{"paper_id":"40a7a1ff-de2d-4806-90a8-0aa8373a9ea7","body_text":"ACTA CHIRURGICA LATVIENSIS • 2014 (14/1)\n26\nSUMMARY \nIntroduction. Many medical and conservative surgical treatment options are available but still hysterectomy remains the most \ncommon gynecological procedure performed worldwide. These procedures are performed because of actual and possible \nmalignant diseases, and benign conditions including pelvic pain, dyspareunia, uterine myomas, adenomyosis, endometriosis, and \nmenometrorrhagia. The impact of hysterectomy on sexual function has always been a great concern to women and is a major source \nof preoperative anxiety. Data regarding the impact of hysterectomy on women’s sexual functioning are not clear and consistent, \nmany women report improvement of sexual functioning after hysterectomy, which may be due to relief of symptoms, while others \ncomplain of sexual dysfunction as a result of hysterectomy. Also discussion about advantages of cervix sparing operations is still \ncontroversial.\nAim of the study. Aim was to assess and compare pre- and post-operative quality of sexual life of gynecological patients undergoing \nplanned hysterectomy, and to find out opinions of patients and their partners about expected impact of operation and changes after \nsurgery. \nMaterial and methods. Questionnaire method was used to survey gynecologic patients undergoing planned subtotal / total \nhysterectomy due to benign indication. Sexual Quality of Life Questionnaire – Female (SQoL-F) was used to assess quality of sexual \nlife before and after surgery. Questions about other influencing factors and patients’ opinions before and after operation were added. \n38 completed questionnaires were used for data analysis. \nResults. Only 55% of subtotal hysterectomy group and 38.9% of total hysterectomy group told their partners completely about \nplanned surgery. Mean period of beginning sexual activities after operation was 5.15 weeks after surgery in subtotal hysterecto my \nand 5.78 weeks in total hysterectomy group. SQoL-F after three months post-operation period was 6.50 points less in total \nhysterectomy group, which was not statistically significant. There was a slight statistically insignificant decrease of SQoL-F points \nwithin each group after three months observation period: -0.44 points in subtotal hysterectomy group and -2.47 points in total \nhysterectomy group. Although patients of total hysterectomy more frequently (22.2% vs. 5%) indicated negative impact on sexual \nfunction after operation, differences were not statistically significant. There were no differences in co-morbidities, concomit ant \nmedications, hormone use history and post-operative complications between groups.\nConclusions. Patients before hysterectomy are worried about possible negative impact of surgery on their sexual function, they do \nnot talk to their partners candidly about planned surgery. There were no statistically significant changes of sexual quality of life found \nafter subtotal and total abdominal hysterectomy operation after three months observation period.\nKey words: sexuality, female sexual function, hysterectomy, sexual quality of life, gynecological surgery\nORIGINAL ARTICLE\nQuality of Female Sexual Function after Conventional \nAbdominal Hysterectomy – Three Months’ Observation\nIeva Briedite*,**, Gunta Ancane***, Irena Rogovska****, Nellija Lietuviete*,**\n*Riga East Clinical University Hospital ‘Gailezers’, Gynecology Clinic, Latvia\n**Riga Stradins University, Department of Obstetrics and Gynecology, Latvia\n***Riga Stradins University, Department and Clinic of Psychosomatic Medicine and Psychotherapy, Latvia\n****Riga Stradins University, Division of Doctoral Studies, Latvia\nto the bladder and nearby nerves, and may even allow \na woman to enjoy a better long-term sex life, while \nothers state that if a growth develops, removing the \ncervix alone carries higher risk (19). Subtotal abdominal \nhysterectomy is easier to perform, with less risk of \nureteric damage, but requires that women have regular \ncervical smears, and may result in cyclical bleeding in a \nsmall proportion of women (11). Hysterectomy involves \nseveral surgical approaches - traditional abdominal \nlaparotomy, vaginal or laparoscopic hysterectomy \n(7). Type of hysterectomy performed depends on \nthe disorder to be treated, the size of the uterus and \nthe skills and preference of the surgeon (4). Use of \nlaparoscopic hysterectomy has become more frequent \n(6). Quality of life measures after surgery did not appear \nINTRODUCTION\nHysterectomy is one of the commonest major gyneco-\nlogical operations (8). Most commonly it is performed \nin women of reproductive age (21). 40% of women \nall over the world will have hysterectomy by the age \nof 64 and indication for the majority will be to relieve \nsymptoms and improve quality of life (10). More than \nhalf of all hysterectomies are carried out because of \nabnormal uterine bleeding, which is associated with a \nwide range of diagnoses that include uterine fibroids, \nendometriosis, adenomyosis, and dysfunctional uterine \nbleeding (4). The types of hysterectomy include total \n(removal of cervix) and subtotal (supracervical removal \nof the uterus), with or without unilateral or bilateral \noophorectomy (13). Some authors argues that leaving \nthe cervix untouched reduces the risk of surgical damage \n10.2478/chilat-2014-0105\n\nACTA CHIRURGICA LATVIENSIS • 2014 (14/1)\n27\nto vary according to type of hysterectomy, whether an \nabdominal or laparoscopic approach was used (16).\nAlthough hysterectomy is usually done to improve \npatient’s quality of life yet it has its own morbidity and \nmortality (1). When women face the decision of whether \nto have a hysterectomy, they should be provided with \ninformation relating indications for surgery, surgical \nprocedure, recovery, and sequel by their physicians \n(9). Hysterectomy related psychological morbidity \ntypically includes depression, anxiety, and stress-related \nsymptoms, it could be triggered by negative perceptions \nabout body image, femininity, youth, energy and \nactivity levels, as well as loss of child-bearing capacity. \nPhysical co-morbidity typically includes increased risk of \ndeveloping pelvic floor prolapse, urinary incontinence \nand sexual dysfunction (7). The data regarding the impact \nof hysterectomy on women’s sexual functioning are not \nclear and consistent, and many practitioners are not \nwell-informed about the possible sexual consequences \nof hysterectomies. (17). Women who are candidates for \nhysterectomy are always concerned about the potential \nnegative effect on their sexual function and the possible \nnegative effect on their relations with their partner’s. \n(9). Female sexual dysfunction (FSD) is defined as a \ndisorder of sexual desire, arousal, orgasm or sexual pain \nthat results in significant personal distress (12). Sexual \ndifficulties are very frequent among women and involve \n20%–50% of the female population worldwide (5). \nFactors such as age, menopause, previous pathological \nconditions and gynecological surgery may adversely \naffect sexual response (18). The most common \nindependent clinical predictor of recent and lifelong FSD \ndiagnosis was relationship dissatisfaction (2). Despite \nthe importance of sexuality in women’s lives, physicians \nask about it reluctantly. (3). Women still remain to have \npoor understanding of the physiology of the genital tract \n(14). Reproductive, menstrual, and sexual functions of \nthe uterus must be considered. Direct sexual function \ninvolves uterine contractions during orgasm, while \nindirect functions include: feeling less feminine after \nhysterectomy, concern about sexual difficulties, or \nchanges in the attitude of her partner (9). Gynecological \nsurgery may influence the sexuality in terms of self-\nimage, sexual pain and orgasm difficulty (18). The \nprevailing view in the literature is that hysterectomy \nimproves the overall quality of life, however, at least \nsome deleterious effects of hysterectomy were reported \nin almost all of the articles (13). The expected changes \ncan affect both partners, which is considered as a \nfundamental issue in the relationship (9). The primary \nmedical conditions causing FSD can be hormonal, \nanatomical, vascular and neural (12). The uterus and \ncervix may be important factors in the physiology of \nsensation and orgasm, which is effected by sensory \nstimuli from contractions of the uterus, cervix, and \nvagina. Hysterectomy may have a negative influence \non this feedback system in the brain (15). Changes \ndepend not only on which nerves were severed by the \nsurgery, but also the genital regions whose stimulation \nthe woman enjoys for eliciting sexual response. Because \nclitoral sensation (via pudendal and genitofemoral \nnerves) should not be affected by hysterectomy (13). \nSexuality of women is conditioned by many cultural, \nreligious, physical, affective, emotional, marital and \nsocioeconomic factors. Sexuality is a dynamic process \nwith a high degree of subjectivity and overlapping that \nimposes difficulties when it comes to assessing each \nfactor involved in the sexual response (18). Long-term \ncontrolled studies need to be conducted to properly \ndetermine the psychological effects of hysterectomy (7). \nHowever, the decision remains up to the women and \nshould be driven by their health needs (9).\nAIM OF THE STUDY\nAim of this study was to assess pre-operative quality of \nsexual life of gynecological patients undergoing planned \ntotal and subtotal hysterectomy without oophorectomy, \nto compare it with post-operative quality of sexual life \nafter three months within the groups and between \ngroups of total and subtotal hysterectomy, and to find \nout patients’ and their partners’ opinions about expected \nimpact of operation and actual changes after surgery. \nMATERIAL AND METHODS\nStudy population was selected to analyze impact only \nof total and subtotal hysterectomy, excluding potential \nnegative effects of hormone loss after oophorectomy. \nStudy group consisted of gynecological patients from \nGynecology Department of Riga East Clinical University \nHospital ‘Gailezers’ undergoing planned hysterectomy \ndue to benign indications. Inclusion criteria were: age \n18-50 years, patients who were sexually active and \nplanned sexual activities within at least six months after \nsurgery, patients who voluntary agreed to participate in \nstudy and were able to fill the questionnaire. Exclusion \ncriteria were: age under 18 years, age above 50 years, \npatients who were no sure about sexual activity after \noperation, patients who did not agree to participate \nin study, patients who had different surgery extent \nduring operation – had unplanned unilateral or \nbilateral oophorectomy, patients who did not proceed \nwith sexual activity within observation period after \noperation. Study was performed in time period from \nAugust 2013 till February 2014. Participation in study \nwas offered to all patients of appropriate age and \nplanned operation until 50 patients were recruited \nand signed agreement form. 25 patients were planned \nin each study group – subtotal and total hysterectomy. \nQuestionnaire method was used to survey patients on \nthe day before operation. Standardized and validated \nSexual Quality of Life Questionnaire – Female (SQoL-F) \n(20) was used to assess quality of sexual life before and \nafter surgery. The 18-item SQoL-F was developed to \nassess the sexual quality of life of women, specifically \nto assess sexual confidence, emotional well-being and \nrelationship issues. The instrument has been validated \nfor use in broad range of women, it is self-administered \nin approximately 7 minutes, recall period is the previous \nfour weeks, each item is rated on a 5-point Likert scale, \ndesigned for use among women who are 18+ in age. \n\nACTA CHIRURGICA LATVIENSIS • 2014 (14/1)\n28\nSQoL-F does not provide cut-scores of sexual function \nlevels, result can be analyzed as primary endpoint. Nine \nquestions were added to find out age, co-morbidities, \nconcomitant medications, history of hormone \n(estrogen / progestin) use in period of last six month \nbefore operation, opinion about expected impact of \noperation, awareness and women’s view about opinion \nof their partners (partners were not asked separately), \nemotional well-being with partner, self-assessment \nof seven domains of sexual function (desire, arousal, \nlubrication, orgasm, satisfaction, pain, partner). Each \nquestionnaire got a code and no private data were used. \nPrior to participation, patients were not screened to rule \nout any particular medical conditions as an indication \nfor operation because of the extensive overlap of \ngynecological indications for each patient. Patients were \ndivided in two groups: subtotal hysterectomy (Group1) \nand total hysterectomy (Group2). Initially there were \n50 patients - 25 patients in each group. There were five \npatients excluded from the Group1: one patient refused \nto continue participation during observation period, \none patient divorced from partner after operation, \nthree patients had unplanned oophorectomy during \noperation, one patient had changed partner after \noperation. There were seven patients excluded from the \nGroup2: one patient refused to continue participation \nafter reading the questionnaire, five patients had \nunplanned oophorectomy during operation, one patient \ndid not proceed with sexual activities within three \nmonths because of suture complications (gynecologist \nrecommendation). In total 38 (20 in Group1 and 18 in \nGroup2) fully and correctly completed questionnaires \nwere used for data analysis. Study was approved by \nthe Ethics Committee of Riga Stradins University. \nSQoL-F calculation was performed in compliance with \nstandardized scoring system. Distribution of variables \nwithin and between groups was assessed using rxc \nor 2x2 frequency tables. Statistical significance of \ndifferences was tested by Pearson chi2 test or Fisher’s \nexact test. SQoL-F mean scores and standardized \nparameters before surgery and 3 months after surgery \nwere calculated for both groups. Statistical significance \nof differences between groups and between different \ntime points within one group was tested by means of \npaired t test, two sample t test and by means of Mann-\nWhitney test. P value less than 0.05 was chosen as a \nlevel of statistical significance.\nRESULTS\nMinimal age of patients was 32 years, maximal age \nwas 50 years. Mean age of Group1 (n=20) was 45.2 ± \n2.92 years, mean age of Group2 (n=18) was 44.5 ± 4.78 \nyears. There were 35% (n=7) patients in Group1 and \n22.2% (n=4) patients in Group2 who had hormone \nusing history in last six months before operation, \ndifferences were not statistically significant (p=0.07). \nThere were 45% (n=9) patients in Group1 and 38.9% \n(n=7) patients in Group2 having other co-morbidity \nexcept gynecological condition. There were 50% \n(n=10) patients in Group1 and 27.8% (n=5) patients \nin Group2 using concomitant medications at the time \nof operation. Differences between the groups were not \nstatistically significant. Standardized SQoL-F points (to \na 0-100 scale) before surgery were 71.61 in Group1 \nand 68.03 in Group2. Analysis of subjective satisfaction \nin main domains of sexual function before operation \nshowed comparatively lower rates of satisfaction in \ndomain of pain – 35% (n=7) in Group1 and 27.8% \n(n=5) in Group2, but differences were not statistically \nsignificant (see Figure 1). Patients’ expectations about \nimpact of planned operation on their sexuality are \ndescribed in Table 1. Although patients of Group2 \nwere worried about possible negative impact more \nfrequently, differences were not statistically significant \n(p=0.12). Only 55% (n=11) of Group1and 38.9% \n(n=7) of Group2 told their partners completely about \nplanned surgery, 30% (n=6) of Group1and 50% (n=9) \nof Group2 told their partners partly about planned \nsurgery, but 15% (n=3) of Group1and 11.1% (n=2) of \nGroup2 did not tell their partners at all about planned \nsurgery. 30% (n=6) of partners of Group1patients and \n38.9% (n=7) of partners of Group2 patients thought \nthat nothing will change about woman’s sexuality after \noperation, 15% (n=3) of partners of Group1patients and \n5.6% (n=1) of partners of Group2 patients thought that \nwoman’s sexual function will improve after operation, \nno one of partners of Group1patients and 11.1% (n=2) \nof partners of Group2 patients thought that woman’s \nsexual function will decline after operation, 55% \n(n=11) patients of Group1and 44.4% (n=8) patients \nof Group2 could not answer about their partner’s \nopinion concerning expected impact of operation on \ntheir sexual function. Mean period of beginning sexual \nactivities after operation was 5.15 weeks after surgery \nin Group1 and 5.78 weeks in Group2, all patients \nfrom both groups proceeded with sexual activities \nafter operation. Patients from Group1 proceeded with \nsexual activities more often after 6 weeks (35%, n=7), \npatients from Group2 proceeded with sexual activities \nmore often after 4 weeks (27.8%, n=5) and 8 weeks \n(27.8%, n=5). Differences were statistically significant \n(p=0.03). Five patients from Group1 (25%) proceeded \nwith sexual activities 2 weeks after surgery, which \nis before recommended post-operative abstinence \nperiod (4 weeks). There were no statistically significant \ndifferences in postoperative complications in Group1 \n(10%, n=2) and Group2 (16.7%, n=3). No one of the \nstudy group patients had any new co-morbidity during \nthree month period after operation. There was a slight \nstatistically insignificant decrease of SQoL-F points \nwithin each group after three months observation \nperiod: -0.44 points in Group1 (p=0.92) and -2.47 points \nin Group2 (p=0.67). Comparing mean standardized \nSQoL-F points between groups after three months post-\noperation period, there was a difference 6.50 points less \nin Group2, which is not statistically significant (p=0.43). \n65% (n=13) patients of Group1and 55.6% (n=10) of \nGroup2 three months after surgery confirmed that they \nfeel emotionally comfortable with their partners, 5% \n(n=1) of Group1and 5.6% (n=1) of Group2 did not feel \n\nACTA CHIRURGICA LATVIENSIS • 2014 (14/1)\n29\nemotionally comfortable, but it was difficult to answer \nfor 30% (n=6) of Group1and 38.9% (n=7) of Group2. \nSubjective reported changes of the main domains of \nsexual function in both groups are depicted on Figure 2 \nand Figure 3. Worsening of sexual function seems to be \nmore frequent in Group2, however differences are not \nstatistically significant. Patients’ self-assessment about \nimpact of hysterectomy operation on their sexuality \nis described in Table 2. Although patients of Group2 \nmore frequently indicated negative impact, differences \nwere not statistically significant (p=0.30). 55% (n=11) \nof partners of Group1patients and 38.9% (n=7) of \npartners of Group2 patients thought that nothing has \nchanged about their partner’s sexuality after operation, \n20% (n=4) of partners of Group1 patients and 27.8% \n(n=5) of partners of Group2 patients thought that their \npartner’s sexual function has improved after operation, \n10% (n=2) of partners of Group1 patients and 27.8% \n(n=5) of partners of Group2 patients thought that their \npartner’s sexual function has declined after operation, \n15% (n=3) of Group1 patients and 5.6% (n=1) of \nGroup2 patients could not answer about their partner’s \nopinion concerning impact of operation on their sexual \nfunction. Although partners of patients of Group2 more \nfrequently indicated negative impact, differences were \nnot statistically significant (p=0.40).\nDISCUSSION\nData from this study prove that sexual health and future \nsexual function is important issue for gynecological \npatients. Usually people undergoing surgical procedures \nanticipate emotional support from their family. \nThis study demonstrates that in case of planned \nhysterectomy there are many patients who did not tell \ntheir partners about operation at all (13.16%) or told \nonly partly (39.47%). If the partners are not aware of \nplanned surgery and possible difficulties, patients lose \nopportunity of wholesome support. Although previous \nstudy data support viewpoint that most probably women \nwill neither lose their sexual desire after hysterectomy, \nnor they will lose their feminine shape or style (9), \nsexuality after hysterectomy is still cause of great \nanxiety of patients and continuous ambiguity for health \ncare providers. Women require more information and \nevidence based data about possible impact of operation \nto be fully informed about all aspects before consent of \nscheduled surgery. \nThis study did not prove statistically significant changes \nof quality of sexual life after operation not within each \nstudy group, nor between two groups of different surgical \nextent – subtotal and total hysterectomy, which can be \nexplained with relatively small initial number of recruited \npatients and loss of 12 excluded patients in the study \nprocess, however in some positions there was tendency \nof more frequent expected negative effects and reported \nnegative changes among patients of total hysterectomy \ngroup. Analyzing each questionnaire separately, there \nwere examples of marked worsening and examples of \nmarked improvement of sexual function in both study \ngroups. It seems that hysterectomy itself and its surgical \ntechnique are major but not the only essential factors \nfrom summary impact on sexual function after surgery. \nData showed the same level of emotional partnership \nwell-being before and after operation (women’s view). \nIn this study there were no further post-operation \ninterviews and relationship analysis performed about \nfuture partnership attitudes and relationship changes in \ncase of telling and not telling partner about operation. \nThere was one patient in subtotal hysterectomy group \nwho divorced from her partner in three months period \nafter operation. Her questionnaire data showed that \nshe did not tell her partner about planned operation, in \nthis case it was impossible to analyze potential reasons \nfor divorce without deeper interview of both partners. \nAsking woman about their partner’s opinions regarding \nplanned operation and post-operative changes brings \nsome risk of misinformation, because partners can \nhave different opinions if asked directly, but according \nto the protocol, partners were not directly involved in \nthe study. Also telling partner incomplete information \nabout planned operation can change his opinion about \nexpected impact of surgery.\nSince there were no statistically significant differences \nin co-morbidities, concomitant medications, hormone \nuse history and post-operative complications between \ngroups, authors consider both study groups comparable. \nWide interpretation of study results and generalization \nto all population of gynecological patients is restricted by \nrelatively small study group, but it gives an opportunity \nto see and analyze tendencies and actualize the problem. \nDisadvantage of questionnaire method is a subjective \nconception of questions, remembrance failures, as well \nas impossible verification or particularization of answers. \nWomen should be provided with as much information \nas possible and invited to participate in the decision \nmaking about the type of hysterectomy. Such \nempowerment may well improve satisfaction rates after \nsurgery (11). Continuous research is necessary to obtain \nmore information about many possible factors that may \nhave an impact on sexual function after hysterectomy. \nAll patients from this study group are continuing \nparticipation in study for further observation period \nto assess quality of sexual life after six months post-\noperation period. \nCONCLUSIONS\nGynecological patients before scheduled hysterectomy \nare worried about possible negative impact of surgery \non their sexual function. Many patients do not tell their \npartners about operation or tell only partly, thereby \ndepriving themselves full emotional support from \npartner. There is no statistically significant impact of \nhysterectomy on sexual quality of life. There are no \nstatistically significant differences in sexual quality of \nlife between total and subtotal hysterectomy.\nConflict of interest: None\n\nACTA CHIRURGICA LATVIENSIS • 2014 (14/1)\n30\nREFERENCES\n1. Amin A, Ali A, Amin Z, Sani FN. Justification for \nhysterectomies and frequency of histopathological \nlesions of hysterectomy at a Teaching Hospital \nin Peshawar, Pakistan // Pak J Med Sci, 2013; \n29(1):170-172 \n2. Burri A, Spector T. Recent and Lifelong Sexual \nDysfunction in a Female UK Population Sample: \nPrevalence and Risk Factors // J Sex Med, 2011; \n8:2420-2430 \n3. Buster JE. Managing female sexual dysfunction // \nFertil Steril, 2013; 100(4): 905-915 \n4. Butt JL, Jeffery ST, Van der Spuy ZM. An audit \nof indications and complications associated with \nelective hysterectomy at a public service hospital \nin South Africa // Int J Gynaecol Obstet, 2012; \n116:112-116 \n5. Cabral PUL, Canario ACG, Spyrides MHC, Uchoa \nSAC, Eleuterio Jr.J, Goncalves AK. Determinants of \nsexual dysfunction among middle-aged women // \nInt J Gynaecol Obstet, 2013; 120:271-274 \n6. Chalermchockchareonkit A, Tekasakul P, \nChaisilwattana P, Sirimai K, Wahab N. Laparoscopic \nhysterectomy versus abdominal hysterectomy \nfor severe pelvic endometriosis // Int J Gynaecol \nObstet, 2012; 116:109-111 \n7. Darwish M, Atlantis E, Mohmed-Taysir T. \nPsychological outcomes after hysterectomy for \nbenign conditions: a systematic review and meta-\nanalysis // Eur J Obstet Gynaecol Reprod Biol, \n2014; 174:5-19 \n8. Davies A, Hart R, Magos A, Hadad E, Morris R. \nHysterectomy: surgical route and complications // \nEur J Obstet Gynaecol Reprod Biol, 2002; 104:148-\n151 \n9. Fram KM, Saleh SS, Sumrein IA. Sexuality after \nhysterectomy at University of Jordan Hospital: \na teaching hospital experience // Arch Gynecol \nObstet, 2013; 287:703-708 \n10. Gupta S, Manyonda I. Hysterectomy for benign \ngynaecological disease // Elsevier review Obstetrics, \nGynaecology and Reproductive Medicine, 2014; \n24(5):135-140 \n11. Gupta S, Manyonda I. Total and subtotal abdominal \nhysterectomy for benign gynaecological disease // \nElsevier review Obstetrics, Gynaecology and \nReproductive Medicine, 2010; 21(2):36-40 \n12. Jha S, Thakar R. Female sexual dysfunction // Eur J \nObstet Gynaecol Reprod Biol, 2010; 153:117-123 \n13. Komisurak BR, Frangos E, Whiple B. Hysterectomy \nImproves Sexual Response? Addressing a Crucial \nOmission in the Literature // J Minim Invasive \nGynecol, 2011; 18(3):288-295 \n14. Lekovic J, Pangasa M, Reiss J, Chan M, Prasad \nL, Taubel DA. Does prior hysterectomy improve \npatients’ understanding of the anatomy and \nphysiology of female reproductive organs? – A \nsurvey // ASRM Abstracts, 2013; 100(3):S406 \n15. Lermann J, Haberle L, Merk S, Henglein K, \nBeckmann MW, Mueller A, Mehlhorn G. \nComparison of prevalence of hypoactive sexual \ndesire disorder (HSDD) in women after five \ndifferent hysterectomy procedures // Eur J Obstet \nGynaecol Reprod Biol, 2013; 167:210-214 \n16. Lethaby A, Mukhopadhyay A, Naik R. Total versus \nsubtotal hysterectomy for benign gynaecological \nconditions (Review) // The Cochrane Library, 2012; \n4:1-73 \n17. Peterson ZD, Rothenberg JM, Bilbrey S, Heiman \nJR. Sexual Functioning Following Elective \nHysterectomy: The Roleof Surgical and Psychosocial \nVariables // J Sex Res, 2010; 47(6):513-527 \n18. Rodriguez MC, Chedraui P, Schwager G, Hidalgo \nL, Perez-Lopez FR. Assessment of sexuality after \nhysterectomy using the Female Sexual Function \nIndex // J Obstet Gynaecol, 2012; 32:180-184 \n19. Sutton C. Past, Present, and Future of Hysterectomy // \nJ Minim Invasive Gynecol, 2010; 17(4):421-435 \n20. Symonds T, Boolell M, Quirk F. Development of a \nquestionnaire on sexual quality of life in women // \nJ Sex Marital Ther, 2005;31(5):385-397 \n21. Turner LC, Shepherd JP, Wang L, Bunker CH, \nLowder JL. Hysterectomy surgical trends: a more \naccurate depiction of the last decade? // Am J \nObstet Gynecol, 2013; 208:277.e1-7 \nAddress: \nIeva Briedite, \nRiga East Clinical University Hospital ‘Gailezers’,\nGynecology Clinic, Hipokrata street 2, \nRiga, LV-1038, \nE-mail: dr.briedite@gmail.com\n\nACTA CHIRURGICA LATVIENSIS • 2014 (14/1)\n31\n60.00\n75.00\n70.00 70.00\n60.00\n35.00\n80.00\n50.00\n55.56\n61.11\n66.67 66.67\n27.78\n77.78\n0\n10\n20\n30\n40\n50\n60\n70\n80\n90\nDesire Arousal Lubrica/g415on Orgasm Sa/g415sfac/g415on Pain Partner\nGroup1\nGroup2\n \n0% 20% 40% 60% 80% 100%\nDesire\nArous al\nLubrica/g415on\nOrgasm\nSa/g415sfac/g415on\nPain\nPartner\nBe/g425er\nNo changes\nWorse\n0% 20% 40% 60% 80% 100%\nDesire\nArous al\nLubrica/g415on\nOrgasm\nSa/g415sfac/g415on\nPain\nPartner\nBe/g425er\nNo changes\nWorse\nFig. 1. Satisfaction rates of main domains of sexual \nfunction before operation (%)\nFig. 2.Changes of main domains of sexual function \nafter operation in Group1 (%)\nFig. 3. Changes of main domains of sexual function \nafter operation in Group2 (%)\nTable 1. Patients’ expectations about impact of \nplanned operation on their sexuality\nExpected impact Group1\nn / total (%)\nGroup2\nn / total (%)\nImprove 4/20 (20) 1/18 (5.6)\nDecline 1/20 (5) 6/18 (33.3)\nNothing will change 8/20 (40) 7/18 (38.9)\nDo not know 7/20 (35) 4/18 (22.2)\nTable 2. Patients’ self-assessment about impact of \nhysterectomy operation on their sexuality\nReported impact Group1\nn / total (%)\nGroup2\nn / total (%)\nImproved 7/20 (35) 5/18 (27.8)\nDeclined 1/20 (5) 4/18 (22.2)\nNothing has changed 10/20 (50) 9/18 (50)\nDo not know 2/20 (10) 0/18 (0)","source_license":"CC0","license_restricted":false}