Women's sense of well-being before and after hysterectomy

The influence of persistent bleeding after supracervical hysterectomy on depressive and anxious symptoms: a prospective bicenter study

PURPOSE

Postoperative spotting is a frequent adverse symptom after laparoscopic supracervical hysterectomy (LSH). The conical excision (eLSH) reduces the postoperative spotting rate, but data in a larger collective are still rare and inconsistent. The influence of persistent bleeding on the anxious and depressive symptoms has not been analyzed yet.

METHODS

311 patients, who underwent a laparoscopic supracervical hysterectomy with conical excision (n = 163), or with straight cervical resection (n = 148) were included. Anxious and depressive symptoms and postoperative spotting were recorded before operation, at 3 month follow-up and at 1 year follow-up in both operative groups using a validated questionnaire (German version of Hospital Anxiety and Depression Scale, HADS-D) and additional questions concerning the frequency and impact of bleeding. Statistical analysis included the impairment of bleeding as well as its impact on depressive and anxious symptoms for both groups.

RESULTS

11.5% after eLSH and 15.5% after LSH reported spotting after 1 year. Supracervical hysterectomy significantly improves depressive and anxious symptoms at 3 and at 12 month follow-up for both groups (p < 0.001) independent on residual spotting. Patients with a preoperative continuous bleeding showed a maximum benefit independent on operative method.

CONCLUSION

Laparoscopic supracervical hysterectomy has a positive effect on anxious and depressive symptoms in the short-term and intermediate-term follow-up. The conical excision of the cervical stump reduces postoperative spotting rate, but has no explicit advantage on symptoms of depression or anxiety, irrespective of residual postoperative spotting.

[Evaluation of quality of life and subjective experience of the disease before and after vaginal hysterectomy among women admitted to the University Hospital in Brazzaville]

Toute maladie est un mal en soi qu’il faut éradiquer car elle altère souvent de façon significative la qualité de la vie. L’hystérectomie vaginale est indiquée pour les patientes qui présentent certaines affections gynécologiques graves, elle est donc bénéfique mais, peut également avoir une répercussion néfaste sur la qualité de vie de la femme. Ainsi nous avons voulu explorer le vécu de la maladie et de l’hystérectomie vaginale (HV) des femmes avant et après l’intervention chirurgicale. Nous avons effectué une étude prospective qualitative, à recueil clinique sur une période de 12 mois; qui a concerné les femmes, ayant subi une hystérectomie vaginale. Celles n’ayant pas accepté de participer à l’étude, ou n’ayant pas de contact téléphonique n’ont pas été incluses. Pendant la maladie, le vécu des femmes a été: l’inconfort sexuel 26/40 (65%); les saignements génitaux 12/40 (30%); les douleurs pelviennes 13/40 (32,5%). En Post-opératoire, ont été noté les dyspareunies transitoires30/40 (75%) ; les céphalées secondaires à l’anesthésie 4/40 (10%). Le vécu psychologique a été dominé avant l’HV par la peur de la chirurgie chez toutes les patientes, les troubles du sommeil 38/40 (95%), l’angoisse 30 /40(75%), un sentiment de honte lié aux difficultés à accomplir l’acte sexuel en raison du prolapsus 26/40(65%) et/ ou en raison des saignements génitaux, dus au fibrome utérin 14/40(35%). Le sentiment de la perte de féminité était déclaré par 26/40 femmes porteuses de prolapsus utérin (65%), la modification de l’estime de soi 26/40 (65%). Ces appréciations subjectives ont été améliorées avec l’HV, contre balançant la perte de leur organe de reproduction. Aucune information n’a été donnée par les femmes à leurs proches et aux membres de la famille avant la chirurgie, traduisant ainsi leur sentiment de gène ou de honte. L’arrêt des symptômes a été observé dans tous les cas, même si dans un cas (1,25%) un nouveau signe au titre des complications (plaie rectale) a éténoté. Concernant l’activité sexuelle, tous les couples ont déclaré leur satisfaction après le traitement. Le vécu dramatique de la maladie et de l’hystérectomie vaginale avant, est nettement amélioré après l’intervention chirurgicale.

The information requirements and self-perceptions of Turkish women undergoing hysterectomy

Objectives:

To investigate the affects, information requirements and self-perceptions of Turkish women undergoing hysterectomy.

Methods:

A descriptive cross-sectional study was conducted on 37 Turkish women undergoing hysterectomy and followed in a gynecology unit of a state hospital in Canakkale, Turkey, between February and August 2012. Data were collected before discharge with a questionnaire composed of 32 questions. Percentage distributions and Chi-square test were used in the evaluation of the data.

Results:

There was a significant relationship between fear of anesthesia and number of pregnancies (p=0.007) and between death during surgery and number of pregnancies in the preoperative period (p=0.027). The relationship between knowing type of surgery and knowing when sutures would be removed was also significant in post-operative period (p=0.045). In addition, there was a significant relationship between women’s living only with their husbands and worrying about not having children anymore (p=0.032).

Conclusion:

The women’s information needs were high and women’s self-perceptions had been affected negatively after hysterectomy. It is recommended that nurses, primarily health professionals should have adequate knowledge on comprehensive care and psychosocial support after hysterectomy.

Psychological outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis

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.

Risks for donors in uterus transplantation

Uterus transplantation (UTx) is an alternative to gestational surrogacy and adoption for patients with absolute uterine infertility. Studies have been conducted in animals, and UTx is now within the reach of clinical application in humans. Procedures in humans have been published, but many medical, ethical, and social problems and risks of UTx require discussion prior to widespread clinical application, from the perspectives of donors, recipients, families, and newborns. In this article, we summarize the burdens and risks of UTx, with a focus on donors who provide the uterus.

Hysterectomy improves sexual response? Addressing a crucial omission in the literature

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.

Prophylactic oophorectomy in premenopausal women and long-term health

OBJECTIVE

To review the data on long-term outcomes in women who underwent prophylactic bilateral oophorectomy, a common surgical procedure that has more than doubled in frequency since the 1960s.

STUDY DESIGN

Literature review of the published data on the consequences of prophylactic bilateral oophorectomy. Special emphasis was given to the Mayo Clinic Cohort Study of Oophorectomy and Aging. Main outcome measures Overall mortality, cardiovascular disease, cognitive impairment and dementia, parkinsonism, osteoporosis, psychological wellbeing and sexual function.

RESULTS

There is a growing body of evidence suggesting that the premature loss of ovarian function caused by bilateral oophorectomy performed before natural menopause is associated with several negative outcomes. In particular, studies have revealed an increased risk of premature death, cardiovascular disease, cognitive impairment or dementia, parkinsonism, osteoporosis and bone fractures, decline in psychological wellbeing and decline in sexual function. The effects involve different organs (e.g. heart, bone, or brain), and different functions within organs (e.g. cognitive, motor, or emotional brain functions). Estrogen treatment may prevent some but not all of these negative outcomes.

CONCLUSION

The potential adverse effects of prophylactic bilateral oophorectomy on heart health, neurological health, bone health and quality of life should be carefully weighed against its potential benefits for cancer risk reduction in women at average risk of ovarian cancer.

Factors associated with postoperative recovery after laparoscopic and abdominal hysterectomy

OBJECTIVES

To determine whether the day-by-day recovery of general wellbeing was faster in women undergoing laparoscopic hysterectomy than in total abdominal hysterectomy and to analyse the association between stress coping and sick-leave and the day-by-day recovery measured as general wellbeing.

STUDY DESIGN

A randomised multicentre trial conducted in five hospitals in the South East of Sweden. Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study and 117 women completed the study. Fifty-five women were randomised to abdominal hysterectomy and 62 to laparoscopic hysterectomy. Day-by-day recovery of general wellbeing was measured by a visual analogue scale 1 week preoperatively, 35 days postoperatively, and during 1 week 6 months postoperatively. Stress-coping capability was measured preoperatively using a specific psychometric measurement. Sick-leave was granted with an initial period of 14 days and prolonged on patient demand with 7 days periods. Effects of operating method and stress-coping ability on the day-by-day recovery adjusted for postoperative complications and analgesics were analysed by means of analysis of variance for repeated measurements.

RESULTS

No significant difference was found in the day-by-day recovery of the general wellbeing between the operating methods. Stress-coping ability did significantly influence the day-by-day recovery of general wellbeing. Duration of sick-leave was associated with the occurrence of postoperative complications but not with stress-coping ability.

CONCLUSIONS

The day-by-day recovery of general wellbeing is not faster in laparoscopic hysterectomy than in abdominal hysterectomy. Women with high stress-coping abilities have a better outcome in general wellbeing than women with low stress-coping capacity. Identification of women with low stress-coping abilities and prevention of complications might be of benefit for improving postoperative wellbeing.

Surgical menopause

OBJECTIVE

Women anticipating surgical menopause often have significant concerns regarding the effects of surgery on psychological well-being and sexuality.

RESULTS

The impact of hysterectomy, often with concurrent oophorectomy, on well-being and sexuality will vary depending on many factors. These include a woman's preoperative mental health and sexual function, the indications for surgery, and the specific procedure being performed. Whether or not estrogen therapy is an option also will affect a woman's postoperative symptoms and experience of surgical menopause.

CONCLUSIONS

The majority of research on the effects of surgical menopause shows improved psychological well-being and sexual function after hysterectomy for benign disease. Women with depression or sexual problems preoperatively are at increased risk for experiencing a worsening of mood and libido postoperatively.

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.

The Psychosocial Outcomes of Total and Subtotal Hysterectomy: A Randomized Controlled Trial

INTRODUCTION

Current controversies involve the adverse effects of hysterectomy on women's psychosocial functioning and whether subtotal as opposed to total hysterectomy mitigates these effects.

AIM

To investigate the psychosocial effects of hysterectomy by examining sexual, pain, and psychological outcomes of total vs. subtotal hysterectomy in a randomized controlled trial.

METHODS

Patients suffering from benign gynecological conditions were randomly assigned to one of two groups: (i) total hysterectomy, that is, laparoscopic assisted vaginal hysterectomy (TOT, N = 32); or (ii) subtotal hysterectomy, that is, supracervical laparoscopic hysterectomy (SUB, N = 31). Both groups were premenopausal and underwent hysterectomy without concurrent oophorectomy. Two premenopausal control groups: (i) minor gynecological surgery (SURG-CON, N = 30); and (ii) healthy nonsurgical controls (NORM-CON, N = 40), were also tested. All surgical groups were assessed 2-3 weeks before surgery and then 6-7 months afterward; the nonsurgical control group was assessed at the time of recruitment and 6-7 months later.

OUTCOME MEASURES

Assessments included semistructured interviews, standardized questionnaires, and standardized gynecological examinations.

RESULTS

For the TOT group, sexual drive, arousal, and sexual behavior significantly improved postoperatively. For the SUB group, sexual behavior and overall sexual functioning significantly improved. For both TOT and SUB groups, unprovoked pain in the abdomen and pain in the abdomen during gynecological examinations was significantly reduced. For both TOT and SUB groups, overall psychological functioning did not significantly change postoperatively. Although between 3% and 16% of women undergoing hysterectomy reported adverse changes in psychosocial well-being after surgery, similar percentages of women in the control groups reported such effects.

CONCLUSIONS

Hysterectomy resulted in a consistent reduction in abdominal pain, some improvement in sexual functioning, but no change in overall psychological functioning. There was no evidence supporting the idea that subtotal hysterectomy produced more favorable psychosocial outcomes than total hysterectomy nor was there any evidence that either type of hysterectomy resulted in adverse effects.

Changes and Factors Influencing Health-related Quality of Life After Hysterectomy in Premenopausal Women with Benign Gynecologic Conditions

BACKGROUND/PURPOSE

A hysterectomy affects a woman's health. This study was performed to identify the factors that affect health-related quality of life (HRQoL) before and after hysterectomy in premenopausal women.

METHODS

This prospective follow-up study recruited 38 women (age range, 33-52 years) who underwent abdominal hysterectomy for nonmalignant causes. SF-36 and self-rated health status were used to assess HRQoL before and after hysterectomy. Data were analyzed using descriptive statistics, nonparametric tests and the generalized estimating equation method for modeling the repeatedly measured responses.

RESULTS

Patients' attitudes toward hysterectomy and subsequent sexual activity were influenced by the surgery. All patients showed significant improvements in the physical component summary (PCS) of SF-36 (mean, 42.1-51.0), but there was no significant difference in the mental component summary (MCS). The significant improvements were found from the five repeated measurements of the self-rated health status (mean, 6.0-7.3). Hemoglobin level was the most important predictor of HRQoL before surgery. Women in employment, with more years of education and previous blood transfusion had high MCS scores after surgery.

CONCLUSION

The overall self-rated health status and PCS showed significant improvements after hysterectomy. Having had a blood transfusion, being educated and employed were positively associated with MCS score after surgery. These findings are vital for preoperative counseling for women undergoing hysterectomy.

Psychosocial effects of hysterectomy: literature review

OBJECTIVES

With the development of less invasive treatments, the suitability of hysterectomy as a treatment for benign symptoms is being reevaluated. This paper critically and comprehensively reviews the psychosocial outcomes of hysterectomy in areas of sexuality, pain, and psychological functioning.

METHODS

Medline, Pub Med, and PsychLit were searched for studies and reviews pertaining to the psychosocial outcomes of hysterectomy. Over 100 studies and reviews, in English, French, and German language, published in the past 30 years were included. Controversial theories and empirical evidence are discussed in the domains of sexuality, pain, and psychological well-being. Special attention is devoted to design, sampling, and measurement issues as well as different surgical approaches with regard to hysterectomy-oophorectomy.

RESULTS

While hysterectomy appears to reduce pain, there do not appear strong psychosexual or psychosocial effects. Nonetheless, there may be a subgroup of women (10-20%) who report negative psychosocial outcomes such as reduced sexual interest, arousal, and orgasm, as well as elevated depressive symptoms and impaired body image.

CONCLUSIONS

More research is necessary to establish which patients may benefit most and which may not. Directions for future research are discussed.

Decision-making tree for women considering hysterectomy

AIMS

This paper reports on a study carried out to establish a decision tree model to describe how women in Taiwan make the decision whether or not to have a hysterectomy. In addition, we examined the predictability of the decision-tree model.

BACKGROUND

Hysterectomy is the second most common surgical procedure performed worldwide. Medical professionals believe that the operation can relieve pain and prevent cervical cancer, thus improving a woman's quality of life. While most physicians advise hysterectomy even for benign uterine conditions, feminists decry the belief that the uterus has no purpose, believing that it is an important symbol of womanhood.

METHODS

The study was conducted in two phases. Phase I, the model development phase, was carried out to generalize data from a qualitative study of 14 women and to establish a tree model outlining their decision to proceed with hysterectomy. The second phase was the model prediction phase that applied inductive and deductive methods to data analysis and development of the decision-tree model. The model tree was then tested with 18 women who were deciding whether or not to undergo hysterectomy. Using the decision-making tree, we studied the women's thought processes and analysed their primary concerns. The study was carried out in 1999-2001.

RESULTS

The study determined 13 criteria that Taiwanese women use when deciding about having a hysterectomy. Developed in accordance with Gladwin's methodology, the model tree successfully predicted 90% of decisions whether or not to have a hysterectomy.

CONCLUSIONS

Nurses working in gynaecological services should understand how women decide to undergo hysterectomy so that the proper counselling and follow-up can be provided. With further testing, our decision tree may help in this process.

Hysterectomy: effects on quality of life and psychological aspects

Most gynaecological disorders are not life-threatening. They may nevertheless severely affect women's quality of life. The majority of hysterectomies are performed to treat non-malignant conditions, to enhance the quality of life rather than save life. Recent research shows an enhancement in quality of life during the early years after hysterectomy. Furthermore, research shows that hysterectomy does not cause any adverse psychological outcome in otherwise psychologically healthy women, but presurgical psychopathology is predictive of postsurgical psychopathology. Research also shows that most gynaecological cancer survivors enjoy a relatively good quality of life.

Perimenopausal androgen decline after oophorectomy does not influence sexuality or psychological well-being

OBJECTIVE

To determine whether oophorectomy during the perimenopause, with the associated decline in ovarian androgens, affects sexual function and psychological well-being negatively.

DESIGN

Prospective, observational study comparing sexuality and psychological well-being in women after hysterectomy only (HYST) vs. hysterectomy and concomitant oophorectomy (HYST+BSO).

SETTING

University hospital and district general hospital.

PATIENT(S)

Three hundred sixty-two perimenopausal women scheduled for elective hysterectomy on benign indication were recruited and 323 (89%) completed the 1-year follow-up (217 in the HYST group and 106 in the HYST+BSO group).

INTERVENTION(S)

The patients were evaluated preoperatively and 1 year after surgery. Postoperatively, estrogen replacement therapy was recommended to all women in the HYST+BSO group and to HYST group subjects with climacteric symptoms.

MAIN OUTCOME MEASURE(S)

Sex steroids (T, androstenedione, DHEA-S, and E(2)) and sex hormone-binding globulin (SHBG) were measured. Free androgen index and free E(2) index were calculated. Sexuality (McCoy's Female Sex Questionnaire) and psychological well-being (Psychological General Well-Being Index) were evaluated.

RESULTS(S)

Preoperatively, no hormonal differences were found between the two groups. At 1-year follow-up, all sex steroid levels and indices were decreased and SHBG was increased in the HYST+BSO group. Ovarian sex steroids were decreased in the HYST group, whereas DHEA-S and SHBG were unaltered. Sexuality was unaltered in the HYST+BSO group, whereas decreased scores were found in 3 of 14 sexual variables in the HYST group. Psychological well-being was improved in both groups. There were no correlations between the observed changes (data 1 year after surgery, compared with preoperative data) in androgen levels and index and the observed changes in any aspect of sexuality or psychological well-being.

CONCLUSION(S)

Hormonal changes after oophorectomy in conjunction with perimenopausal hysterectomy do not significantly change postoperative (1-year) sexual or psychological well-being.

The integration of a woman's perspective in hysterectomy decisions

It has been argued, based on a limited amount of research data, that patient participation in decision-making regarding surgery, results not only in more patient satisfaction, but also in better surgery outcomes. Especially in a procedure such as hysterectomy, with far-reaching consequences and many potential side effects, it may therefore be relevant to promote an active role of the patient in the decision-making process. The article identifies contextual elements that might promote this active role. Subsequently a model of participative, informed decision-making is outlined. The model entails that clinical guidelines should be adjusted to the particular situation at hand and that patients should be fully informed about hysterectomy-involved risks. An overview of the various guidelines and risks is provided. Proper counseling in the decision-making phase as well as in the post-hysterectomy period is advocated. Throughout the article attention is paid to documented and undocumented ethnic differences regarding various aspects of hysterectomy, particularly differences in patient participation around the world.

Respective consequences of abdominal, vaginal, and laparoscopic hysterectomies on women's sexuality

OBJECTIVE

To determine the relative effects of abdominal, vaginal or laparoscopic approaches for hysterectomy on female sexuality.

STUDY DESIGN

One hundred and seventy women who underwent abdominal (n=68), vaginal (n=67), and laparoscopic (n=35) hysterectomy for benign disease were studied. Pre- and postoperative sexuality was assessed by questionnaire.

RESULTS

Overall, sexuality after hysterectomy remained unchanged in 60.4% of cases, and improved or deteriorated in 21.3 and 18.3%, respectively. Postoperative delay in resuming sexual activity was shorter after vaginal (45.2+/-6.7 days) hysterectomy than after abdominal hysterectomy (62.4+/-9.3 days). Deterioration of sexual function occurred more frequently after abdominal hysterectomy (24%) than after vaginal (13.5%) or laparoscopic (8.5%) hysterectomy.

CONCLUSION

These results indicate that the impact of vaginal and laparoscopic hysterectomy on women's sexuality may be milder than that of abdominal hysterectomy.

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.

Alteration of sexual function after classic intrafascial supracervical hysterectomy and total hysterectomy

STUDY OBJECTIVE

To investigate possible advantages of classic intrafascial supracervical hysterectomy (CISH) over total hysterectomy with respect to sexual function.

DESIGN

Retrospective study (Canadian Task Force classification II-2).

SETTING

Department of obstetrics and gynecology at a university teaching hospital.

PATIENTS

One hundred eight women who had undergone CISH and 125 who had total hysterectomy.

INTERVENTION

A standard questionnaire sent to all 233 patients a minimum of 12 and maximum of 24 months after hysterectomy.

MEASUREMENTS AND MAIN RESULTS

Data obtained on sexual function were classified by changes (improved, no change, deteriorated) before and after hysterectomy. No significant difference was found between groups in mean time interval between surgery and first intercourse. Overall, over two-thirds of women experienced either no change or improvement in sexual function regardless of which procedure was performed, with no statistically significant differences in changes in libido, frequency of coitus, frequency of orgasm, and degree of orgasm.

CONCLUSIONS

Women who underwent CISH and total hysterectomy had no statistically significant differences with regard to postoperative sexual function.

[Local investigation concerning psychic and sexual functioning a short time after hysterectomy]

Hysterectomy is one of the most common operations done throughout the world. Patients' concerns about sexual functioning after hysterectomy is great.

OBJECTIVE

We wanted to evaluate, through a local investigation based on a questionnaire, the psychosexual impact of this operation and to compare our data to those available in the literature.

PATIENTS AND METHODS

534 patients operated between of 01.01.1997 and 31.12.1997 for a benign uterine pathology (prolapse excluded) were included. Questions were about sexual and psychological functioning after hysterectomy. The main outcome measures were changes in the sexual life, sexual desire, orgasm, dyspareunia, frequency of sexual relations. Abdominal and vaginal surgical approaches were compared for some items when possible.

RESULTS

After the operation, 83.3% of the patients felt better, 30.4% of the patients mentioned changes in their sexual life, 32% of low libido rates was noticed (and there was a significant difference between abdominal and vaginal surgical approaches), 27.6% of the patients had less frequent orgasm and only 8.8% experienced orgasm more frequently, 15% suffer from dyspareunia, and 15% were more engaged in sexual intercourse.

CONCLUSION

Psychosexual impact of hysterectomy is limited and is not more frequent when vaginal surgery is performed, but pre- and post-operative prevention can be useful.

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.

The general health in women suffering from gynaecological disorders is improved by means of hysterectomy

Gynaecological disorders can have adverse effects on women's general health, and for a substantial number of these women hysterectomy is performed. This study aims to evaluate the long-term impact of hysterectomy on this outcome variable. The patient-group was tested pre-operatively and 6 and 12 months after hysterectomy. The control-group was tested once. This study shows that the general health in women suffering from gynaecological disorders is significantly lower compared with that of the control-group (p < 0.00). Both 6 and 12 months after the hysterectomy, however, the patient-group has reached the same level of their general health as the control-group. Twenty-eight per cent of their potentiality for improved health has been obtained. For those women with poorest health both pre- and postoperatively, other factors than the hysterectomy have had a negative impact on their general health and lives. The results from this study suggest that hysterectomy is associated with a positive long-term impact on women's general health.

Are the physiologically and psychosocially based symptoms in women suffering from gynecological disorders alleviated by means of hysterectomy?

Women experiencing gynecological disorders can suffer from a diversity of symptoms and problems. To what extent women are relieved of their physiologically and psychosocially based symptoms by hysterectomy is an important issue. This study aims to evaluate the long-term impact of hysterectomy on such symptoms and to compare the findings with those of a control group. Women with gynecological disorders experienced physiologically based symptoms, such as pelvic pain and urinary incontinence, to a greater degree than did the control group (p < 0.05), whereas bowel function and menopausal symptoms were equally distributed in the two groups. Furthermore, these women experienced psychosocially based symptoms, such as fatigue and insomnia, to a greater degree than the control group (p < 0.05), whereas the groups did not differ in psychological well-being or sexual function. After hysterectomy, however, pelvic pain and sleeping disturbances were alleviated, and the state of energy and urinary function were improved (p < 0.00). Bowel function, menopausal symptoms, psychological well-being, sexual function, and self-perception as a woman were not influenced by the operation. Both 6 and 12 months after hysterectomy, no differences between the patients and the control group were found, except for the tendency of patients not to gain weight after the operation. The symptoms are mostly improved or unchanged after hysterectomy, and additional problems do not seem to follow the operation.

Overview of women's decision making regarding elective hysterectomy, oophorectomy, and hormone replacement therapy

Over 600,000 hysterectomies are performed each year in the United States, the majority of which are to improve quality of life for perimenopausal women. Hysterectomy rates for common conditions differ between African American and white women, and African American women undergo surgery at a younger age for most diagnoses. Many hysterectomies are accompanied by elective oophorectomy, and hormone replacement therapy (HRT) is commonly used, especially among women experiencing surgical menopause, despite questions about its long-term benefits and risks. Despite the high rates of hysterectomy in the United States, little is known about how women make decisions regarding this surgery and, in particular, how ethnic and cultural factors may influence these decisions. This article provides a review of what is currently known about the epidemiology of hysterectomy, oophorectomy, and HRT use and identifies gaps in knowledge about women's decision making, with a special focus on ethnic variations and cultural influences, issues addressed by the Ethnicity, Needs, and Decisions of Women (ENDOW) project.