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Till SR, Schrepf A, Pierce J, Moser S, Kolarik E, Brummett C, As-Sanie S. Sexual function after hysterectomy according to surgical indication: a prospective cohort study. Sex Health 2022; 19:46-54. [PMID: 35226836 PMCID: PMC9297198 DOI: 10.1071/sh21153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/19/2022] [Indexed: 02/15/2024]
Abstract
BACKGROUND Our aims were to describe characteristics of sexual function prior to and 6months following benign hysterectomy in patients with three common surgical indications, and to identify preoperative factors that influence the magnitude and direction of change in sexual function after the procedure. METHODS This prospective observational cohort study enrolled women (n =80) undergoing hysterectomy for benign indications. Patients were categorised into three groups according to surgical indication: (1) pelvic pain (PP), (2) abnormal uterine bleeding (AUB), and (3) pelvic organ prolapse (POP). Primary outcome was Female Sexual Function Index (FSFI), which patients completed preoperatively and 6months postoperatively. RESULTS The study included 80 patients, of whom 25.0% (n =20) had surgical indication of PP, 46.3% (n =37) of AUB, and 28.7% (n =23) of POP. PP patients experienced a significant improvement in overall sexual function, as well as orgasm and pain domains following hysterectomy. Significant improvements were not found in AUB and POP patients. In multivariate analysis, lower baseline sexual function (P <0.001), younger age (P =0.013), and pelvic pain<6months (P =0.020) were each independently associated with improvement in sexual function, but surgical indication was not significant. CONCLUSION Individual patient factors including younger age, lower baseline sexual function, and short duration of pelvic pain are associated with a higher likelihood of improvement in sexual function after hysterectomy. Surgical indication does not appear to be predictive of postoperative sexual function once accounting for other factors.
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Affiliation(s)
- Sara R. Till
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Andrew Schrepf
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
- Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Jennifer Pierce
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Stephanie Moser
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Ellen Kolarik
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Chad Brummett
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
- Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
| | - Sawsan As-Sanie
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
- Chronic Pain & Fatigue Research Center, University of Michigan, Ann Arbor, Michigan
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Abstract
Objective: Using the unit-level data of women aged 15–49 years from National Family Health Survey-IV (2015–2016), the article maps the prevalence of hysterectomy across districts in India and examines its determinants. Methods: Descriptive statistics, multivariate techniques, Moran’s Index and Local indicators of Spatial Association were used to understand the objectives. The data were analysed in STATA 14.2, Geo-Da and Arc-GIS. Results: In India, the prevalence of hysterectomy operation was 3.2%, the highest in Andhra Pradesh (8.9%) and the lowest in Assam (0.9%). Rural India had higher a prevalence than urban India. The majority of women underwent the operation in private hospitals. Hysterectomy prevalence ranged between 3% and 5% in 126 districts, 5% and 7% in 47 districts and more than 7% in 26 districts. Moran’s Index (0.58) indicated the positive autocorrelation for the prevalence of hysterectomy among districts; a total of 202 districts had significant neighbourhood association. Variation in the prevalence of hysterectomy was attributed to the factors at the primary sampling unit, district and state level. Age, parity, wealth and insurance were positively associated with the prevalence of hysterectomy, whereas education and sterilization was negatively associated. Conclusion: Hysterectomy operation in India presented the geographical, socio-economic, demographic and medical phenomenon. The high prevalence of hysterectomy in many parts of the country suggested conducting in-depth studies, considering the life cycle approach and providing counselling and education to women about their reproductive rights and informed choice. Surveillance and medical audits and promoting the judicial use of health insurance can be of great help.
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Affiliation(s)
- Angad Singh
- International Institute for Population Sciences, Mumbai, India
| | - Dipti Govil
- International Institute for Population Sciences, Mumbai, India
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Afiyah RK, Wahyuni CU, Prasetyo B, Dwi Winarno D. Recovery time period and quality of life after hysterectomy. J Public Health Res 2020; 9:1837. [PMID: 32728576 PMCID: PMC7376450 DOI: 10.4081/jphr.2020.1837] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Women who had undergone hysterectomy have to overcome problems related to sexual and reproductive health. They often suffer a decline in self-esteem due to sexual dysfunction and the inability to give birth, along with their quality of recovery. This study aims to describe the relationships between recovery time and the components of quality of life after hysterectomy. D esign and methods: 103 women post-hysterectomy from several community-integrated health center in Surabaya were selected using the total sampling technique. Results: Findings show that there is relationship between recovery time period and sexual activity (P=0.000). However, no significant relationship exists between recovery time period personal relationships and social support. Conclusions: It is recommended that nurses should improve their social support for women and families during recovering, to avoid pathological stress and improve quality of life. Significance for public health Hysterectomy has several impacts on women, affecting their quality of life. Different length of recovery time period may affect quality of life after hysterectomy. Adequate help and support from friends, family and health care professionals, could improve their quality of life after surgery. Three components of quality of life are discussed, namely personal relationships, social support, and sexual activity. This study describes the relationships between recovery time period and the components of quality of life after hysterectomy
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Affiliation(s)
| | | | - Budi Prasetyo
- Department of Obstetrics and Gynecology, Faculty of Medicine
| | - Didik Dwi Winarno
- Master Student, Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
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Wang Y, Ying X. Sexual function after total laparoscopic hysterectomy or transabdominal hysterectomy for benign uterine disorders: a retrospective cohort. Braz J Med Biol Res 2020; 53:e9058. [PMID: 32077466 PMCID: PMC7025449 DOI: 10.1590/1414-431x20199058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/04/2019] [Indexed: 01/23/2023] Open
Abstract
The objective of this study was to evaluate changes in sexual function after total laparoscopic hysterectomy (TLH) or transabdominal hysterectomy (TAH). This retrospective cohort study included patients with benign uterine tumors that were divided into TLH group and TAH group based on the hysterectomy technique used. Baseline, intraoperative, and postoperative characteristics were compared between groups. Postoperative sexual function was assessed using the Brief Index of Sexual Functioning for Women. The TLH and TAH groups contained 119 patients (age, 51.5±6.1 years) and 126 patients (age, 50.0±4.7 years), respectively. Baseline characteristics were comparable between groups, although uterine size was larger in the TAH group (P<0.001). Compared with the TAH group, the TLH group had a longer operative time (130.0±36.2 vs 107.3±28.5 min, P<0.001), lower pain index at 24 h (2.0±1.6 vs 4.0±2.6, P<0.001), and shorter hospitalization time (5.7±1.1 vs 8.1±1.2 days, P<0.001). Many patients in the TLH and TAH groups reported decreased satisfaction with their sexual life (67.5 and 56.0%, respectively), reduced frequency of sexual activity (70.1 and 56.0%, respectively), decreased libido (67.5 and 56.0%, respectively), orgasm dysfunction (42.9 and 42.9%, respectively), and increased dyspareunia (77.9 and 85.7%, respectively). However, there was no significant difference between groups in any of the indexes of postoperative sexual function (P>0.05). Both TLH and TAH had comparable negative effects on sexual function in women treated for benign uterine tumors in China, with a decreased frequency of sexual activity, reduced libido, orgasm dysfunction, and increased dyspareunia.
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Affiliation(s)
- Yiqun Wang
- Jiangsu Zhenjiang Maternal and Child Health Hospital, Zhenjiang, China.,Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaoyan Ying
- Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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He H, Yang Z, Zeng D, Fan J, Hu X, Ye Y, Bai H, Jiang Y, Lin Z, Lei Z, Li X, Li L, Gan J, Lan Y, Tang X, Wang D, Jiang J, Wu X, Li M, Ren X, Yang X, Liu M, Wang Q, Jiang F, Li L. Comparison of the short-term and long-term outcomes of laparoscopic hysterectomies and of abdominal hysterectomies: a case study of 4,895 patients in the Guangxi Zhuang Autonomous Region, China. Chin J Cancer Res 2016; 28:187-96. [PMID: 27199516 PMCID: PMC4865611 DOI: 10.21147/j.issn.1000-9604.2016.02.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To evaluate the short-term and long-term outcomes after laparoscopic hysterectomy (LH) compared with abdominal hysterectomy (AH) in case of benign gynecological disease. METHODS A multi-center cohort retrospective comparative study of population among 4,895 hysterectomies (3,539 LH vs.1,356 AH) between 2007 and 2013 was involved. Operative time (OT), estimated blood loss (EBL), intra-operative and post-operative complications, passing flatus; days with indwelling catheter, questionnaires covering pelvic floor functions and sexual functions were assessed. RESULTS The EBL (174.1±157.4 vs. 263.1±183.2 cc, LH and AH groups, respectively), passing flatus (38.7±14.1 vs. 48.1±13.2 hours), days with indwelling catheter (1.5±0.6 vs. 2.2±0.8 days), use of analgesics (6.5% vs. 73.1%), intra-operative complication rate (2.4% vs. 4.1%), post-operative complication rate (2.3% vs. 5.7%), post-operative constipation (12.1% vs. 24.6%), mild and serious stress urinary incontinence (SUI) post-operative (P<0.001; P=0.014), and proportion of Female Sexual Functioning Index (FSFI) total score <26.55 post-operative (P<0.001) of the LH group were significantly less than those of AH group. There were no significant differences in OT (106.5±34.5 vs. 106.2±40.3 min) between the two groups. CONCLUSIONS LH is a safe and efficient operation for improving patients?long-term quality of life (QoL), and LH is a cost-effectiveness procedure for treating benign gynecological disease. LH is superior to AH due to reduced EBL, reduced post-operative pain and earlier passing flatus.
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Affiliation(s)
- Hongying He
- Department of Gynecological Oncology, Cancer Institute and Hospital of Guangxi Medical University, Nanning 530021, China
| | - Zhijun Yang
- Department of Gynecological Oncology, Cancer Institute and Hospital of Guangxi Medical University, Nanning 530021, China
| | - Dingyuan Zeng
- Department of Gynecological Oncology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou 545005, China
| | - Jiangtao Fan
- Department of Gynecological and Obstetrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
| | - Xiaoxia Hu
- Department of Gynecological and Obstetrics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530022, China
| | - Yuan Ye
- Department of Gynecological and Obstetrics, The Affiliated Hospital of Guilin Medical University, Guilin 541004, China
| | - Hua Bai
- Department of Gynecological and Obstetrics, The Maternal & Child Health Hospital, Nanning 530003, China
| | - Yanming Jiang
- Department of Gynecological and Obstetrics, The People's Hospital of Liuzhou, Liuzhou 545006, China
| | - Zhong Lin
- Department of Gynecological and Obstetrics, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, China
| | - Zhiying Lei
- Department of Gynecological and Obstetrics, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise 533000, China
| | - Xinlin Li
- Department of Gynecological and Obstetrics, Liuzhou Maternal & Child Health Hospital, Liuzhou 545000, China
| | - Lian Li
- Department of Gynecological and Obstetrics, The First People's Hospital of Nanning, Nanning 530000, China
| | - Jinghua Gan
- Department of Gynecological and Obstetrics, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning 530001, China
| | - Ying Lan
- Department of Gynecological and Obstetrics, The First Affiliated Hospital of Guangxi Technology University, Liuzhou 545000, China
| | - Xiongzhi Tang
- Department of Gynecological and Obstetrics, The People's Hospital of Guilin, Guilin 541002, China
| | - Danxia Wang
- Department of Gynecological and Obstetrics, The People's Hospital of Beihai, Beihai 536100, China
| | - Junsong Jiang
- Department of Gynecological and Obstetrics, The People's Hospital of Hechi, Hechi 546300, China
| | - Xiaoyan Wu
- Department of Gynecological and Obstetrics, The People's Hospital of Baise, Baise 533000, China
| | - Meiying Li
- Department of Gynecological and Obstetrics, The First People's Hospital of Yulin, Yulin 537000, China
| | - Xiaoqing Ren
- Department of Gynecological and Obstetrics, Wuzhou Worker's Hospital, Wuzhou 543001, China
| | - Xiaomin Yang
- Department of Gynecological and Obstetrics, The People's Hospital of Guigang, Guigang 537100, China
| | - Mei Liu
- Department of Gynecological and Obstetrics, The First People's Hospital of Qinzhou, Qinzhou 535001, China
| | - Qinmei Wang
- Department of Gynecological and Obstetrics, The Third People's Hospital of Liuzhou, Liuzhou 545007, China
| | - Fuyan Jiang
- Department of Gynecological and Obstetrics, Liuzhou Tumor Hospital, Liuzhou 545000, China
| | - Li Li
- Department of Gynecological Oncology, Cancer Institute and Hospital of Guangxi Medical University, Nanning 530021, China
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