A total of 678 women were interviewed about symptoms before as well as advantages and disadvantages after abdominal hysterectomy. Medical complications, side effects, days of hospitalization and some possible differences between supravaginal hysterectomy (SVH) and total hysterectomy (TH) were also investigated. TH had been performed in 79% and SVH in 21% of the women. Leiomyoma was the most frequent diagnosis (79%). Heavy menstrual bleeding and dysmenorrhea were the dominant symptoms before surgery. After the operation, 71% of the women had no subjective gynecological complaints. Relief from heavy bleeding and pain was considered the major advantage and as many as 29% of the women experienced no disadvantage at all with the operation. Regarding sexual life, 39% experienced intercourse as much improved or better and 40% as unchanged. An intraabdominal abscess was more often found postoperatively in patients operated with TH than with SVH but with this exception no objective finding favoured one method more than the other. When new, alternative treatments such as endometrial ablation and GnRH analogues are introduced and promoted they should be subjected to careful evaluation and compared with the therapeutic efficacy of hysterectomy.
The role of cultural background in the etiology of depressive symptoms associated with hysterectomy has been rarely explored. However, the increasing interest in the transcultural aspects of psychiatry in the last decade gives a particular relevance to this subject. In the current study, 152 women underwent hysterectomy in a downtown hospital of a large city. The population under study consisted of women of various ethnic backgrounds, French Canadian (35%), English Canadian (29%), European (22%) and other (14%). The women completed the Zung self-rating depression scale (SDS) before the operation and six times after during a one year period. They also answered two questionnaires, the first before the operation and the last one a year after. These questionnaires explored the presence of fears, misconceptions, the attitudes toward the operation, the satisfaction regarding medical care and the general pre- and post-operative adjustment. English Canadian women reported the lowest scores on the SDS; they had few misconceptions and fears. They had the best post-operative adjustment of the three groups. French Canadian women showed intermediate scores on the SDS and expressed more misconceptions and feelings of mutilations pre-operatively. Women of European origin showed the highest scores on the SDS at all observations, expressed more regrets about the operation and had a more difficult post-operative adjustment than the other two groups. This study suggests that cultural factors may contribute to the reaction to hysterectomy in women of different ethnic backgrounds. Education, the type of society: patriarchal versus matriarchal, the emphasis on the women's reproductive ability in a particular culture, are among other factors that seem to play an important role.
Wide small-area variations in the rates of elective surgical procedures and lack of systematic outcome measurement have raised questions about the appropriateness of such surgery. Our objective was to determine the feasibility of routine evaluation of indications for and outcomes of elective surgery.
Participants consisted of 138 surgeons and 5313 patients who underwent 1 or more of 6 specific surgical procedures (for a total of 6274 operations). Surgical indications were evaluated according to published guidelines. Patients' self-reported health-related quality of life (HRQOL) before and at appropriate intervals after surgery was measured with standard, validated generic and disease-specific instruments. Patient-specific results were routinely sent to the surgeons, from whom feedback was requested.
Surgeons provided information on the indications for surgery for 44% to 95% of the 6 procedures, and the indications matched the guidelines in 73% to 99% of cases. Completed HRQOL questionnaires were returned by 58% of the patients. Postoperative HRQOL scores were markedly improved in most patients, but in 2% to 26% of the various procedures, there was either no change or a deterioration in HRQOL. In most of the procedure groups a small proportion of patients had relatively minor symptoms and disability preoperatively, but in the cataract surgery group this proportion was large. Opinion among the participating surgeons was divided as to the potential value of this method of evaluation. The cost of the outcome evaluation program was about $12/patient.
Evaluation of indications for and outcomes of elective surgery could be implemented systematically at reasonable cost and could be included in an accountability framework for health services. Most surgeons were not enthusiastic about this kind of evaluation.
This article describes the prevalence of hysterectomy, women's own opinions of it, and socioeconomic characteristics of hysterectomized women compared to non-hysterectomized ones. The questionnaire was sent in spring 1989 to 2000 45 to 64-year-old Finnish women picked randomly from the Population Census. After two reminders, 1713 (86%) had responded. One fifth of the women had had a hysterectomy and 5% had also had both ovaries removed. Among the highest educated there were less hysterectomized women than among the less educated. The largest differences in the prevalence of hysterectomy were between counties, not between socioeconomic groups. Fourty-one percent of the hysterectomized women had themselves wished hysterectomy, 25% did not have any specific opinion about the operation. Results raise further questions about clinical decision making and regional variation of hysterectomy.
This prospective interview study was conducted to elucidate the psychological, social and sexual consequences of hysterectomy on the women's partners. In addition to the interviews, a check-list of psychological symptoms was used. Twenty-four partners to women who were scheduled for hysterectomy because of benign uterine diseases entered the study. The men were interviewed before hysterectomy and 12-15 months later. Approximately half of the men reacted with ambivalence towards their partners' decision to undergo hysterectomy. The main concerns of the men were possible complications related to the operation and a diagnosis of cancer. Generally, the men did not receive information from the medical staff, neither before nor after the hysterectomy. The women's symptoms before operation had a negative impact on sexual life and quality of life of the partners. Hysterectomy showed a positive effect not only on the sexual life but also on the overall quality of life of the majority of the men. In conclusion, the men in this study seem to have predominantly supportive attitudes and adequate reactions concerning their partner's hysterectomy. A decrease of their psychological symptoms postsurgery and an improvement of sexual life and overall quality of life could be observed.
A total of 678 women were interviewed about psychological reactions and sexual adjustment after abdominal hysterectomy with and without simultaneous oophorectomy. The response rate was high and complete questionnaires were returned by 86% of the women. A more positive attitude towards the operation was found in the group of women where the ovaries had been preserved. Women who had undergone oophorectomy experienced a deteriorated sexual life compared to women with preserved ovaries. This was observed regardless of age and in different parameters such as 'coital frequency' and 'experience of intercourse'. The negative effects of sexual life as a result of hysterectomy with simultaneous oophorectomy are important to bear in mind and should be discussed with the woman prior to surgery.
OBJECTIVE: To compare laparoscopic hysterectomy and abdominal total hysterectomy regarding influence on postoperative psychological wellbeing and surgical measures. DESIGN: A prospective, open, randomised multicentre trial. SETTING: Five hospitals in the South East of Sweden. POPULATION: Hundred and twenty-five women scheduled for hysterectomy for benign conditions were enrolled in the study, and 119 women completed the study. Fifty-six women were randomised to abdominal hysterectomy and 63 to laparoscopic hysterectomy. METHODS: Psychometric tests measuring general wellbeing, depression and anxiety preoperatively and 5 weeks and 6 months postoperatively. MAIN OUTCOME MEASURES: Effects of operating method on the psychological wellbeing postoperatively. Analysis of data regarding operating time, peroperative and postoperative complications, blood loss, hospital stay and recovery time. RESULTS: No significant differences in the scores were observed between the two groups in any of the four psychometric tests. Both the surgical methods were associated with a significantly higher degree of psychological wellbeing 5 weeks postoperatively compared with preoperatively. The operating time was significantly longer for the laparoscopic hysterectomy group, but the duration of the stay in hospital and sick-leave were significantly shorter for laparoscopic hysterectomy group compared with the abdominal hysterectomy group. CONCLUSIONS: General psychological wellbeing is equal after laparoscopic and abdominal hysterectomy within 6 months after the operation. The advantages of the laparoscopic hysterectomy are the shorter stay in hospital and shorter sick-leave, but these issues must be balanced by a longer duration of the operation.
The aim of this study was to describe how women experienced short admission in abdominal hysterectomy and to describe patterns of behaviours in short admission. A Short admission is now widely used in Denmark in relation to hysterectomy and involves one to two postoperative days. The diagnostic, prognostic and clinical indicators are well described in the literature. Documentation however, is sparse regarding the experiences of the women involved. This article presents and discusses the women's own experiences and the impact of the short admission. The results are part of a lager evaluation of women and staff experiences overall. The design is exploratory and descriptive. Ten women who underwent a hysterectomy were selected consecutively from August 2001 and were followed from their initial examination to 1 month following hospital discharge. Data were collected by individual interviews. To grasp a complex reality and patterns of behaviour a typical-type methodology were used. As a result three types of women were identified: (i) The intervening type, (ii) the cooperative type and (iii) the unsure type. The women considered dialogue with the staff to be essential in short admissions. Women in this study who described emotional reactions considered it important that staff do not refrain from speaking about sensitive subjects. In conclusion the importance of dialogue creates new demands for the staff, as somatic care in this context has changed to be more oriented towards information and follow-up. The women in this study did not have any physical side effects but reported some psychological areas of importance. An outpatient clinic staffed by nurses could cover the needs of the woman.
The goal of the study was to examine women's experiences with gynaecologic symptoms and how they decided to undergo hysterectomy. For this purpose, twenty-nine women were interviewed in hospital within three days of undergoing hysterectomy. The interviews elicited information about the nature of the problem that caused the women to seek medical help, actions taken to solve their problem, their relationship with their gynaecologist, information seeking patterns and decision-making about hysterectomy. Although findings revealed that the symptoms women suffered had a negative impact on their lives, most women delayed seeking medical help and attributed their symptoms to factors other than a physical problem in their reproductive system. Most of the participants' information about the symptoms and possible treatments came from their consulting other women with similar problems. The women reported that their gynaecologist did not initiate a comprehensive discussion about other treatments and their advantages and disadvantages. Only women who had informed themselves about other treatments actively discussed alternatives to hysterectomy with their physicians. The women's decision-making process about undergoing hysterectomy was difficult and depended primarily on the women's illness experiences, age, wish for future children, information they gathered from their gynaecologist and from other women. The findings are discussed in relation to the importance of information provision by gynaecologists and its effects on women's decision-making about hysterectomy.