Hysterectomy and sexual wellbeing: more questions are yet to be answered

Editor—Roovers et al take subjective distress into account in their examination of sexual outcomes after hysterectomy.1 This is a much needed aspect of the research on this topic. I am disappointed that, as so often in this type of research, the method does not include the use of a well validated interview or self report measure to assess sexual function. I am concerned about the interpretation of the results for the women who developed new sexual symptoms after their operation. New sexual problems developed in 9 (23%) patients after vaginal hysterectomy, 8 (24%) patients after subtotal abdominal hysterectomy, and 12 (19%) patients after total abdominal hysterectomy. For previously asymptomatic women undergoing hysterectomy the rate of new sexual problems (about one out of five) is troubling and does not imply that sexual symptoms after hysterectomy are rare. Moreover, more women than not (according to the paper, more than 50%) continued to be troubled by existing sexual problems after hysterectomy. I hesitate to accept the authors' conclusion that sexual pleasure is enhanced after hysterectomy, particularly since they did not directly measure sexual enjoyment or satisfaction. Sexual pleasure cannot simply be inferred from the absence or presence of a few symptoms. Several elements are curiously absent from prospective studies of hysterectomy and sexual function, including a consideration of the incidence of sexual problems in the general population compared with that among women undergoing hysterectomy. Strong evidence either for or against the hypothesis that hysterectomy may affect sexual function negatively is lacking. Neither the study by Roovers et al nor other research to date has successfully addressed this question. Competing interests: None declared. References - 1.Roovers JPWR, van der Bom JG, van der Vaart CH, Heintz APM. Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. BMJ 2003;327: 774-8. (4 October.) [DOI] [PMC free article] [PubMed] [Google Scholar]