Hysterectomy and Sexual Functioning
Abstract & commentary
Source: Rhodes JC, et al. Hysterectomy and sexual functioning. JAMA 1999;282:1934-1941.
Each year, more than half a million women in the United States decide to have a hysterectomy for the treatment of gynecologic conditions. There is understandable concern about the effects of hysterectomy on sexual functioning. Existing data, mostly from small retrospective samples, indicates that 13%-37% of women report a deterioration in sexual functioning, 16%-47% report no change, and 34%-70% report improvement in sexual functioning.
The current study is a two-year prospective study. As part of the Maryland Women’s Health Study, measures of sexual functioning were assessed prior to hysterectomy and at 6, 12, 18, and 24 months post-operatively. The sample included both large urban and small rural hospitals. The majority of women in the study were referred by gynecologists at the time of surgical posting (66%) or from their office (33%); 1% of patients were self-referred. Of 1604 patients contacted, 81% agreed to participate. The main reason for declining was too little time to complete the in-home interview before hysterectomy. Sexual functioning was evaluated as follows:
1. an open-ended inquiry as to the "frequency of sexual relations over the past month"
2. a 6-point Likert scale from "all of the time" to "none of the time" for dyspareunia, orgasm, and vaginal dryness;
3. an 8-point Likert scale from "every day" to "not at all" for libido;
4. a 4-point Likert scale from "very strong" to very mild" for strength of orgasm.
Compared to all hysterectomy patients in the state of Maryland, study participants were younger (43.3 vs 44.6 years), had a shorter length of stay (3.4 vs 3.8 days), lower hospital charges, and were more likely insured by an HMO. Table 1 summarizes statistically significant results.
| Table-Sexual Functioning Before and After Hysterectomy | |||
| Function | Baseline | 12-Month Follow-up | 24-Month Follow-up |
| Having sexual relations | 70.5% | 77.6% | 76.7% |
| Sexual relations/month | 2.3 | 3.1 | 2.9 |
| Any dyspareunia | 40.8% | 18.4% | 14.9% |
| Frequent dyspareunia | 7.6% | 4.3% | 3.6% |
| Orgasms experienced | 62.8% | 72.4% | 71.5% |
| Strong orgasms | 44.6% | 58.4% | 57.3% |
| No vaginal dryness | 37.3% | 46.8% | 46.7% |
| Low libido | 10.4% | 6.3% | 6.2% |
Only prehysterectomy dyspareunia and depression (after adjustment for age) predicted dyspareunia after hysterectomy. Prehysterectomy lack of orgasm, increasing age, and bilateral oophorectomy (after adjustment for age), and depression (after adjustment for age) predicted lack of orgasm after hysterectomy. Prehysterectomy vaginal dryness and depression (after adjustment for age) predicted vaginal dryness after hysterectomy. Finally, low libido and depression (after adjustment for age) before hysterectomy predicted low libido after hysterectomy. The primary limitation of the current study is short period of time between the interview and hysterectomy (a time during which sexual functioning may have been negatively affected by anxieties about the upcoming surgery).
Comment by Donald M. Hilty, MD
The results of this large prospective study are very encouraging, and challenge previous findings from smaller, retrospective studies. There are potential biological and many psychological mechanisms (relief, reduced fear of pregnancy, freedom from vaginal bleeding) that could account for the observed improvements in sexual function after hysterectomy. It is also possible that women simply feel better after hysterectomy and that sexual functioning improves along with overall health status and quality of life. In the current study, prehysterectomy depression predicted worse sexual functioning after hysterectomy buy the study did not evaluate mood post-operatively. Further evaluation of this issue is warranted. In any event, these data are encouraging for the many women that are contemplating this procedure.
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