For the majority of women, hysterectomy is elective surgery. However, it seldom feels that way. As our post bag testifies, in many cases from the moment a woman presents at the doctors’ surgery with a gynaecological disorder, she “feels as if she’s on a conveyor belt with little information, choice or support”. Post-operatively, after a few days in the hospital, she is passed medically fit and discharged to contemplate how this piece of elective surgery may affect the rest of her life and her relationships.
Removal of the uterus may be undertaken for a number of medical reasons although it is only performed to save life in relatively few cases. Whatever the primary indication, hysterectomy may be accompanied by alterations in sexuality that may occur for a variety of biological and psychological reasons. For instance, some research has shown the important role that the cervix plays in the experience of orgasm.
This organ is routinely removed during total hysterectomy in the UK even when it is healthy. In other instances, the symptoms necessitating hysterectomy may have disturbed the closeness of the relationship to such an extent that the couple finds resumption of intimacy difficult when the physical problem has disappeared.
For some women, however, sexual problems occurring after the operation may be a continuation or further evolution of previously existing difficulties. Some women, who may have experienced years of pain or discomfort through their condition, may be so negatively conditioned towards sexual activity that they abstain or avoid sexual activity post-operatively.
However, for many women, the opposite reaction occurs. Freed of the symptoms as a result of surgery, a woman may find her sexual responsiveness reawakened. With myriad different reactions possible, it is perhaps not surprising that post-operatively there is an increased incidence of depression when compared with the after-effects of other major surgery.
The success of the operation then depends upon two things, each as important as the surgeon’s skill; the woman’s self-esteem and the partner’s reaction.
Research has shown a crucial link between information giving and the perception of being cared for by health professionals. Women who present their bodies to medics without knowledge or understanding of the what, why and after effects, suffer considerably more postoperative complications than the woman who insists on knowing as much as possible and feels in control at all times [except whilst under the anaesthetic of course!] After all, a woman is the greatest expert in the world on herself.
The woman’s husband or sexual partner is the second most important factor in determining the success of the surgery. Most men (and quite a few women) don’t understand the nature of the female anatomy or the functional results of hysterectomy and may harbour many misconceptions regarding sexuality after the operation. If the man equates the removal of the uterus with loss of libido or diminished femininity, he may inadvertently avoid sexual interaction with her. Men who appear indifferent to uterine removal may actually feel anxious or guilty about subsequent sexual activity with their partner.
A hysterectomy can be seen as a unifying experience, one that the couple face together, talking and listening to each other’s needs, communicating their feelings as they change day by day.
With the right support network in place, which should include her partner as well as medical staff, there is no reason why a woman’s sexual function cannot improve following recuperation from the operation. If health-care professionals take the time that is necessary to assuage fears and doubts regarding such operations and provide a reasonable amount of factual information to both the woman and her sexual partner, few sexual difficulties will ensue postoperatively. However, whilst counselling is routine prior to sterilisation or vasectomy, no such norm exists for hysterectomies. As with all types of surgery that may have an impact on sexuality, such counselling ought to be a routine part of the care for a hysterectomy patient.