, despite improvements in symptoms related to the disease, improvements in sexuality are not guaranteed and occasionally there may be deteriorations. This review will summarize the current literature assessing sexual symptoms following benign gynecological surgery, including hysterectomy, and bilateral salpingo-oophorectomy, tubal ligation, anti-incontinence surgery and pelvic organ prolapse reconstruction with and without mesh. In the majority of cases, sexual function and quality of life benefit from these surgical interventions. However, it is critical that physicians remain aware of the potential for negative outcomes. Subjects who experience worsening should undergo thorough evaluation early in the postoperative period in order to mitigate symptoms. Treatment modalities for sexual dysfunction following surgery should be the focus of future research.
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Helpman L, Greenstein A, Hartoov J, Abramov L. Genito-Sensory Analysis in Women with Arousal and Orgasmic Dysfunction. J Sex Med 2009; 6:1039-1044. [DOI: 10.1111/j.1743-6109.2008.01167.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Verit FF, Verit A. A Turkish Study of Prevalence and Risk Factors for Low Sexual Function in Women. J Sex Med 2008; 5:2973-4. [DOI: 10.1111/j.1743-6109.2008.01016.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lowenstein L, Davis C, Jesse K, Durazo-Arvizu R, Kenton K. Comparison between sensory testing modalities for the evaluation of afferent nerve functioning in the genital area. Int Urogynecol J 2008; 20:83-7. [PMID: 18923804 DOI: 10.1007/s00192-008-0733-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 09/13/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Lior Lowenstein
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology and Urology, Loyola University Stritch School of Medicine, Loyola University Medical Center, Maywood, IL 60153, USA.
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Vardi Y, Salonia A, Lowenstein L, Mueller ER, Giraldi A, Laan E. Should Nerve‐Sparing Procedures Be Reserved to Men Only? J Sex Med 2008; 5:2259-63. [DOI: 10.1111/j.1743-6109.2008.00995.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Szeverényi P, Török Z. [The relationship between hysterectomy and sexual life according to the latest research]. Orv Hetil 2008; 149:589-95. [PMID: 18353739 DOI: 10.1556/oh.2008.28338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hysterectomy is one of the most frequent surgical interventions. Both specialists and lay people are interested in the following question: what kind of late psychosexual consequences does hysterectomy have? In the past years many publications showed a new aspect of the effects of hysterectomy on sexual life. The results of these prospective, randomized studies show that the late psychosexual changes do not primarily depend on the surgical method (vaginal, abdominal total or subtotal hysterectomy). The most significant predictive factor is the quality of sexual relationship before the operation. In the light of the evidence of the latest research, women can be reassured about the fact that hysterectomy, performed due to a benign disease, usually ameliorates the function of the organs in the small pelvis, i.e. positive change in sexual life can be expected. On the basis of the observations, this statement is valid for 2 years after the intervention. To analyze the effects after this period, further long-term studies are required. In this literature review the authors present the most significant study results published in the recent past.
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Affiliation(s)
- Péter Szeverényi
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Altalános Orvostudományi Kar Szülészeti és Nogyógyászati Klinika Debrecen Nagyerdei krt. 98., 4032.
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Dalpiaz O, Kerschbaumer A, Mitterberger M, Pinggera GM, Colleselli D, Bartsch G, Strasser H. Female sexual dysfunction: a new urogynaecological research field. BJU Int 2008; 101:717-21. [PMID: 18190620 DOI: 10.1111/j.1464-410x.2007.07442.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To critically review published data on the urogynaecological aspects of female sexual dysfunction (FSD), as FSD is a developing multidisciplinary issue associated with several biological, medical and psychological factors. METHODS The reported prevalence of FSD is 19-50% and women with lower urinary tract symptoms or urinary incontinence (UI) not only complain of a deteriorating of quality of life but also of sexual life with an incidence as high as 26-47%. Furthermore, urogynaecological surgery represents an important but underestimated cause of FSD. Different databases (Pub Medical, Medline, serial titles, the Cochrane library and the NLM gateway database) were searched for the keywords 'sexuality; sexual function; urinary incontinence; pelvic organ prolapse; questionnaire; symptom severity; epidemiology; quality of life; instruments; sexual health; vagina; vaginal surgery; pelvic surgery'. RESULTS There is a lack of a standardized instrument for assessing FSD. Recent studies investigate the impact of UI on sexual function, but the pathophysiology has not been elucidated. Vaginal or pelvic surgery does not affect overall sexual satisfaction. CONCLUSIONS Our investigation highlights the need for studies to assess the anatomical, physiological and sensory mechanisms related to FSD. Specific questionnaire are needed to quantify the problem. In the definition, symptoms assessment and preoperative counselling is important, to make a distinction between overall sexual function and individual parameters, such as psychosocial context. Only in this way, will it be possible to identify new therapeutic targets. A definition of success in urogyneacological terms should include aspects of quality of life and quality of sexual life. Immediate research in this field is needed.
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Affiliation(s)
- Orietta Dalpiaz
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria.
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Biologic basis for female orgasm: A retrospective report. CURRENT SEXUAL HEALTH REPORTS 2007. [DOI: 10.1007/s11930-007-0015-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lukkarinen H, Lukkarinen O. Sexual satisfaction among patients after coronary bypass surgery or percutaneous transluminal angioplasty: Eight-year follow-up. Heart Lung 2007; 36:262-9. [PMID: 17628195 DOI: 10.1016/j.hrtlng.2006.12.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2005] [Accepted: 12/11/2006] [Indexed: 01/23/2023]
Abstract
BACKGROUND Cardiovascular diseases are currently the leading cause of death worldwide. In addition to risk factor prevention, the treatment interventions of coronary artery disease (CAD) include medication, percutaneous transluminal coronary angioplasty (PTCA) with stenting, and coronary artery bypass grafting (CABG). Patients with CAD have a more than twofold risk of sexual dysfunctions compared with age-matched healthy persons. The physiologic changes in sexual satisfaction, such as erectile dysfunctions in men and impaired sexual arousal in women, correlate with the severity of CAD. OBJECTIVES The purpose of this study was to describe the long-term effects of treatment interventions on the sexual satisfaction of patients with CAD. METHODS The original study series consisted of 280 patients with CAD who were followed up for 8 years. There were 189 men and 91 women. At the baseline of the study, 100 patients underwent CABG, 100 patients underwent PTCA, and 80 patients were prescribed medication. Eight years later, we were able to reach 63 patients who underwent CABG, 50 patients who underwent PTCA, and 34 patients who were prescribed medication. Descriptive statistics, the chi-square test for testing group differences, and McNemar's test for dependent sample were used to analyze the data. RESULTS Sixty percent of the patients were satisfied with their sexual functions before the treatment interventions, and 63% were satisfied 8 years after the interventions; 52% of men and 77% of women were sexually satisfied before the interventions. Eight years later, 59% of men and 70% of women were satisfied with their sex life. In the CABG group, 57% of the patients were satisfied with their sexual functions preoperatively, whereas 62% were satisfied 8 years later. The corresponding results were 56% and 64% in the PTCA group and 73% and 62% in the medication group, respectively. Women were more satisfied with their sex life than men (P = .002) before the interventions. However, the satisfaction of women declined during the 8-year follow-up period, whereas that of men increased, but the change was not statistically significant. CONCLUSION The findings provide new knowledge about the long-term impacts of treatment interventions on the sexual satisfaction of patients with CAD.
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Affiliation(s)
- Hannele Lukkarinen
- Department of Nursing Science and Health Administration, Faculty of Medicine, University of Oulu, Oulu University Hospital, Oulu, Finland
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Vardi Y. Female Sexual Dysfunction after Pelvic Surgery: Is There a Place for Nerve-Sparing Surgery? Eur Urol 2006; 50:14-6. [PMID: 16647803 DOI: 10.1016/j.eururo.2006.03.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Accepted: 03/06/2006] [Indexed: 01/23/2023]
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Salonia A, Briganti A, Dehò F, Zanni G, Rigatti P, Montorsi F. Women's sexual dysfunction: a review of the "surgical landscape". Eur Urol 2006; 50:44-52. [PMID: 16650925 DOI: 10.1016/j.eururo.2006.03.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 03/22/2006] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To assess the impact of urogynaecologic surgery for stress urinary incontinence, oncologic pelvic surgery, and hysterectomy on women's overall sexual health. METHODS We used Ovid and PubMed (updated January 2006) to conduct a literature electronic search on MEDLINE that included peer-reviewed English-language articles. We analysed all studies identified that provided any functional outcome data about urogynaecologic surgery for the treatment of stress urinary incontinence, radical cystectomy for bladder cancer, surgery for rectal cancer, and hysterectomy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data. RESULTS Most studies showed that either urogynaecologic or oncologic pelvic surgery may have a significant impact on women's sexual health. Epidemiology varied widely among the studies and reported either improvement or impairment of postoperative sexual functioning, due to different definitions, study designs, and small cohorts of patients. An increasing number of studies have prospectively examined this issue and have found often controversial findings about the role of pelvic and perineal surgery in women's sexual health. CONCLUSIONS Although numerous controversies exist, data demonstrate an overall positive impact of the surgical repair for stress urinary incontinence on resolution of coital incontinence, coupled with an improvement of overall sexual life. In contrast, genitourinary and rectal cancers are commonly associated with treatment-related sexual dysfunction, but few studies rigorously assessed women's postoperative sexual function after major oncologic pelvic surgery. Data about the functional outcome after hysterectomy are often contradictory. Adequately powered prospective clinical trials are needed.
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Affiliation(s)
- Andrea Salonia
- Department of Urology, Scientific Institute H. San Raffaele, Milan, Italy.
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