Hysterectomy: social and psychosexual aspects

Hysterectomy and sexual (dys)function: An analysis of sexual dysfunction after hysterectomy and a search for predictive factors

OBJECTIVES

Research about sexual function after hysterectomy is inconclusive. Possible predictive factors for sexual (dys)function are yet to be identified. The aim of this study is to assess the effect of hysterectomy on sexual function in women 3 and 12 months after hysterectomy for benign indications. Furthermore hypothesized predictive factors will be evaluated.

STUDY DESIGN

A prospective multicentre cohort study with follow-up at 3 and 12 months after hysterectomy was performed. To assess sexual function a short-form FSFI was used, a score ≤ 19 means sexual dysfunction). Linear mixed model repeated measure analysis was used to assess changes in sexual function in women who were sexually active at all three measure points (N = 260). Linear mixed model analyses were also used for the predictor analyses.

RESULTS

The FSFI score increased from 20.94 at baseline to 23.81 at 12 months post hysterectomy. The number of women experiencing sexual dysfunction was 86 (33.1 %). Women without preoperative sexual dysfunction had a significantly higher FSFI score 4.5 (95 % CI 3.5-5.6) one year after the operation than women indicating sexual dysfunction before surgery. Women who were living alone had a significantly higher FSFI score of 2.31 (0.7-4.0) when compared to women who were married or living together.

CONCLUSION

FSFI score increases significantly after hysterectomy, which indicates a better sexual function after the operation. Sexual dysfunction before hysterectomy (FSFI score ≤ 19) and being married or living together are predictive factors for a lower FSFI score post hysterectomy.

Recovery 3 and 12 months after hysterectomy: epidemiology and predictors of chronic pain, physical functioning, and global surgical recovery

Chronic postsurgical pain (CPSP) is 1 important aspect of surgical recovery. To improve perioperative care and postoperative recovery knowledge on predictors of impaired recovery is essential. The aim of this study is to assess predictors and epidemiological data of CPSP, physical functioning (SF-36PF, 0-100), and global surgical recovery (global surgical recovery index, 0-100%) 3 and 12 months after hysterectomy for benign indication.A prospective multicenter cohort study was performed. Sociodemographic, somatic, and psychosocial data were assessed in the week before surgery, postoperatively up to day 4, and at 3- and 12-month follow-up. Generalized linear model (CPSP) and linear-mixed model analyses (SF-36PF and global surgical recovery index) were used. Baseline data of 468 patients were collected, 412 (88%) patients provided data for 3-month evaluation and 376 (80%) patients for 12-month evaluation.After 3 and 12 months, prevalence of CPSP (numeric rating scale ≥ 4, scale 0-10) was 10.2% and 9.0%, respectively, SF-36PF means (SD) were 83.5 (20.0) and 85.9 (20.2), global surgical recovery index 88.1% (15.6) and 93.3% (13.4). Neuropathic pain was reported by 20 (5.0%) patients at 3 months and 14 (3.9%) patients at 12 months. Preoperative pain, surgery-related worries, acute postsurgical pain on day 4, and surgery-related infection were significant predictors of CPSP. Baseline level, participating center, general psychological robustness, indication, acute postsurgical pain, and surgery-related infection were significant predictors of SF-36PF. Predictors of global surgical recovery were baseline expectations, surgery-related worries, American Society of Anesthesiologists classification, type of anesthesia, acute postsurgical pain, and surgery-related infection.Several predictors were identified for CPSP, physical functioning, and global surgical recovery. Some of the identified factors are modifiable and optimization of patients' preoperative pain status and psychological condition as well as reduction of acute postsurgical pain and surgery-related infection may lead to improvement of outcome.

Hysterectomy and subsequent psychological health: findings from a British birth cohort study

BACKGROUND

The association between hysterectomy and subsequent, long-term psychological health is still not well characterised. We aimed to test the association between hysterectomy and subsequent psychological health and examine variation in this association by characteristics of hysterectomy.

METHODS

Using data on women in the MRC National Survey of Health and Development, followed up since birth in 1946 until age 53 years (N=1790) the associations between hysterectomy and General Health Questionnaire (GHQ)-28 scores were tested.

RESULTS

There was no clear association between hysterectomy status and GHQ-28 score at age 53 years when grouping all hysterectomies together. However, this masked significant variation in association by characteristics of hysterectomy. In unadjusted analyses women who had undergone hysterectomy for cancer had mean GHQ-28 scores at age 53 years which were 49.0% higher (95% CI: 3.4%, 94.7%) than women who had not undergone hysterectomy. In analyses adjusted for prior psychological state and vulnerability, lifetime socioeconomic position, weight at age 26 years, smoking status and hormone replacement therapy use, women who had undergone hysterectomy before age 40 years had GHQ-28 scores 29.5% higher (95% CI: 2.7%, 56.3%) than women who had not undergone hysterectomy.

CONCLUSIONS

Our findings suggest that women who undergo hysterectomy at a young age are a defined group who may require more support than other women to maintain good psychological health in middle-age.

Laparoscopic vs vaginal hysterectomy for benign pathology

OBJECTIVE

The objective of the study was to compare length of stay, blood loss, operative time, and pain of laparoscopic and vaginal hysterectomy.

STUDY DESIGN

This was a prospective, randomized, controlled comparison between vaginal (VH) and laparoscopic (LH) hysterectomy among 60 consecutive patients with a uterine volume of 300 mL or less and without uterine prolapse. Patients were followed up for 12 months.

RESULTS

The groups were significantly different for mean operative time (VH: 81 +/- 30 minutes; LH: 99 +/- 25 minutes; P = .033) and blood loss (LH: 83 +/- 57 mL; VH: 178 +/- 149 mL; P = .004). Bilateral adnexectomy was performed when preoperatively planned in 73% of cases of the vaginal arm, whereas it was always performed in the laparoscopic arm (P = .045). Postoperative pain on day 0 and the number of days of analgesic request were higher in the vaginal group (P = .023 and P = .017, respectively). LH was associated with a reduced hospital stay (LH: 2.7 +/- 0.5 days; VH: 3.2 +/- 0.6 days; P < .001).There were no differences between the groups at the follow-up.

CONCLUSION

Laparoscopic hysterectomy results in a shorter hospital stay, less blood loss, and less postoperative pain compared with vaginal hysterectomy.

Preoperative analgesia with local lidocaine infiltration for abdominal hysterectomy pain management

OBJECTIVE

To evaluate the impact of preemptive local analgesia at the incision site in reducing pain in women undergoing abdominal hysterectomy for a benign myomatous uterus.

STUDY DESIGN

In this prospective, randomized, double-blinded, placebo-controlled study, 20 mL of 1% lidocaine or 0.9% saline was injected at the abdominal incision site prior to the performance of the hysterectomy. Thirty-two women were enrolled in the study, 16 received preemptive analgesia while 14 were treated by placebo; 2 were excluded. All operations were performed under general anesthesia. The standard postoperative pain treatment consisted of oral analgesia with ibuprofen (400 mg) in liquid-filled capsules. Morphine (10 mg) was used for rescue analgesia. Pain intensity was self-evaluated with the use of a 100 mm visual analog scale.

RESULTS

Compared to the placebo group, women who received preemptive analgesia with lidocaine 1% perceived a significant reduction in postoperative pain in the first hours after surgery (2 h: 50.1+/-27.9 versus 70.6+/-22.6, p=0.043; 5 h: 42.5+/-25.2 versus 64.6+/-28.3, p=0.043; 8 h: 31.2+/-22.4 versus 53.3+/-30.3, p=0.031).

CONCLUSION

Preemptive analgesia with lidocaine 1% is a simple, cheap and efficient mode to reduce pain in the first hours after hysterectomy.

Psychological wellbeing after laparoscopic and abdominal hysterectomy-a randomised controlled multicentre study

OBJECTIVE

To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures.

DESIGN

A prospective, open, randomised multicentre trial.

SETTING

Five hospitals in the South East of Sweden.

POPULATION

Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study, and 119 women completed the study. Fifty-six women were randomised to abdominal hysterectomy and 63 to laparoscopic hysterectomy.

METHODS

Psychometric tests measuring general wellbeing, depression and anxiety preoperatively and 5 weeks and 6 months postoperatively.

MAIN OUTCOME MEASURES

Effects of operating method on the psychological wellbeing postoperatively. Analysis of data regarding operating time, peroperative and postoperative complications, blood loss, hospital stay and recovery time.

RESULTS

No significant differences in the scores were observed between the two groups in any of the four psychometric tests. Both the surgical methods were associated with a significantly higher degree of psychological wellbeing 5 weeks postoperatively compared with preoperatively. The operating time was significantly longer for the laparoscopic hysterectomy group, but the duration of the stay in hospital and sick-leave were significantly shorter for laparoscopic hysterectomy group compared with the abdominal hysterectomy group.

CONCLUSIONS

General psychological wellbeing is equal after laparoscopic and abdominal hysterectomy within 6 months after the operation. The advantages of the laparoscopic hysterectomy are the shorter stay in hospital and shorter sick-leave, but these issues must be balanced by a longer duration of the operation.

Does hysterectomy affect genital sensation?

OBJECTIVES

To evaluate vaginal and clitoral sensation before and after hysterectomy and to assess pre- and post-surgery changes in sexual function.

STUDY DESIGN

Quantitative sensory thresholds for warm, cold, and vibratory sensations were measured at the vagina and clitoris 1 day prior to and 3 months following surgery. A survey was performed 18 months following operation to evaluate long-term changes in sexual function.

PARTICIPANTS

Twenty-seven women, aged 30-57 years, who were admitted for elective hysterectomy.

MAIN OUTCOME MEASURES

Genital sensation and reported sexual function.

RESULTS

There was significant deterioration in sensation to cold and warm stimuli at the anterior and posterior vaginal wall after surgery. Vaginal vibratory sensation thresholds tended to increase. Clitoral thermal and vibratory sensation thresholds remained unchanged before and after surgery. Of the 22 patients who participated in the follow-up survey, 17 did not report any decline in sexual function, while 4 patients reported deterioration in genital sensation and in sexual function.

CONCLUSION

The results demonstrate quantifiable sensory loss in the vagina after hysterectomy, with preservation of clitoral sensation. Only a minority of patients reported a decline in their sexual function. These findings highlight the relative importance of clitoral as compared to vaginal sensation in sexual function.

Sexuality after hysterectomy: a review of the literature and discussion of nurses' role

AIM

To review the literature on studies of sexuality after hysterectomy and to identify barriers to nursing assessment of this aspect of human functioning.

METHODS

Articles published between 1970 and 2002 on female sexuality, hysterectomy, and nursing assessment of sexuality were located using MEDLINE, CINAHL, Psychlit and Sociofile databases. Study findings were reviewed in relation to the effect of hysterectomy on sexuality, as well as women's perspectives on hysterectomy. Barriers to nursing assessment of sexual functioning are described with suggestions for inclusion of this topic in practice.

CONCLUSIONS

There are very few nursing studies on the topic, which may reflect the lack of inclusion of sexual assessment and education in clinical practice. Reasons for this are discussed, and instruments used in sex research are described. There are a number of gaps in the knowledge base on to this topic. Future research in this area is needed to provide direction for nurses in this aspect of clinical practice.

Sexuality after hysterectomy

OBJECTIVE

To review the literature regarding sexuality after hysterectomy and identify areas for future research.

DATA SOURCES

Articles published between 1970 and 2000 on sexuality and hysterectomy were located using MEDLINE, CINAHL, Psychlit, and Sociofile databases.

STUDY SELECTION

English language research dealing with the topic was reviewed.

DATA EXTRACTION

Study findings were categorized and include studies of the effect of hysterectomy on sexuality, women's perspectives on hysterectomy, and information sharing with women prior to surgery.

DATA SYNTHESIS

A number of studies have explored sexuality after hysterectomy. Many of these studies have methodologic flaws, including vague measures of sexual satisfaction and potential for recall bias. A major source of bias is that the first measure of sexual satisfaction/functioning was performed in the immediate preoperative period when symptoms are more likely to affect sexual functioning.

CONCLUSIONS

There are a number of gaps in the knowledge base pertaining to this topic. Future research in this area is needed to provide direction for nurses in the clinical area. Topics for future research include what women and their partners want to know about sexuality following hysterectomy and the most efficient methods to provide them with this information. In addition, sexuality in premorbid women needs to be more fully described.

Total laparoscopic hysterectomy with laparosonic coagulating shears: a retrospective report of 200 consecutive cases

Despite 10 years of intensive education and training in Australia only around 14% of hysterectomies are performed with laparoscopic assistance. In particular total laparoscopic hysterectomy (TLH) has a poor penetration rate because of perceived technical difficulties that include instrumentation, prolonged operating times and an increase in complications. We present a series of 200 consecutive cases of TLH with very good results and propose that because of the many advantages that this technique offers that it should become the standard procedure for benign uterine disease.

Reducing costs of laparoscopic hysterectomy

STUDY OBJECTIVE

To establish the role of laparoscopic hysterectomy using reuseable surgical equipment.

DESIGN

Prospective, observational study (Canadian Task Force classification II-2).

SETTING

Tertiary major teaching hospital.

PATIENTS

Fifty consecutive women carefully selected for laparoscopic hysterectomy.

INTERVENTIONS

The ultrasonically activated (harmonic) scalpel was used for coagulative cutting of pedicles and ligaments attached to the uterus and adnexa, backed by bipolar diathermy. No nonabsorbable material was left in the pelvis at the conclusion of the procedures.

MEASUREMENTS AND MAIN RESULTS

Patient characteristics, uterine weight, histology, operating time, recovery, analgesic requirements, and hospital stay were recorded. Complications were noted and critically assessed for constructive quality assurance appraisal. Outcomes were satisfactory according to both patients and gynecologists.

CONCLUSION

This pilot study suggests that the method is an efficacious, cost-effective, and well-controlled technique of laparoscopic hysterectomy.