{"paper_id":"87fa5f5b-14cc-41f1-8a14-fe5b86c40702","body_text":"SHS Web of Conferences 51, 02009 (2018) https://doi.org/10.1051/shsconf/20185102009\nInt. Conf. SOCIETY. HEALTH. WELF ARE. 2016\nSubjective perceptions of life among women\nafter hysterectomy\nLubica Banovcinova∗ and Sona Jandurova\nComenius University in Bratislava, Slovakia\nAbstract. Hysterectomy is the most commonly performed gynaecological\nsurgery, which can influence woman´s life in sexual, psychological,\nhormonal and social sphere. The aim of this study was to examine the\nsubjective perceptions of life among women after hysterectomy (positive\nand negative effects of surgery, sources of social support, satisfaction\nwith support, satisfaction with life and health). 70 women who underwent\nhysterectomy (mean age was 47.66 ± 9.47 y.; 29–72) were assigned\nfor this study. The Multidimensional scale of perceived social support\n(MSPSS) and additional questions were used to gain information on social\nsupport, positive and negative effects of surgery, satisfaction with support,\nsatisfaction with life and health. The majority (68.6%) of respondents prefer\nhusband or partner as a source of support and were subjectively satisfied with\nthis support (81.4%). 20% sought support outside family and friends network\nand priest, psychologist and support groups were their preferred supporters.\nThe most cited positive aspects of hysterectomy were the disappearance of\nsymptoms and reduced fear of uterine cancer. Most women did not see any\nnegative consequences of surgery (45.7%) and were subjectively satisfied\nwith their life (90%). Since the social support is one of the important\nfactors affecting women’s life, healthcare professionals should also focus\non building and strengthening patient’s support network when working with\nthese groups of women.\nKey words: hysterectomy, gynaecological surgery, negative effects,\nsubjective perceptions of life.\n1 Introduction\nQuality of life is an important outcome variable in clinical research as medical interventions\ncan affect it in both positive and negative ways [ 1]. Health-related QoL is a multidimensional\nconcept, which encompasses physical, emotional and social aspects associated with a given\ndisease or its treatment [ 2]. Hysterectomy is the most commonly performed gynaecological\nsurgery, which results in sterility, absence of menstruation and consequences in sexual,\npsychological, hormonal and social sphere.\nMany women receive hysterectomy due to nonmalignant symptoms such as menstrual\npain, menorrhagia, unexplained uterine bleeding and chronic pelvic pain, which have\nan adverse effect on a woman’s quality of life. Most women reported a reduction in\nphysical symptoms and pain and an increase in health perceptions and quality of life after\nhysterectomy [2].\n∗ Corresponding author: banovcinova@jfmed.uniba.sk\nC⃝ The Authors, published by EDP Sciences. This is an Open Access article distributed under the terms of the\nCreative Commons Attribution License 4.0 (http://creativecommons.org/licenses/by/4.0/).\n\nSHS Web of Conferences 51, 02009 (2018) https://doi.org/10.1051/shsconf/20185102009\nInt. Conf. SOCIETY. HEALTH. WELF ARE. 2016\nOther positive outcomes relate to the cessation of abnormal uterine bleeding and\nrelief from monthly menstrual symptoms, pelvic pain caused by endometriosis, pressure\nsymptoms associated with fibroids, urinary incontinence, sexual function, and depression and\nanxiety [ 3]. In symptomatic women with menstrual or related disorders where conservative\ntreatment has failed, total or subtotal hysterectomy may improve quality of life and reduce\npsychiatric symptoms, with both procedures having an equally beneficial effect [ 1, 4].\nHowever, hysterectomy may also result in the development of new problems such as\npelvic/ abdominal pain, urinary problems, constipation, weight gain, fatigue, lack of interest\nor enjoyment in sex, depression, anxiety and negative feelings about oneself as a woman\n[2]. Concerns also include loss of childbearing capacity, change in self-image, social and\ndomestic disruptions, long recovery times, and wound pain up to a year after surgery [ 3].\nIt represents very stressful event, as it involves the loss of body parts associated with\nwomanhood and femininity, causing significant changes in women’s bodies [5, 6]. Femininity\nhas been proposed as a positively valued quality, thus, the perception of losing one’s\nfemininity is a serious and threatening event in a woman’s life [ 2]. Hysterectomy leave\nwomen burdened by infertility, negative body image, and feeling flawed as a woman and\nsexually undesirable. Unfortunately, these concerns are rarely voiced and addressed, as\npatients often feel uncomfortable and embarrassed [ 7].\nAshing-Giwa et al. [ 7] describes a hysterectomy-related stigma on womanhood as well\nas single women’s difficulty in dating. Concerns about loss of fertility [ 8], femininity and\nrelated psychological problems are common also among women treated for gynaecological\ncancer. Numerous factors may contribute to the surrounding emotional turmoil as women\nare required to make treatment choices for survival that negatively impact on fertility and\nchildbearing decisions [ 8]. Factors that have been identified to increase the risk of post-\noperative psychological problems include young age at time of surgery, lower socioeconomic\nstatus, educational level, poor social support and pessimism, etc. Research suggests that\nage may be particularly relevant in psychological distress after hysterectomy, showing that\nyounger women (under 50 years old) tend to have better physical functioning than older\nwomen but worse emotional wellbeing and quality of life [ 5]. Cooper et al. [ 8] suggest that\nwomen who undergo hysterectomy at a young age are a defined group who may require more\nsupport than other women to maintain good psychological health in middle age. On the other\nhand, social support and emotional wellbeing are often affected by debilitating symptoms as\nwell as hysterectomy [ 9].\nThe purposes of this study were as follows: 1) to investigate the subjective perceptions of\nlife among women after hysterectomy (positive and negative effects of surgery, satisfaction\nwith life and health); 2) to explore women’s sources of social support and their satisfaction\nwith support; 3) to investigate whether perceived social support influences women’s health\noutcomes.\n2 Methods\nSeventy women who underwent hysterectomy, between the ages of 29 and 72 were assigned\nfor this study. Women underwent surgery for a variety of reasons, including myoma,\nendometriosis, cancer, menorrhagia/dysfunctional uterine bleeding, urinary incontinence,\ncomplications during labour, and chronic pelvic pain syndromes. The questionnaire was filled\nout only by women having hysterectomy regardless of length of time elapsed since surgery,\nindication and age. Respondents were between the ages of 29 and 72. The average age of the\nrespondents was 47.66 and the mean age at the time of surgery was 43.31.\nThe selection of the participants was intentional: the operative procedure – hysterectomy –\nwas the basic criterion for inclusion in the research sample.\n2\n\nSHS Web of Conferences 51, 02009 (2018) https://doi.org/10.1051/shsconf/20185102009\nInt. Conf. SOCIETY. HEALTH. WELF ARE. 2016\nIn data collection, we employed two questionnaires supplemented by additional\nquestions.\nShort Form 36 Health Subject Questionnaire (SF 36) is a frequently used tool for\nassessing the quality of life in various medical branches because of its good reporting\nvalue. It evaluates 8 basic dimensions that affect the quality of life. In addition, question\n1 can be converted into “self-rated health” and question 2 into “changes in health” scores.\nSF-36 consists of eight subscales: bodily pain, physical functioning, physical role limitations,\ngeneral health perceptions, vitality, emotional role limitations, mental health and social\nfunctioning. Subscale score and SF-36 questionnaire components are in the range of 0–100,\nthe higher value means better perceived health status.\nThe perceived social support was measured by the Multidimensional questionnaire of\nperceived social support by Zimet, Dahlem and Farley. The questionnaire is composed of\n12 items in which respondents assess whether they are provided with the necessary help\nand support from the family, friends and important persons in their personal life on the 7\npoint scale from “Definitely Disagree” to “Definitely Agree”. The evaluation allows three\ngroups of social support resources to be identified: the family (items 3, 4, 8 and 11), friends\n(6, 7, 9 and 12) and another significant person in life (items 1, 2, 5 and 10). The values of\nthe items are added separately. The highest score means a higher degree of perceived social\nsupport [10].\nAdditional question was used to gain information on positive and negative effects of\nsurgery and satisfaction with support.\n3 Results\nBaseline characteristics and clinical variables are summarised in Table 1. The main age of\nrespondents was 47.66 and mean age during surgery 43.31 years. Majority of respondents\nwere married (77%), had at least a high school education (80%) and had 1–2 children (61.44).\nTo investigate the subjective perceptions of life among women after hysterectomy\n(positive and negative effects of surgery), we formulated two open questions. The summary\nof the most frequented answers is presented in Figs. 1 and 2.\nIn this question, up to 45.71% of women answered that they did not see any negative\nconsequences, 21.43% of women considered the negative effects of hormonal changes\n(symptoms of menopause), 15.71% of respondents labelled the loss of fertility. One\nrespondent wrote that for her the biggest negative was the long-term drop out of work and, in\nparticular, of the condition, a major weakening of the body.\nThe most commonly cited positive aspect of hysterectomy was that 42.86% reduction/\nelimination of disease-related problems, reduced fear of endometrial cancer (27.14%) and\n“other” where respondents wrote, e.g. that they save on contraceptives and sanitary napkins,\nhave a longer and more precise orgasm, pain relief.\nTable 2 presents results from generic questionnaire of quality of life SF 36. Respondents\nreached the highest average score in physical functioning subscale, while the worst results\nwere achieved in subscales vitality and bodily pain.\nMost respondents evaluated their health as “good” (58.57%) or “very good” (27.14%),\nonly 3 women (4.29%) rated their health as “bad”.\nOn Fig. 3, we can see that 40% of women evaluated their health approximately the same as\nbefore surgery, and up to 27.14% felt much better or somewhat better (15.71%) than before\nsurgery. 15.71% of respondents felt somewhat worse and 1.43% much worse than before\nhysterectomy.\n3\n\nSHS Web of Conferences 51, 02009 (2018) https://doi.org/10.1051/shsconf/20185102009\nInt. Conf. SOCIETY. HEALTH. WELF ARE. 2016\nTable 1. Sample characteristics.\nFrequency n(%)\nAge (mean±SD) 47.66 ± 9.47\nAge during surgery (mean ± SD) 43.31± 9.12\nEducation\n