[Risk factors for hysterectomy among Brazilian women]

Prevalence of hysterectomy and associated factors in Brazilian women aged 50 and older: findings from the Brazilian Longitudinal Study of Ageing (ELSI-Brazil)

BACKGROUND

Hysterectomy is a gynaecological surgical procedure in which the uterus is removed as a treatment for both malignant and benign gynaecological diseases. A hysterectomy is also performed to minimise risks in women with problems related to the uterus. This study aimed to estimate the prevalence of reported hysterectomy and associated risk factors in Brazilian women aged 50 and older.

METHODS

A cross-sectional study using data from the Brazilian Longitudinal Study of Ageing (ELSI-Brazil) was conducted. A total of 5,293 women aged 50 and over who participated in the ELSI-Brazil study in 2015 and 2016 were included. The prevalence rate of hysterectomy was estimated and the main reasons for performing the surgery were identified. The bivariate analyses utilised the chi-square test, while multivariate analyses employed Poisson regression with a robust estimator.

RESULTS

The reported prevalence of hysterectomy was 17.8%. The most prevalent reason for the surgery was the presence of uterine myoma. Significant and independent associations were observed in women aged 63 and older, married, having undergone preventive exams, hormonal treatment, had up to three deliveries and having a private health plan.

CONCLUSION

The main objective of the study was achieved. The prevalence of hysterectomy in Brazilian women aged 50 and older was 17.8%. Significant associations were observed with participants' sociodemographic and clinical characteristics reinforcing the importance of considering the reproductive characteristics of women as indicators of health status.

[Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil]

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

Factors associated with hysterectomy among older women from Latin America and the Caribbean

To identify factors associated with hysterectomy, data collected from 1999-2000 were assessed from seven cities of the Health, Well-Being and Aging in Latin America and the Caribbean Study on 6,549 women, aged 60 years and older. Hysterectomy prevalence ranged from 12.8% in Buenos Aires (Argentina) to 30.4% in Bridgetown (Barbados). The median age for having had a hysterectomy ranged from 45 to 50 years across the cities and was 47 years in the pooled sample. Ethnic differences in hysterectomy rates were partially explained by differences across cities. Factors significantly associated with lower odds for hysterectomy included older age, household crowding conditions, and having public/military or no health insurance, compared to having private health insurance. Women who had three or more children were less likely to have had a hysterectomy, a finding that differs from most previous studies. Socioeconomic position related to rates of hysterectomy in late life rather than hysterectomies earlier in life. However, the nature of these differences varied across birth cohorts. The findings suggested that adverse socioeconomic factors were most likely related to hysterectomy risk by affecting access to health care, whereas parity was most likely acting through an effect on decision-making processes.

Does life-course socioeconomic position influence racial inequalities in the occurrence of uterine leiomyoma? Evidence from the Pró-Saúde Study

We aimed to investigate whether life-course socioeconomic position mediates the association between skin color/race and occurrence of uterine leiomyomas. We analyzed 1,475 female civil servants with baseline data (1999-2001) of the Pró-Saúde Study in Rio de Janeiro State, Brazil. Life-course socioeconomic position was determined by parental education (early life socioeconomic position), participant education (socioeconomic position in early adulthood) and their combination (cumulative socioeconomic position). Gynecological/breast exams and health insurance status were considered markers of access to health care. Hazard ratios (HR) and 95% confidence intervals (95%CI) were estimated using Cox proportional hazards models. Compared with white women, black and parda ("brown") women had higher risk of reporting uterine leiomyomas, respectively HR: 1.6, 95%CI: 1.2-2.1; HR: 1.4, 95%CI: 0.8-2.5. Estimates were virtually identical in models including different variables related to life-course socioeconomic position. This study corroborated previous evidence of higher uterine leiomyomas risk in women with darker skin color, and further suggest that life-course socioeconomic position adversity does not influence this association.

Medical borderlands: engineering the body with plastic surgery and hormonal therapies in Brazil

This paper explores medical borderlands where health and enhancement practices are entangled. It draws on fieldwork carried out in the context of two distinct research projects in Brazil on plastic surgery and sex hormone therapies. These two therapies have significant clinical overlap. Both are made available in private and public healthcare in ways that reveal the class dynamics underlying Brazilian medicine. They also have an important experimental dimension rooted in Brazil's regulatory context and societal expectations placed on medicine as a means for managing women's reproductive and sexual health. Off-label and experimental medical use of these treatments is linked to experimental social use: how women adopt them to respond to the pressures, anxieties and aspirations of work and intimate life. The paper argues that these experimental techniques are becoming morally authorized as routine management of women's health, integrated into mainstream Ob-Gyn healthcare, and subtly blurred with practices of cuidar-se (self-care) seen in Brazil as essential for modern femininity.

Experiências e expectativas de mulheres submetidas à histerectomia

Este estudo objetivou compreender as experiências e expectativas de mulheres submetidas à histerectomia. O referencial filosófico do estudo foi a Fenomenologia Social de Alfred Schütz. Os dados foram coletados por meio de entrevistas com dez mulheres que realizaram histerectomia eletiva. A análise dos depoimentos mostrou que a mulher, diante da necessidade da histerectomia, evoca mitos e constructos sociais referentes à retirada do útero e transcende-os, decidindo pela cirurgia em decorrência dos sinais e sintomas vivenciados em seu cotidiano. Ao ser submetida à histerectomia, experiencia um processo positivo de mudanças, com melhora na vida sexual e nas relações sociais. Tem como projeto a busca por qualidade de vida, considerando as necessidades biopsicossociais vivenciadas nesse período do ciclo vital. O conhecimento das vivências da mulher após histerectomizada oferece subsídios aos profissionais de saúde que cuidam dessa clientela, sinalizando ações conforme suas experiências e expectativas de cuidado.

A repercussão da histerectomia na vida de mulheres em idade reprodutiva

Estudo qualitativo, do tipo descritivo-exploratório, cujo método foi a História de Vida. O objetivo foi identificar e analisar a repercussão da histerectomia na vida da mulher em idade reprodutiva. Foram entrevistadas doze mulheres em pós-operatório de histerectomia. O cenário foi o ambulatório de ginecologia de um hospital especializado na assistência à mulher e à criança, no Rio de Janeiro, entre julho e outubro de 2006. Foi realizada análise temática, emergindo duas categorias: "Vida pré: ligada à doença" e "Vida pós: adaptação". Algumas mulheres referiram uma influência benéfica da histerectomia, trazendo a resolução de problemas, com uma conotação de cura. Porém, para outras significou uma difícil perda. Fatores como sexualidade, sensação de vazio e questões ligadas à reprodução geraram dúvidas no imaginário das mulheres. Considerar estes fatores é fundamental para a implementação de uma assistência específica e que atenda as necessidades desta clientela.

Representações de mulheres acerca da histerectomia em seu processo de viver

Estudo qualitativo, exploratório-descritivo, realizado com os objetivos de conhecer as representações sociais de mulheres submetidas à histerectomia e identificar alguns fatores que interferem no seu processo de viver. Foram informantes 12 mulheres histerectomizadas em um hospital universitário no Rio Grande do Sul. Os dados foram coletados em setembro e outubro de 2006 por meio de entrevistas e tratados pela análise de conteúdo temática. Foram identificadas duas categorias: representações negativas e representações positivas da histerectomia no viver das mulheres. Ambas referem-se ao significado atribuído ao útero e ao contexto vivencial da mulher. As negativas foram ancoradas em preconceitos, incapacidade de serem mães e no desinteresse sexual, com possíveis interferências na vida conjugal. As positivas, no bem-estar após a cirurgia e na melhoria da qualidade de vida. É essencial disponibilizar espaço para a problematização do viver sem útero, com vistas a prevenir conflitos pessoais e conjugais.