Psychosexual aspects of hysterectomy

Abstract

p b atient permission to allow the performance of a hysterectomy is an W area of medicine where informed consent is of critical importance because not only does this operation carry the operative morbidity and mortality that other surgical procedures have, but it also alters the genital anatomy of the patient and in so doing may carry detrimental psychosexual consequences for some patients. 1-s Although there is controversy regarding the causal relationship of the procedure and psychosexual sequelae, reports of psychological and sexual morbidity can be found in medical literature both from the United States and abroad. 6-16 However, other studies have found no increase in adverse psychological outcome from hysterectomy as compared with cholecystectomy or tubal ligation. 17-23 When reported, postoperative psychosexual problems appear to be more prevalent in patients with the following profiles: 1) preoperative history of depression, sexual dysfunction, or other psychological disturbancesgA°A2,1s,24,25; 2) age less than 35-40 years, limited educational attainment, or conflict about future childbearing9,12A4,21,25-28; 3) poor preoperative understanding of the proposed surgery and what changes to expect postoperatively29-32; 4) belief that the uterus has unique psychological and sexual importancea°'32-34; and 5) absence of pelvic pathology. 14As Since ancient times, the uterus has had important psychosexual and sociocultural significance. 35 Symbols of the uterus existed as early as the Paleolithic era, and in Sanskrit the same word is used for womb and for temple. 36 The ancient Greek word for uterus (hystera) is derived from the word meaning after, referring to the placenta or, in lay terms, the afterbirth. 3s Over time, the word hysteria (derived from hystera) came to have negative connotations because the uterus was felt to be central to diseases of women. 37 Galen taught that most of the ills of women could be traced to the womb. 38 George Engelmann, addressing the American Gynecological Society in 1877 on a series of different diseases, believed the etiology of illness in women could be traced to uterine pathology; he coined the term hystero-neuroses. ''as The condition of hysteria was attributed to the wandering of the uterus to different parts of a woman's body, causing a variety of symptoms and erratic behavior. 3a Although this notion has been discarded, hysteria, defined as a psychoneurotic condition characterized by emotional outbursts and sensory disturbances, 39 is still considered by many to be more common in women. © 1990 by The Jacobs Institute of Women's Health 1049-3867/90/$3.50