Introduction

Hysterectomy (removal of the uterus) is the most common gynecological operation performed today. As many as 25% of women will undergo one of several forms of hysterectomy:

• vaginal hysterectomy - where the uterus is removed through the vaginal opening, without an abdominal incision
• subtotal abdominal hysterectomy - the uterus is removed through a low abdominal incision, but the cervix is left in place
• total hysterectomy - the uterus, including the cervix, is removed through an abdominal incision

Many women are worried that hysterectomy will affect their ability to enjoy sexual intercourse, or their sexual attractiveness. To see whether sexual well-being is influenced by one type of hysterectomy more than another, researchers in the Netherlands conducted a study. Here's a summary of the results they reported in the British Medical Journal.

What they did

Over an 18-month period all women who had been offered hysterectomies in 13 Dutch hospitals completed a questionnaire before, and 6 months after, their surgery. There were 36 questions - 16 on the patient's own perception of her sexuality and frequency of intercourse, 18 on problems arising during sex, and two 'summary' questions as to their general satisfaction with sexuality.

The main analysis concentrated on those women who were sexually active before and after hysterectomy, comparing their outcome with different surgical techniques.

What they found out

Out of 477 women questioned, 413 gave permission for their answers to be analyzed. However, only 352 women who had a male partner replied to the 6-month questionnaire. Of these, 310 were sexually active both before and after surgery; 29% had a vaginal hysterectomy, 25% had a subtotal hysterectomy, and 47% had a total hysterectomy. There were no significant differences among actual surgical techniques for those who remained, or became, sexually active after surgery.

Sexual pleasure improved, on average, after all three types of surgery. There was a reduction in all sexual problems reported before surgery, again with all three types of operation.

Six months after hysterectomy, 43% of vaginal, 41% of subtotal, and 39% of total hysterectomy patients still reported one or more bothersome problems. The differences between these groups were not significant (i.e. they could have emerged by chance alone). New sexual problems developed in 23%, 24%, and 19% of the patient groups, respectively; again, there was no significant difference between the types of operation.

What does this mean?

Once again, an 'old wives tale' has been laid to rest. Women faced with having a hysterectomy needn't worry that one type of operation rather than another will adversely affect their sex life. Rather the reverse. As in many other cases, precise knowledge can usually help dispel anxieties.