Hysterectomy and women satisfaction: total versus subtotal technique

Introduction The impact of different surgical procedures on women’s satisfaction after hysterectomy is a topical issue. The aim of this study was to investigate the impact of sub-total and total hysterectomy on women’s satisfaction, evaluated with questionnaire assessment of sexual activity, body image, and health status.

A prospective, randomized, non-blind study was conducted. In the study period of 3 years, 105 women were enrolled and completed the questionnaires [EuroQol (EQ-5D), body image scale (BIS), sexual activity questionnaire] 2 weeks before and 1 year after surgery.

Both total and sub-total hysterectomy resulted with improvements in the women’s sexual satisfaction (1 year after surgery), but no statistically significant differences were reached between the two groups. A highly significant difference (P < 0.001) in the perception of the body image between total and sub-total hysterectomy, at 1 year after surgery, was underlined. The health-related quality of life resulted significantly better in the “sub-total hysterectomy” group 1 year after surgery (P < 0.05).

Considering these results, why should a total hysterectomy be performed, if the women’s satisfaction seems to be higher using the sub-total technique? In our opinion, the woman undergoing hysterectomy for benign conditions must be counseled regarding the differences between the two techniques and, when possible, a choice must be offered to the woman. Similar content being viewed by others

Thakar R, Ayers S, Clarkson P, Manyonda I (2002) Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med 347:1318–1325 Carlson KJ, Nichols DH, Schiff I (1993) Indications for hysterectomy. N Engl J Med 328:856–860 Sutton C (1997) Hysterectomy: a historical perspective. Baillieres Clin Obstet Gynaecol 11:1–22 Storm HH, Clemmensen IH, Manders T, Brinton LA (1992) Supravaginal uterine amputation in Denmark 1978–1988 and risk of cancer. Gynecol Oncol 45(2):198–201 Haas S, Acker D, Donahue C, Katz ME (1993) Variation in hysterectomy rates across small geographic areas of Massachusetts. Am J Obstet Gynecol 169:150–154 Carlson KJ, Miller BA, Fowler FJ Jr (1994) The mine women’s health study. I. outcomes of hysterectomy. Obstet Gynecol 83:556–565 Kjerulff KH, Langenberg PW, Rhodes JC, Harvey LA, Guzinski GM, Stolley PD (2000) Effectiveness of hysterectomy. Obstet Gynecol 95:319–326 Virtanen HS, Makinen JI, Tenho T, Kiiholma P, Pitkanen Y, Hirvonen T (1993) Effects of abdominal hysterectomy on urinary and sexual symptoms. Br J Urol 72:868–872 Gimbel H (2007) Total or subtotal hysterectomy for benign uterine diseases? A meta-analysis. Acta Obstet Gynecol Scand 86(2):133–144 Lethaby A, Ivanova V, Johnson NP (2006) Total versus subtotal hysterectomy for benign gynaecological conditions (review). Cochrane Coll, pub2:1–33, CD004993 EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208 Hopwood P, Fletcher I, Lee A, Al Ghazal S (2001) A body image scale for use with cancer patients. Eur J Cancer 37:189–197 Thirlaway K, Fallowfield L, Cuzick J (1996) The sexual activity questionnaire: a measure of women’s sexual functioning. Qual Life Res 5:81–90 Stead M, Fountain J, Napp V, Brown J (2004) Psychometric properties of the body image scale in women with benign gynaecological conditions. Eur J Obstet Gynecol Reprod Biol 114(2):215–220 Smith PH, Ballantyne B (1968) The neuroanatomical basis of denervation of the urinary bladder following major pelvic surgery. Br J Surg 55:929–933 Parys BT, Haylen B, Hutton JL, Parsons KF (1989) The effect of simple hysterectomy on vescicourethral function. Br J Urol 64:594–599 Weber Am, Lee J-C (1996) Use of alternative techniques of hysterectomy in Ohio, 1988–1994. N Engl J Med 335:483–489 (Erratum, N Engl J Med 1996;335:1406) Schaffer JI, Word A (2002) Hysterectomy—still a useful operation. N Engl J Med 347(17):1360–1362 Maresh MJA, Metcalfe MA, McPherson K et al (2002) The VALUE national hysterectomy study: description of the patients and their surgery. BJOG 109:302–312 Scott JR, Sharp HT, Dodson MK, Norton PA, Warner HR (1997) Subtotal hysterectomy in modern gynecology: a decision analysis. Am J Obstet Gynecol 176:1186–1192 Sloan D (1978) The emotional and psychosexual aspects of hysterectomy. Am J Obstet Gynecol 131:598–605 Gimbel H, Zobbe V, Andersen BA, Filtenborg T, Gluud C, Tabor A (2003) Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results. BJOG 110:1088–1098 Roovers JPWR, van der Bom JG, van der Vaart CH, Heintz PM (2003) Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. BMJ 327:774–779 Gutl P, Greimel ER, Roth R, Winter R (2002) Women’s sexual behavior, body image and satisfaction with surgical outcomes after hysterectomy: a comparison of vaginal and abdominal surgery. J Psychosom Obstet Gynaecol 23:51–59 Jacobson GS, Shaber RE, Armstrong MA, Hung Y (2006) Hysterectomy rates for benign indications. Obstet Gynecol 107:1278–1283 Zekam N, Oyelese Y, Goodwin K, Sinai I, Queenan JT (2003) Total versus subtotal hysterectomy: a survey of gynecologists. Obstet Gynecol 102:301–305 Author information Authors and Affiliations Corresponding author Rights and permissions About this article Cite this article Gorlero, F., Lijoi, D., Biamonti, M. et al. Hysterectomy and women satisfaction: total versus subtotal technique. Arch Gynecol Obstet 278, 405–410 (2008). https://doi.org/10.1007/s00404-008-0615-6 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-008-0615-6