Women who undergo hysterectomies are likely to experience dramatic improvements in their sex lives and should not fall victim to misconceptions suggesting the operation will damage sexual function, researchers reported yesterday.
In today's edition of the Journal of the American Medical Association, University of Maryland epidemiologists reported that women who had hysterectomies have intercourse more frequently, experience less pain and achieve more frequent and stronger orgasms than before surgery.
Those findings contradict some earlier medical studies and popular beliefs suggesting the operation can damage sexual function, the researchers said. The researchers questioned 1,132 Maryland women in person before the operation and then called them several times in the two years afterward.
Concerns about post-operative sexual problems are not baseless, but the women who suffer ill effects are far outnumbered by those who benefit, the report said.
"A lot of women worry that it will affect their sexual functioning, and in some sense that's logical because the uterus and the cervix are involved in sexual functioning," said researcher Kristen Kjerulff, an associate professor of epidemiology at the University of Maryland school of medicine. "Several other studies have found that it's the No. 1 worry women have about the operation."
But sexual activity among the survey respondents increased significantly, and the rate of those who complained of pain during intercourse fell from 27 percent before surgery to 4 percent two years later.
"Even if you're not impressed by the improvements we've observed, the data don't support the notion that hysterectomy impairs sexual function for a majority of women," said Julia C. Rhodes, the report's lead author.
Kjerulff said women who are in good health should not interpret the study as endorsing hysterectomy to improve sexual response in the absence of compelling medical reasons. "The women who were in this study had severe problems with bleeding and pelvic pain and so forth and had had these problems for years," she said.
Hysterectomy is a major abdominal surgery with a high price tag and a lengthy recuperation period. A surgeon removes the uterus, sometimes taking the ovaries and fallopian tubes as well. U.S. doctors perform about 600,000 hysterectomies a year, making it the most common major surgery for women other than cesarean section.
The most common reason for having the operation is the presence of fibroids, benign tumors in the uterus. Doctors also use hysterectomy to treat cancer, menstrual disorders and endometriosis, a condition in which tissue lining the uterus migrates to other parts of the body, causing pain, bleeding or infertility.
Surgery that eliminates those conditions and associated pain and bleeding improves a woman's sexual response and her attitude about even attempting to have sex, said Rhodes. Moreover, being freed from concerns about becoming pregnant would also help women relax.
Nancy D. Gaba, an assistant professor of obstetrics and gynecology at George Washington University, welcomed the Maryland research. "It's one of those situations where the opposite of what people think is true," Gaba said. "I'm glad women will be aware of that."
It's essential for a woman considering hysterectomy to discuss her unique sexual characteristics with her doctors beforehand because in some cases it could influence the type of surgery that is performed.
For example, some women who explain that their sexual response is directly related to the cervix can have modified hysterectomies that remove the uterus but not the cervix, Gaba said. The Maryland study should promote such conversations between doctors and patients, who frequently are too embarrassed to bring it up, she said.
Rhodes said all the women in the study had hysterectomies to resolve noncancerous conditions that caused bleeding, pain or discomfort. Most were 35 to 50 years old.
There is no reason to think that the Maryland women, who represent a racial, ethnic and economic cross-section of the state, would respond differently to hysterectomy from women across the nation, she said.