Journal of Psychosomatic Research
Volume 59, Issue 3 , Pages 117-129 , September 2005

Psychosocial effects of hysterectomy: Literature review

  • Nicole Flory

      Affiliations

    • Department of Psychology, McGill University, Montreal, Quebec, Canada
    • Corresponding Author InformationCorresponding author. 16 Gardner Street, Arlington, MA 02474, United States. Tel.: +1 781 316 8082; (Cell) +1 514 212 7733
  • ,
  • François Bissonnette

      Affiliations

    • Department of Obstetrics and Gynecology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
  • ,
  • Yitzchak M. Binik

      Affiliations

    • Department of Psychology, McGill University, Montreal, Quebec, Canada
    • Sex and Couple Therapy Service, Department of Psychology, McGill University Health Center (Royal Victoria Hospital), Montreal, Quebec, Canada

Received 26 July 2004 ,Accepted 18 May 2005.

References 

  1. Lepine LA, Hillis SD, Marchbanks PA, Koonin LM, Morrow B, Kieke BA, et al. Hysterectomy surveillance—United States, 1980–1993. MMWR Surveill Summ. 1997;46(4):1–15
  2. Ryan MM, Dennerstein L, Pepperell R. Aspects of hysterectomy. A prospective study. Br J Psychiatry. 1989;154:516–522
  3. Farrell SA, Kieser K. Sexuality after hysterectomy. Obstet Gynecol. 2000;95(6 Pt 2):1045–1051
  4. Torpy J, Lymn C, Glass RM. Hysterectomy. JAMA. 2004;291:1526
  5. Rannestad T, Eikeland OJ, Helland H, Qvarnstrom U. Are the physiologically and psychosocially based symptoms in women suffering from gynecological disorders alleviated by means of hysterectomy?. J Womens Health Gend Based Med. 2001;10(6):579–587
  6. Coulter A, McPherson K, Vessey M. Do British women undergo too many or too few hysterectomies?. Soc Sci Med. 1988;27(9):987–994
  7. Gutl P, Greimel ER, Roth R, Winter R. Women's sexual behavior, body image and satisfaction with surgical outcomes after hysterectomy: a comparison of vaginal and abdominal surgery. J Psychosom Obstet Gynaecol. 2002;23(1):51–59
  8. Broder MS, Kanouse DE, Mittman BS, Bernstein SJ. The appropriateness of recommendations for hysterectomy. Obstet Gynecol. 2000;95(2):199–205
  9. Bachmann GA. Hysterectomy. A critical review. J Reprod Med. 1990;35(9):839–862
  10. Wright RC. Hysterectomy—past present and future. Obstet Gynecol. 1969;33(4):560
  11. Ayoubi JM, Fanchin R, Monrozies X, Imbert P, Reme JM, Pons JC. Respective consequences of abdominal, vaginal, and laparoscopic hysterectomies on women's sexuality. Eur J Obstet Gynecol Reprod Biol. 2003;111(2):179–182
  12. Ellstrom MA, Astrom M, Moller A, Olsson JH, Hahlin MA. Randomized trial comparing changes in psychological well-being and sexuality after laparoscopic and abdominal hysterectomy. Acta Obstet Gynecol Scand. 2003;82:871–875
  13. Tulandi T, Levy B. So you're having a hysterectomy. Hoboken (NJ): Wiley; 2003;
  14. Roovers JP, van der Bom JG, van der Vaart CH, Heintz AP. Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. BMJ. 2003;327(7418):774–778
  15. Thakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. 2002;347(17):1318–1325
  16. Halttunen M. Female sexuality does not need a uterine cervix: no need for subtotal hysterectomy. Acta Obstet Gynecol Scand. 2004;83(2):119–120
  17. Hasson HM. Cervical removal at hysterectomy for benign disease. Risks and benefits. J Reprod Med. 1993;38(10):781–790
  18. Munro MG. Supracervical hysterectomy:…a time for reappraisal. Obstet Gynecol. 1997;89(1):133–139
  19. Saini J, Kuczynski E, Gretz HF, Sills ES. Supracervical hysterectomy versus total abdominal hysterectomy: perceived effects on sexual function. BMC Womens Health. 2002;2(1):1
  20. Sills ES, Saini J, Appelgate MS, Mcgee M, Gretz HF. Supracervical and total abdominal hysterectomy trends in New York State: 1990–1996. Bull N Y Acad Med. 1998;75(4):903–910
  21. Farquhar CM, Sadler L, Harvey S, McDougall J, Yazdi G, Meuli KA. Prospective study of the short-term outcomes of hysterectomy with and without oophorectomy. Aust N Z J Obstet Gynaecol. 2002;42(2):197–204
  22. Steege JF. Indications for hysterectomy: have they changed?. Clin Obstet Gynecol. 1997;40(4):878–885
  23. Katz A. Sexuality after hysterectomy: a review of the literature and discussion of nurses' role. J Adv Nurs. 2003;42(3):297–303
  24. Alexander DA, Naji AA, Pinion SB, Mollison J, Kitchener HC, Parkin DE, et al. Randomised trial comparing hysterectomy with endometrial ablation for dysfunctional uterine bleeding: psychiatric and psychosocial aspects. BMJ. 1996;312(7026):280–284
  25. Bernhard LA. Sexuality expectations and outcomes in women having hysterectomies. Chart. 1986;83(10):11
  26. Bernhard LA. Consequences of hysterectomy in the lives of women. Health Care Women Int. 1992;13(3):281–291
  27. Dennerstein L, Wood C, Burrows GD. Sexual response following hysterectomy and oophorectomy. Obstet Gynecol. 1977;49(1):92–96
  28. Marchant-Haycox S, Salmon P. Patients' and doctors' strategies in consultations with unexplained symptoms. Interactions of gynecologists with women presenting menstrual problems. Psychosomatics. 1997;38(5):440–450
  29. Meston CM. The effects of hysterectomy on sexual arousal in women with a history of benign uterine fibroids. Arch Sex Behav. 2004;33(1):31–42
  30. Meston CM, Bradford A. A brief review of the factors influencing sexuality after hysterectomy. Sex Rel Ther. 2004;19(1):5–14
  31. Wade J, Pletsch PK, Morgan SW, Menting SA. Hysterectomy: what do women need and want to know?. J Obstet Gynecol Neonatal Nurs. 2000;29(1):33–42
  32. Walcher W, Ralph G, Lahousen M, Scheer I, Tamussino K, Rollett H. Sexuality following radical operations. Zentralbl Gynakol. 1988;110(18):1109–1116
  33. Lalinec-Michaud M, Engelsmann F. Anxiety, fears and depression related to hysterectomy. Can J Psychiatry. 1985;30(1):44–47
  34. Kuppermann M, Varner RE, Summitt RL, Learman LA, Ireland C, Vittinghoff E, et al. Effect of hysterectomy vs. medical treatment on health-related quality of life and sexual functioning: the medicine or surgery (Ms) randomized trial. [See Comment] JAMA. 2004;291(12):1447–1455
  35. Yazbeck C. Sexual function following hysterectomy. Gynecol Obstet Fertil. 2004;32(1):49–54
  36. Zobbe V, Gimbel H, Andersen BM, Filtenborg T, Jakobsen K, Sorensen HC, et al. Sexuality after total vs. subtotal hysterectomy. Acta Obstet Gynecol Scand. 2004;83(2):191–196
  37. Clarke A, Black N, Rowe P, Mott S, Howle K. Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study. Br J Obstet Gynaecol. 1995;102(8):611–620
  38. Lambden MP, Bellamy G, Ogburn-Russell L, Preece CK, Moore S, Pepin T, et al. Women's sense of well-being before and after hysterectomy. J Obstet Gynecol Neonatal Nurs. 1997;26(5):540–548
  39. Rhodes JC, Kjerulff KH, Langenberg PW, Guzinski GM. Hysterectomy and sexual functioning. JAMA. 1999;282(20):1934–1941
  40. Gath D, Cooper P, Day A. Hysterectomy and psychiatric disorder: I. Levels of psychiatric morbidity before and after hysterectomy. Br J Psychiatry. 1982;140:335–342
  41. Aumeerally Z, Lilford RJ, Johnson NJ. The disappearing vagina syndrome. Eur J Obstet Gynecol Reprod Biol. 1996;69(2):141–142
  42. Fleming V. Hysterectomy: a case study of one woman's experience. J Adv Nurs. 2003;44(6):575–582
  43. Craig GA, Jackson P. Sexual life after vaginal hysterectomy. BMJ. 1975;3(5975):97
  44. Ewert B, Slangen T, van Herendael B. Sexuality after laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc. 1995;3(1):27–32
  45. Kjerulff KH, Rhodes JC, Langenberg PW, Harvey LA. Patient satisfaction with results of hysterectomy. Am J Obstet Gynecol. 2000;183(6):1440–1447
  46. Stovall TG, Ling FW, Crawford DA. Hysterectomy for chronic pelvic pain of presumed uterine etiology. Obstet Gynecol. 1990;75(4):676–679
  47. Carlson KJ, Miller BA, Fowler FJ. The Maine Women's Health Study: II. Outcomes of nonsurgical management of leiomyomas. Abnormal bleeding, and chronic pelvic pain. Obstet Gynecol. 1994;83(4):566–572
  48. Coppen A, Bishop M, Beard RJ, Barnard GJ, Collins WP. Hysterectomy, hormones, and behaviour. A prospective study. Lancet. 1981;1(8212):126–128
  49. Everson SA, Matthews KA, Guzick DS, Wing RR, Kuller LH. Effects of surgical menopause on psychological characteristics and lipid levels: the healthy women study. Health Psychol. 1995;14(5):435–443
  50. Gath D, Rose N, Bond A, Day A, Garrod A, Hodges S. Hysterectomy and psychiatric disorder: are the levels of psychiatric morbidity falling?. Psychol Med. 1995;25(2):277–283
  51. MacDonald SR, Klock SC, Milad MP. Long-term outcome of nonconservative surgery (hysterectomy) for endometriosis-associated pain in women <30 years old. Am J Obstet Gynecol. 1999;180(6 Pt 1):1360–1363
  52. Poad D, Arnold EP. Sexual function after pelvic surgery in women. Aust N Z J Obstet Gynaecol. 1994;34(4):471–474
  53. Martin RL, Roberts WV, Clayton PJ. Psychiatric status after hysterectomy. A one-year prospective follow-up. JAMA. 1980;244(4):350–353
  54. Ferroni P, Deeble J. Women's subjective experience of hysterectomy. Aust Health Rev. 1996;19(2):40–55
  55. Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review. Fertil Steril. 1987;47(1):94–100
  56. Kaiser R, Kusche M, Wurz H. Hormone levels in women after hysterectomy. Arch Gynecol Obstet. 1989;244(3):169–173
  57. Newton N, Baron E. Reactions to hysterectomy: fact or fiction?. Prim Care. 1976;3(4):781–801
  58. Oldenhave A, Jaszmann LJ, Everaerd WT, Haspels AA. Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age. Am J Obstet Gynecol. 1993;168(3 Pt 1):765–771
  59. Chakravarti S, Collins WP, Newton JR, Oram DH, Studd JW. Endocrine changes and symptomatology after oophorectomy in premenopausal women. Br J Obstet Gynaecol. 1977;84(10):769–775
  60. Richards DH. A post-hysterectomy syndrome. Lancet. 1974;2(7887):983–985
  61. Virtanen H, Makinen J, Tenho T, Kiilholma P, Pitkanen Y, Hirvonen T. Effects of abdominal hysterectomy on urinary and sexual symptoms. Br J Urol. 1993;72(6):868–872
  62. Bellerose SB, Binik YM. Body image and sexuality in oophorectomized women. Arch Sex Behav. 1993;22(5):435–459
  63. Sherwin BB, Gelfand MM, Brender W. Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause. Psychosom Med. 1985;47(4):339–351
  64. Sherwin BB, Gelfand MM. Sex steroids and affect in the surgical menopause: a double-blind, cross-over study. Psychoneuroendocrinology. 1985;10(3):325–335
  65. Galyer KT, Conaglen HM, Hare A, Conaglen JV. The effect of gynecological surgery on sexual desire. J Sex Marital Ther. 1999;25(2):81–88
  66. Cosson M, Rajabally R, Querleu D, Crepin G. Long term complications of vaginal hysterectomy: a case control study. Eur J Obstet Gynecol Reprod Biol. 2001;94(2):239–244
  67. Thakar R, Manyonda I, Stanton SL, Clarkson P, Robinson G. Bladder, bowel and sexual function after hysterectomy for benign conditions. Br J Obstet Gynaecol. 1997;104(9):983–987
  68. Cutler WB. Hysterectomy: before and after. New York: Harper & Row; 1988;
  69. Weber AM, Walters MD, Schover LR, Church JM, Piedmonte MR. Functional outcomes and satisfaction after abdominal hysterectomy. Prim Care Update Ob Gyns. 1998;5(4):203
  70. Masters WH, Johnson VE. Human sexual response. Boston: Little Brown; 1966;
  71. Sloan D. The emotional and psychosexual aspects of hysterectomy. Am J Obstet Gynecol. 1978;131(6):598–605
  72. Zussman L, Zussman S, Sunley R, Bjornson E. Sexual response after hysterectomy–oophorectomy: recent studies and reconsideration of psychogenesis. Am J Obstet Gynecol. 1981;140(7):725–729
  73. Whipple B, Gerdes CA, Komisaruk BR. Sexual response to self-stimulation in women with complete spinal cord injury. J Sex Res. 1996;33(3):231–240
  74. Kinsey A, Pomeroy W, Martin C, Gebhard P. Sexual behavior in the human female. Philadelphia: WB Saunders; 2004;
  75. Singer I. The goals of human sexuality. New York: WW Norton; 1973;
  76. Kilkku P. Supravaginal uterine amputation vs. hysterectomy. Effects on coital frequency and dyspareunia. Acta Obstet Gynecol Scand. 1983;62(2):141–145
  77. Kilkku P, Gronroos M, Hirvonen T, Rauramo L. Supravaginal uterine amputation vs. hysterectomy. Effects on libido and orgasm. Acta Obstet Gynecol Scand. 1983;62(2):147–152
  78. Kilkku P, Gronroos M, Rauramo L. Supravaginal uterine amputation with preoperative electrocoagulation of endocervical mucosa. Description of the method. Acta Obstet Gynecol Scand. 1985;64(2):175–177
  79. Grimes DA. Role of the cervix in sexual response: evidence for and against. Clin Obstet Gynecol. 1999;42(4):972–978
  80. Mah K, Binik YM. The nature of human orgasm: a critical review of major trends. Clin Psychol Rev. 2001;21(6):823–856
  81. Seidenschnur G, Beck H, Uplegger H, Werner H, Kolmorgen K. Attitude and sex behavior following hysterectomy. Zentralbl Gynakol. 1989;111(1):53–59
  82. Helstrom L, Lundberg PO, Sorbom D, Backstrom T. Sexuality after hysterectomy: a factor analysis of women's sexual lives before and after subtotal hysterectomy. Obstet Gynecol. 1993;81(3):357–362
  83. Mah K, Binik YM. Do all orgasms feel alike? Evaluating a two-dimensional model of the orgasm experience across gender and sexual context. J Sex Res. 2002;39(2):104–113
  84. Utian WH. Effect of hysterectomy, oophorectomy and estrogen therapy on libido. Int J Gynaecol Obstet. 1975;13(3):97–100
  85. Nathorst-Boos J, Fuchs T, von Schoultz B. Consumer's attitude to hysterectomy. The experience of 678 women. Acta Obstet Gynecol Scand. 1992;71(3):230–234
  86. Nathorst-Boos J, von Schoultz B. Psychological reactions and sexual life after hysterectomy with and without oophorectomy. Gynecol Obstet Invest. 1992;34(2):97–101
  87. Rozenman D, Janssen E. Sexual function after hysterectomy. JAMA. 2000;283(17):2238–2239
  88. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States—prevalence and predictors. JAMA. 1999;281(6):537–544
  89. Darling CA, McKoy-Smith YM. Understanding hysterectomies: sexual satisfaction and quality of life. J Sex Res. 1993;30(4):324–335
  90. Huffman JW. The effect of gynecologic surgery on sexual reactions. Am J Obstet Gynecol. 1950;59(5):915–917
  91. Naughton MJ, McBee WL. Health-related quality of life after hysterectomy. Clin Obstet Gynecol. 1997;40(4):947–957
  92. Kuppermann M, Varner RE, Summit RL, Learman LA, Ireland C, Vittinghoff E, et al. Effect of hysterectomy vs. medical treatment on health-related quality of life and sexual functioning. JAMA. 2004;291(12):1447
  93. Maas CP, ter Kulie MM. The effect of hysterectomy on sexual functioning. In:  Weijenborg PT editors. Annual review of sex research. vol. 14:2003;p. 83–113
  94. Amias AG. Sexual life after gynaecological operations: II. BMJ. 1975;2(5972):680–681
  95. Francis WJ, Jeffecoate TN. Dyspareunia following vaginal operations. J Obstet Gynaecol Br Commonw. 1961;68:1–10
  96. Jewett JG. Vaginal length and incidence of dyspareunia following total abdominal hysterectomy. J Obstet Gynaecol Br Commonw. 1952;63(2):400–407
  97. Masters WH, Johnson VE. Human sexual inadequacy. Boston: Little Brown and Company; 1970;
  98. Schofield MJ, Bennett A, Redman S, Walters WA, Sanson-Fisher RW. Self-reported long-term outcomes of hysterectomy. Br J Obstet Gynaecol. 1991;98(11):1129–1136
  99. Hillis SD, Marchbanks PA, Peterson HB. The effectiveness of hysterectomy for chronic pelvic pain. Obstet Gynecol. 1995;86(6):941–945
  100. Kjerulff KH, Langenberg PW, Rhodes JC, Harvey LA, Guzinski GM, Stolley PD. Effectiveness of hysterectomy. Obstet Gynecol. 2000;95(3):319–326
  101. Polivy J. Psychological reactions to hysterectomy: a critical review. Am J Obstet Gynecol. 1974;118(3):417–426
  102. Schanzer K. Psychosomatic aspects of hysterectomy. Gynakol Geburtshilfliche Rundsch. 1993;33(Suppl 1):16–18
  103. Bachmann GA. Psychosexual aspects of hysterectomy. Womens Health Issues. 1990;1(1):41–49
  104. Kaltreider NB, Wallace A, Horowitz MJ. A field study of the stress response syndrome. Young women after hysterectomy. JAMA. 1979;242(14):1499–1503
  105. Meikle S, Brody H, Pysh F. An investigation into the psychological effects of hysterectomy. J Nerv Ment Dis. 1977;164:36–41
  106. Carlson KJ, Miller BA, Fowler FJ. The Maine Women's Health Study: I. Outcomes of hysterectomy. Obstet Gynecol. 1994;83(4):556–565
  107. Andersen BL. Surviving cancer: the importance of sexual self-concept. Med Pediatr Oncol. 1999;33(1):15–23
  108. Osborn MF, Gath DH. Psychological and physical determinants of premenstrual symptoms before and after hysterectomy. Psychol Med. 1990;20(3):565–572
  109. Helstrom L. Sexuality after hysterectomy: a model based on quantitative and qualitative analysis of 104 women before and after subtotal hysterectomy. J Psychosom Obstet Gynaecol. 1994;15(4):219–229

 This research was supported by a Canadian Foundation for Women's Health grant to N. Flory and a Canadian Institute of Health Research grant to Y. M. Binik. This paper stands in partial fulfillment of N. Flory's PhD requirements and received the Student Research Award from the Society of Sex Therapy and Research in 2005.

PII: S0022-3999(05)00113-3

doi: 10.1016/j.jpsychores.2005.05.009

Journal of Psychosomatic Research
Volume 59, Issue 3 , Pages 117-129 , September 2005