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Hysterectomy pp 133-138 | Cite as

Evidence Based Review of Hysterectomy and Sexuality

  • Farah LoneEmail author
Chapter
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Abstract

Hysterectomy is a commonly performed surgical procedure for benign conditions such as period related problems, uterine fibroids and pelvic pain and also for actual and possible malignancies. The types of hysterectomy include total and subtotal with or without removal of ovaries. The surgical routes include abdominal, vaginal and endoscopic. Women undergoing hysterectomy are worried about possible side effect of the surgery on their sexuality. Factors such as hormonal, anatomical, vascular, neurogenic and psychological can have a detrimental effect on various aspects of sexual functioning.

There is a lack of clarity in the literature as to whether hysterectomy improves or attenuates sexuality. The research on the effect of hysterectomy on sexuality is not conclusive. Current evidence suggests that dyspareunia reduces after hysterectomy. Symptom relief may have led to increased sexual enjoyment and increased orgasm frequency. Hysterectomy may reduce the discomfort of pain and bleeding, resulting in positive psychological factors such as elimination of anxiety over cancer risk and unwanted pregnancy.

Sexual function does not usually deteriorate after hysterectomy although a few women may develop sexual problems. Sexual function in women who have subtotal abdominal hysterectomy is similar with total abdominal hysterectomy. While women report an improvement of sexual functioning after hysterectomy, this may be the result of the relief of symptoms from the removal of uterus, some women develop sexual dysfunction as a result of hysterectomy.

Keywords

Abdominal hysterectomy Total hysterectomy Subtotal hysterectomy Vaginal hysterectomy Laparoscopic hysterectomy Robotic hysterectomy Radical hysterectomy Sexuality Sexual problems Dyspareunia Libido Psychological 

References

  1. 1.
    Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA. 1999;281(6):537–44.CrossRefPubMedGoogle Scholar
  2. 2.
    Hayes RD, Bennett CM, Fairley CK, et al. What can prevalence studies tell us about female sexual difficulty and dysfunction? J Sex Med. 2006;3:589–95.CrossRefPubMedGoogle Scholar
  3. 3.
    West SL, D’Aloisio AA, Agans RP, et al. Prevalence of low sexual desire and hypoactive sexual desire disorder in a nationally representative sample of US women. Arch Intern Med. 2008;168:1441–9.CrossRefPubMedGoogle Scholar
  4. 4.
    DeRogatis LR, Graziottin A, Bitzer J, et al. Clinically relevant changes in sexual desire, satisfying sexual activity and personal distress as measured by the profile of female sexual function, sexual activity log, and personal distress scale in postmenopausal women with hypoactive sexual desire disorder. J Sex Med. 2009;6:175–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Dennerstein L, Guthrie JR, Hayes RD, DeRogatis LR, Lehert P. Sexual function, dysfunction, and sexual distress in a prospective, population-based sample of mid-aged, Australian-born women. J Sex Med. 2008;5:2291–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Whiteman MK, Hillis SD, Jamieson DJ, et al. Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol. 2008;198:31–7.CrossRefGoogle Scholar
  7. 7.
    Bhattacharya S, Mollison J, Pinion S, et al. A comparison of bladder and ovarian function two years following hysterectomy or endometrial ablation. BJOG. 1996;103:898–903.CrossRefGoogle Scholar
  8. 8.
    Lalinec-Michaud M, Engelsmann F. Psychological profile of depressed women undergoing hysterectomy. J Psychosom Obstet Gynecol. 1988;8:53–66.CrossRefGoogle Scholar
  9. 9.
    Rhodes JC, Kjerulff K, Langenberg PW, Guzinski GM. Hysterectomy and sexual functioning. JAMA. 1999;282:1934–41.CrossRefPubMedGoogle Scholar
  10. 10.
    Dennerstein L, Wood C, Burrows GD. Sexual responses following hysterectomy and oophorectomy. Obstet Gynaecol. 1977;49:92–6.Google Scholar
  11. 11.
    Helstorm L, Lundberg PO, Sorborm D, Backstorm T. Sexuality after hysterectomy: factor analysis of women’s sexual lives before and after subtotal hysterectomy. Obstet Gynaecol. 1995;74:142–6.Google Scholar
  12. 12.
    Darling CA, McKay-Smith YM. Understanding hysterectomies: sexual satisfaction and quality of life. J Sex Res. 1993;30:324–35.CrossRefGoogle Scholar
  13. 13.
    Langer R, Neuman M, Ron-el R, et al. The effect of total abdominal hysterectomy on bladder function in asymptomatic women. Obstet Gynecol. 1989;74:205–7.PubMedGoogle Scholar
  14. 14.
    Carlson KJ, Miller BA, Fowler Jr FJ. The Maine Women’s Health Study I. Outcomes of hysterectomy. Obstet Gynecol. 1994;83:556–65.CrossRefPubMedGoogle Scholar
  15. 15.
    Kjerulff KH, Langenberg PW, Greenaway L, Uman J, Harvey LA. Urinary incontinence and hysterectomy in a large prospective cohort study in American women. J Urol. 2002;167:2088–92.CrossRefPubMedGoogle Scholar
  16. 16.
    Griffith-Jones MD, Jarvis GJ, McNamara HM. Adverse urinary symptoms after total abdominal hysterectomy—fact or fiction? Br J Urol. 1991;67:295–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Thakar R. Dispelling the myth-does hysterectomy cause pelvic organ dysfunction. BJOG. 2004;111:20–3.CrossRefPubMedGoogle Scholar
  18. 18.
    Farrell SA, Kieser K. Sexuality after hysterectomy. Am J Obstet Gynaecol. 2000;95:1045–51.Google Scholar
  19. 19.
    Roussis NP, Waltrous L, Kerr A, et al. Sexual response in the patient after hysterectomy: total abdominal versus supracervical versus vaginal procedure. Am J Obstet Gynaecol. 2004;190:1427–8.CrossRefGoogle Scholar
  20. 20.
    Alexander AD, Naji AA, Pinion SB, et al. A randomised trial of hysterectomy versus endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial outcome. Br Med J. 1996;312:280–312.CrossRefGoogle Scholar
  21. 21.
    Wierrani F, Huber M, Grin W, et al. Prospective libido and genital sexual sensitivity following various forms of hysterectomy. J Gynecol Surg. 1995;11:127–32.CrossRefGoogle Scholar
  22. 22.
    Galyer KT, Conaglen HM, Hare A, Conaglen JV. The effect of gynecological surgery on sexual desire. J Sex Marital Ther. 1999;25:81–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Roovers JWR, Van der Bom JG, Van der Vaat CH, Heintz PM. Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy and total abdominal hysterectomy. Br Med J. 2003;327:774–7.CrossRefGoogle Scholar
  24. 24.
    Jewett JF. Vaginal length and incidence of dyspareunia following total abdominal hysterectomy. Am J Obstet Gynaecol. 1952;63:400–7.CrossRefGoogle Scholar
  25. 25.
    Weber AM, Walters MD, Piedmonte MR. Sexual function and vaginal anatomy in women before and after surgery for pelvic organ prolapse and urinary incontinence. Am J Obstet Gynaecol. 2000;182:1610–5.CrossRefGoogle Scholar
  26. 26.
    Kilkku P, Gronoos M, Hirovnen T, Rauramo L. Supravaginal uterine amputation versus hysterectomy: effects on libido and orgasm. Acta Obstet Gynecol Scand. 1983;62:147–52.CrossRefPubMedGoogle Scholar
  27. 27.
    Kilkku P. Supravaginal uterine amputation versus hysterectomy: effects on coital frequency and dyspareunia. Acta Obstet Gynecol Scand. 1983;62:141–5.CrossRefPubMedGoogle Scholar
  28. 28.
    Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. 2002;347:1318–25.CrossRefPubMedGoogle Scholar
  29. 29.
    Zobbe V, Gimbel H, Anderson BM, et al. Sexuality after total and subtotal hysterectomy. Acta Obstet Gynecol Scand. 2004;83:191–6.CrossRefPubMedGoogle Scholar
  30. 30.
    Van der Wiel HBM, Weijmar Schultz WCM, Hallensleben A, et al. Sexual functioning following treatment of cervical cancer. Eur J Gynecol Oncol. 1988;9:275–81.Google Scholar
  31. 31.
    Schover LR, Fife M, Gershenson DM. Sexual dysfunction and treatment of early stage cervical cancer. Cancer. 1989;63:204–12.CrossRefPubMedGoogle Scholar
  32. 32.
    Horton B. Sexual outcomes arising from diagnosis and treatment of cervical cancer and cervical intraepithelial neoplasia: a review of literature. J Sex Marital Ther. 1991;6:29–39.CrossRefGoogle Scholar
  33. 33.
    Weijmar Schultz WCM, Bransfield DD, Van der Wiel HBM. Sexual functioning following female genital cancer treatment: a critical review of methods of investigation and results. J Sex Marital Ther. 1992;7:29–64.CrossRefGoogle Scholar
  34. 34.
    Siebel MM, Freeman MG, Graves WL. Carcinoma of the cervix and sexual function. Obstet Gynecol. 1980;55:484–7.Google Scholar
  35. 35.
    Thranov I, Klee M. Sexuality amongst gynaecologic cancer patients–a cross-sectional study. Gynecol Oncol. 1994;52:14–9.CrossRefPubMedGoogle Scholar
  36. 36.
    Bergmark K, Avall-Lundqvist E, Dickman PW, et al. Vaginal changes and sexuality in women with a history of cervical cancer. N Engl J Med. 1999;340:1383–9.CrossRefPubMedGoogle Scholar
  37. 37.
    Grumann M, Robertson R, Hacker NF, Sommer G. Sexual functioning in patients following radical hysterectomy for stage 1B cancer of the cervix. Int J Gynecol Cancer. 2001;11:372–80.CrossRefPubMedGoogle Scholar
  38. 38.
    Jensen PT, Groenvold M, Klee MC, et al. Does radical hysterectomy have an impact on sexual function in early stage cervical cancer patients? Int J Gynecol Cancer. 2003;13:22.Google Scholar
  39. 39.
    Maas CP, ter Kuile MM, Laan E, et al. Objective assessment of sexual arousal in women with a history of hysterectomy. BJOG. 2004;111:456–62.CrossRefPubMedGoogle Scholar
  40. 40.
    Lee JH, Choi JS, Hong JH, Joo KJ, Kim BY. Does conventional or single port laparoscopically assisted hysterectomy affect female sexual function? Acta Obstet Gynecol Scand. 2011;90(12):1410–5.CrossRefPubMedGoogle Scholar
  41. 41.
    Serati M, Salvatore S, Uccella S, Laterza RM, Cromi A, Ghezzi F, Bolis P. Sexual function after radical hysterectomy for early-stage cervical cancer: is there a difference between laparoscopy and laparotomy? J Sex Med. 2009;6(9):2516–22.CrossRefPubMedGoogle Scholar
  42. 42.
    Gil-lbanez B, Diaz-Feijoo B, Perez-Benavente A, Puig-Puig O, Franco-Camps S, Centeno C, Xercavins J, Gil-Moreno A. Nerve sparing technique in robotic-assisted radical hysterectomy: results. Int J Med Robot 2013. doi:  10.1002/rcs 1480. Epub.
  43. 43.
    Kuppermann M, Summitt Jr RL, Varner RE, McNeeley SG, Goodman-Gruen D, Learman LA, et al. and Total or Supracervical Hysterectomy Research GroupSexual functioning after total compared with supracervical hysterectomy: a randomized trial. Obstet Gynecol. 2005;105(6):1309–18.CrossRefPubMedGoogle Scholar
  44. 44.
    Thakar R, Ayers S, Georgakapolou A, Clarkson P, Stanton S, Manyonda I. Hysterectomy improves quality of life and decreases psychiatric symptoms: a prospective and randomised comparison of total versus subtotal hysterectomy. BJOG. 2004;111(10):1115–20.CrossRefPubMedGoogle Scholar
  45. 45.
    Flory N, Bissonnette F, Amsel RT, Binik YM. The psychosocial outcomes of total and subtotal hysterectomy: a randomized controlled trial. J Sex Med. 2006;3(3):483–91.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  1. 1.Obstetrics and GynaecologyRoyal Cornwall HospitalCornwallUK

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