Psychosocial and emotional sequelae of hysterectomy

Abstract

Hysterectomy has long been reputed to be followed by a high incidence of psychological and sexual sequelae. Historically, the uterus was thought to have a profound influence on psychological health. Psychoanalytic viewpoints attributed sequelae of hysterectomy to the loss of reproductive capability and the damaged self-concept of femininity. Others have emphasized the crisis nature of hysterectomy and a phasic pattern of adjustment. Retrospective studies have shown an increased psychiatric-hospital admission rate, an increased incidence of psychiatric referral, an increased frequency of treatment with antidepressants, and deterioration in sexual relationships. Some authors did not find evidence of increased sequelae. Many methodological problems were encountered in the retrospective studies and the early prospective studies. In two recent prospective studies a high incidence of psychopathology was found in women prior to hysterectomy. These studies differed as to the type of diagnosis and the outcomes of women after hysterectomy, but in both of them psychological problems after hysterectomy tended to occur in women who had such problems before surgery. Further research is needed to validate the results of these studies and to determine whether the interventions of the prospective trials may in themselves have been therapeutic.