Hysterectomy and Tubal Ligation

Because of the reproductive organs' identification with sexuality and childbearing, gynecologic surgery can be a stressful experience for women. This article reviews the research on the psychological sequelae of tubal ligation and hysterectomy. Overall, the research suggests that factors such as age, marital problems, parity, previous psychiatric history and personality problems, the timing of surgery, and pathways to surgery can help to identify women who may be at risk for adverse sequelae following tubal ligation. The literature also indicates that the decision to undergo tubal sterilization should be taken only by patients who are well informed about its effect and outcome. Although several studies have found a high incidence of psychological and sexual disorders among women who have undergone hysterectomy, control groups have not been used and often information has not been available on patients' social and sexual functioning before the surgery. A prospective design is needed to provide conclusive evidence of the effects of hysterectomy. It appears that most psychiatric problems occur in women who had such problems prior to the surgery. Other risk factors for a poor outcome after hysterectomy include younger age, lower educational status, absence of any concern preoperatively or excessive anxiety, absence of perceived support in the immediate social network, a poor relationship with one's mother, and negative expectations of the operation. Clinicians can play an important role in determining whether hysterectomy is indicated, adequately preparing the woman and her partner for surgery, and identifying those women who are having problems adapting to the operation and arranging psychotherapeutic intervention.