Hysterectomy Won't Lower Sexual Function
'Compelling' Evidence That Surgery Improves Quality of Life
Oct. 23, 2002 -- New research should help reassure the roughly 600,000 women in the U.S. who have hysterectomies each year. Investigators found no decline in sexual and bowel function among women taking part in a British study, and urinary function actually improved.
"The lay press has given many women the idea that having a total hysterectomy will affect their orgasms," says Joseph Schaffer, MD, of the University of Texas Southwestern Medical Center (UTSW). "Worries about sexual function are probably the leading reason that women ask for subtotal hysterectomies. This research does not find that one surgery is better than the other in this regard, or with regard to other quality-of-life concerns."
The study compared women having total hysterectomies, in which both the uterus and the cervix are removed, to women having subtotal or partial hysterectomies, in which the cervix is spared. The vast majority of surgeries in the U.S. involve total removal, but there has been some suggestion that the less radical approach results in fewer long-term problems.
Researcher Isaac Manyonda, MD, PhD, and colleagues from St. George's Hospital in London, found little difference one year after surgery among 279 women who had either total or subtotal hysterectomies. No major differences were seen in the frequency of intercourse or orgasm. The study findings are reported in the Oct. 24 issue of TheNew England Journal of Medicine.
Fewer women in both groups reported problems with urinary function -- including frequent and nighttime urination -- following hysterectomies. Women who had subtotal hysterectomies recovered from surgery faster than the other patients, but 7% also continued to experience monthly bleeding or spotting.
"One message from this study is that no one surgical approach is clearly best," Manyonda tells WebMD. "Another message is that this surgery can dramatically improve quality of life."
Hysterectomies are typically performed in women who have abnormal uterine bleeding and pelvic pain. They are far more common in the U.S. than in most other parts of the world, including the U.K., and many experts believe that too many American women have them.
"I have no doubt that a woman whose life has been made miserable by heavy bleeding or pain will have a better quality of life after having a hysterectomy," ob-gyn Jeanette S. Brown, MD, tells WebMD. "But for women who don't really need this surgery, the risks are not worth it."
Brown recently published a study showing that women who have had hysterectomies have a 40% to 60% greater risk of problems with urinary incontinence after the age of 60. She directs the Women's Continence Center at the University of California in San Francisco.
"The hysterectomy rate in the U.S. is close to 40%, compared to 20% in the U.K. and 11% in Scandinavia," she says. "And even within the United States, hysterectomies are performed far more often in some areas than in others. It is not likely that women are different in areas where hysterectomies are more common."
But Schaffer, who wrote an editorial accompanying the latest hysterectomy study, tells WebMD the findings should reassure women who need the surgery. He directs the urogynecology and reconstructive pelvic surgery program at UTSW.
"This is some of the most compelling evidence we have that hysterectomy really does improve quality of life," he says. -->