Iranian Women's Self-concept after Hysterectomy: A Qualitative Study

Examining the changes in women's lives after the hysterectomy operation: Experiences of women from Turkey

PURPOSE

The aim of the study is to examine what kind of changes the operation has brought about in the social and psychological life of women.

METHODS

The study was a hermeneutic-phenomenological research conducted using qualitative research methods. It took place between May and July 2023 at a university hospital located in Istanbul, Turkey. Following ethical approval, the study included a total of 24 women who had undergone a 'total abdominal hysterectomy, bilateral salpingo-oophorectomy.' These participants were selected using a combination of maximum diversity sampling and random sampling methods. Data collection was carried out using a semi-structured interview form. The interviews were conducted using face-to-face interview techniques and in-depth interview methods. Qualitative data analysis involved using the coding paradigm of Grounded Theory and Straus and Corbin's coding framework. For the analysis of quantitative data, SPSS version 28.0 was employed, while qualitative data were analyzed using MaxQDA Analytics Pro 2022.

RESULTS

The study found that the participants had a mean age of 47 ± 7.53, and the majority, 66.7%, had not reached menopause before the operation. The qualitative analysis of the semi-structured interviews revealed five main themes, which were identified as follows: 'hysterectomy experiences', 'the impact of hysterectomy on sexual life', 'the significance attributed to the uterus', 'the significance attributed to femininity', and 'self-efficacy after hysterectomy'.

CONCLUSIONS

The study revealed that women experienced changes in self-perception, body image, a sense of organ loss, and developed negative attitudes towards menopause following a hysterectomy. Additionally, there was a noticeable connection between the meanings attributed to the uterus and femininity, which was often influenced by cultural and social factors. In light of these findings, it is recommended that women receive counseling from healthcare professionals before undergoing a hysterectomy. This guidance can help women better understand and cope with the physical, emotional, and cultural aspects of the procedure.

Tools for assessing the quality of life of hysterectomized women: A systematic review

AIMS AND OBJECTIVES

Since hysterectomy surgery is a major and invasive procedure, it can affect the quality of life of women in many ways. This study aimed to review and critique the psychometric properties of tools used to measure the quality of life of hysterectomized women.

METHOD

An advanced search was conducted in international (PubMed, Web of Science, Scopus, PsycINFO, Embase) as well as national databases (SID and Magiran) to retrieve articles published from 2000 to 2024, using keywords related to hysterectomy and quality of life. Then, the psychometric properties of the tools found in these articles were evaluated by COSMIN checklist.

RESULTS

The psychometric properties of tools were analyzed using the COSMIN checklist. Among the 20 general and specific tools examined, content validity had not been evaluated in 15 tools, construct validity had not been evaluated in four tools, criterion validity had not been evaluated in eight tools, internal consistency had not been evaluated in five tools, responsiveness had not been evaluated in 16 tools, and interpretability had not been assessed in 18 tools, and measurement error had not been evaluated in any of the tools.

CONCLUSION

The results showed that none of the evaluated tools have all the criteria of Cosmin's checklist. Of course, construct validity and reliability had been assessed in most of the tools. Meanwhile, there was no tool to measure the quality of life of hysterectomized women specifically. Therefore, it seems that developing a tool with acceptable psychometric properties is necessary to measure the quality of life of hysterectomized women specifically.

Adaptation to Hysterectomy: Design and Psychometric Properties Assessment of Hysterectomy Adaptation Scale

Background

Adaptation to complications of hysterectomy is one of the topics of concern for women and health care providers. There is no instrument for evaluating adaptation to hysterectomy. This study aimed to design the Hysterectomy Adaptation Scale (HAS) and assess its psychometric properties.

Materials and Methods

This methodological study was conducted from 2018 to 2020 in Mashhad, Iran. To develop the item pool, qualitative data from directed content analysis and data from the review of adaptation and coping instruments were used. The face, content, construct validity, internal consistency, and stability were used to evaluate the psychometric properties of HAS.

Results

The final version of the HAS consisted of 24 items with a reported content validity index of 0.9. Six factors were extracted from the principal component analysis, which explained 60.3 of the observed variance. Model fit indices in confirmatory factor analysis showed that the model was well fitted. The values of the alpha coefficient and intra-class coefficient were 0.86 and 0.95, respectively.

Conclusions

The HAS is a valid and reliable scale for evaluating the adaptation level of hysterectomized Iranian women. HAS can distinguish between hysterectomized women who have adapted to hysterectomy and those who have not. It can be used to assess the adaptation of hysterectomized women in research and clinical practice.

Women's Experiences Following Peripartum Hysterectomy: A Qualitative Study

Objective

Peripartum hysterectomy is a major operation and is inevitably performed where certain indications require removal of the uterus at the time of delivery or in the immediate postpartum period. It is a traumatic birth event that affects women's physical, physiological, psychological, social, and sexual health. This study aimed to explore the lived experiences of women undergone peripartum hysterectomy.

Materials and methods

Qualitative phenomenological design was adopted to explore the lived experiences of women undergone peripartum hysterectomy. Purposive sampling technique was adopted to enroll the participants and 19 women were interviewed before saturation of responses was reached. All interviews were audio recorded and then transcribed into verbatims. Colaizzi's thematic analysis method was used to analyze the data.

Results

Based on participants' verbatims eight major themes emerged: Awareness status regarding peripartum hysterectomy; Body's response to peripartum hysterectomy; Perceived need of support; Facilitators in overcoming post-hysterectomy challenges; Relational turbulence; financial burden; Perceived psychological adaptation; Disturbed body image and low self-esteem.

Conclusion

Derived themes in the present study highlighted the multidimensional effects of peripartum hysterectomy. Peripartum hysterectomy affected physical, psychological, sexual and financial health of the women. Increased dependence and changes in the self concept are the other problems faced by peripartum hysterectomy women. Need based individualized psychological therapeutic interventions will facilitate the successful adaptation to the traumatic situation by the reinforcement of positive coping mechanisms.

Correlation analysis of hysterectomy and ovarian preservation with depression

The relationship between hysterectomy and ovarian preservation and depression is controversial. This study aimed to determine the association of hysterectomy and ovarian preservation with depression using National Health and Nutrition Examination Survey. To assess the association between hysterectomy with or without ovariectomy and depression, we used 3 methods. Method 1: propensity score model (PSM) was established. Method 2 was logistics regression analysis of hysterectomy and depression before and after PSM. Method 3 was a logistics regression analysis of the relationship between hysterectomy and different depressive symptoms. At the same time, in order to evaluate the association between hysterectomy with or without oophorectomy and depression, we explored the effect of four different surgical procedures on depression using logistic regression equations. We enrolled 12,097 women, of whom 2763 underwent hysterectomy, 34.455% were positive for depression. After weighting, 33.825% of the total sample had a PHQ ≥ 5. Finally, a total of 2778 women were successfully matched by propensity score, and 35.537% of them were positive for depression. The OR for PHQ ≥ 5 was 1.236 after crude adjustment of covariates and 1.234 after exact adjustment. This suggests that Hysterectomy is strongly associated with positive depression. Positive depression (PHQ ≥ 5) was associated with little interest, feeling down and trouble concentrating. It was not associated with trouble sleeping, feeling tired, poor appetite, feeling bad, slow moving or speaking, and suicidal thoughts. Oophorectomy-alone is not associated with depression. Hysterectomy-alone is a risk factor for depression, but Hysterectomy combined with Oophorectomy has a stronger correlation with depression than Hysterectomy-alone. Women who have had a Hysterectomy are at higher risk of depression than women who have not had a Hysterectomy, and this risk may be exacerbated if the uterus and ovaries are removed. When clinically appropriate, surgeons should try to preserve the patient's ovaries.

The real experience with women's hysterectomy: A meta-synthesis of qualitative research evidence

AIM

The aim of this meta-synthesis was to identify and synthesize qualitative research evaluating the real feelings, inner needs and emotional experience of women undergoing hysterectomy.

DESIGN

Meta-synthesis.

METHODS

The PubMed, Web of Science, Cochrane Library, CINAHL, Embase, Ovid Medline and Sino Med were systematically searched until November 2021 and updated until June 2022. Two reviewers independently extracted data into a Microsoft Excel sheet. Qualitative meta-synthesis was performed by coding relevant citations, organizing codes into descriptive themes and developing analytical themes.

RESULTS

Qualitative meta-synthesis yielded three themes and nine sub-themes: comprehensive consideration before hysterectomy (a. disease factors; b. fertility factors; c. opinions of others); emotions and experience after hysterectomy (a. postoperative physical condition; b. psychological resilience to the loss of the uterus; c. changes in the couple's relationship); coping strategies (a. self-denial and avoidance; b. change of perception and self-adjustment; c. seek help from others).

Spontaneous perforation of pyometra—is hysterectomy required in the emergent setting? A case report and literature review

Spontaneous perforation of pyometra is a rare event associated with significant morbidity and mortality when diffuse peritonitis is present. While malignant lesions of the cervical tract are the most common cause of pyometra, several benign conditions can contribute to this diagnosis. Traditionally hysterectomy has been the surgical approach of choice for this clinical entity; however, in the setting of septic shock, temporizing techniques may offer the opportunity to stabilize patients and complete a thorough work up before committing to definitive resection. This report explores a case of septic shock secondary to spontaneous perforation of pyometra that was definitively managed with peritoneal lavage and wide drainage. Intraoperative hysteroscopy and uterine biopsy were performed, and no malignancy was identified on final pathology. Intraoperative hysteroscopy along with peritoneal lavage and wide drainage may reduce the morbidity and mortality associated with sepsis from spontaneous perforation of pyometra and potentially avoid unnecessary hysterectomy.

Psychometric properties of a Farsi translation of the Functionality Appreciation Scale (FAS) in Iranian adolescents

The 7-item Functionality Appreciation Scale (FAS; Alleva et al., 2017) measures an individual's appreciation of their body for what it can do and is capable of doing (i.e., functionality appreciation). However, few studies have assessed the psychometric properties of the FAS in non-English speaking populations and in younger age groups. Here, we examined the psychometric properties of a novel Farsi translation of the FAS in Iranian adolescent girls and boys. A sample of 828 Iranian adolescents completed the FAS alongside the Rosenberg Self-Esteem Scale and the Beck Depression Inventory-II. Participants were randomly split into a first split-half for exploratory factor analysis (EFA) or a second split-half for confirmatory factor analysis (CFA). The EFA broadly supported a 1-dimensional model of FAS scores, although one item had low item-factor loadings. The CFA indicated that both the 6- and 7-item models had adequate fit. In further analyses, we found that the 7-item unidimensional model was invariant across gender and that higher FAS scores were significantly associated with higher self-esteem and lower depressive symptoms, indicative of convergent validity. These results provide evidence that the Farsi translation of the FAS is reliable and valid for use in Iranian adolescent girls and boys.