Subjective perceptions of life among women after hysterectomy

3% no negative effects 46% other 1% Fig. 1. What do you consider to be the most negative aspect of hysterectomy? When analyzing the differences between two groups by desire for a (another) child, a significant difference was found only in mental health. The women who answered “yes” in response to the question, “Before the hysterectomy, would you have wanted a (another) child?”, achieved a lower score in mental health subscale than those who said “no”, as shown in Table 3. 4 SHS Web of Conferences 51, 02009 (2018) https://doi.org/10.1051/shsconf/20185102009 Int. Conf. SOCIETY. HEALTH. WELF ARE. 2016 reduction/ elimination of symptoms of the desease 43% end of menstruation 7% reduced fear of emdometrial cancer 27% no positives 16% other 7% Fig. 2. What do you consider the most positive aspect of hysterectomy? Table 2. Average values of each quality of life dimension according to the SF-36 questionnaire. Mean SD Range Physical functioning 88.07 12.67 45 100 Social functioning 74.64 22.81 12.5 100 Role limitations due to physical health problems 70.36 34.65 0 100 Role limitations due to emotional health problems 75.24 33.42 0 100 Mental health 67.43 13.89 28 88 Vitality, energy, fatigue 52.07 15.68 5.0 90 Bodily pain 44.14 24.57 0 100 General health 63.79 17.80 20 100 Changes in health 62.50 27.83 0 100 Physical health 69.63 11.76 41.11 95.19 Mental health 63.39 12.61 28.57 91.07 Self-rated health 61.79 21.33 0 100 When comparing the impact of different types of hysterectomy on individual quality of life dimensions, we found a statistically significant difference in the pain and role limitations due to emotional problems. Respondents, who underwent abdominal hysterectomy tend to achieve worse mean scores in both dimensions. As shown in Table 5, no significant difference in quality of life results was found among groups of respondents according to the performed oophorectomy. The Multidimensional scale of perceived social support was used to explore women’s sources of social support and their satisfaction with support. The questionnaire allows you to specify 3 groups of resources (family, friends, other significant person). Social support from family and significant others were perceived in equal amounts (mean 23.37 and 24.66; SD = 4.11; 3.48 respectively). Slightly lower scores were achieved by respondents in subscale of perceived social support from friends (mean 22.07; SD = 4.21). 5 SHS Web of Conferences 51, 02009 (2018) https://doi.org/10.1051/shsconf/20185102009 Int. Conf. SOCIETY. HEALTH. WELF ARE. 2016 27.14% 15.71% 40% 15.71% 1.43% Fig. 3. How would you rate your health today compared to before surgery? To a standardized questionnaire about perceived social support, we even added an open question about who respondents considered the greatest source of social support. As expected the most commonly cited source of support was husband/partner (68.7%), followed by children (12.86%) and female family member (8.57%). Only 14 women sought support outside their normal social network, with priest, psychologist and support groups being the most cited (35.72%; 21.43%, respectively). Spearman correlation analysis was performed between quality of life domains, and the total and three subscales of social support (Table 7) to investigate whether perceived social support influence women’s health outcomes. Positive correlation was found between total social support and family and friends subscale, and mental health components ( p< 0.05). Perceived social support from family was also significantly associated with vitality dimension ( p< 0.05) as well as self-rated health (p< 0.05). 4 Discussion Respondent’s mean age was 47.66 ± 9.47 years. The majority were less than 50 years old, were employed, had secondary education level, were living with husband/partner. Most of them prefer husband or partner as a source of support and were subjectively satisfied with support from husband/partner and only one fifth sought support outside family and friends network and priest, psychologist and support groups were their preferred supporters. The aim of our research was to explore the perception of women who for various reasons in the past underwent hysterectomy. The results show that most women are satisfied with the outcome of the surgery and do not see any negative consequences. In contrast, most women reported a positive reduction in symptoms and disease-related problems and assessed their health better than before surgery. These results coincide with the findings of several authors. Satisfaction with hysterectomy has consistently been reported as being high among women who undergo hysterectomy [3, 11, 12]. However, hysterectomy may sometimes result in new symptoms related to pain, sexual dysfunction, and psychological distress [ 12, 13]. In our study, some women see the symptoms of menopause and loss of fertility as limiting. When analyzing the differences between two groups by desire for a (another) child, a significant difference was found in mental health. The women, who would have wanted another child, achieved a lower score in mental health subscale. Loss of fertility is particularly 6 SHS Web of Conferences 51, 02009 (2018) https://doi.org/10.1051/shsconf/20185102009 Int. Conf. SOCIETY. HEALTH. WELF ARE. 2016 Table 3. Post-hysterectomy quality of life by desire for a (another) child ( N = 70). Would have wanted a N MR U p (another) child Physical functioning yes 14 33.11 358.500 .616 no 56 36.10 Social functioning yes 14 30.25 318.500 .271 no 56 36.81 Role limitations due to physical health problems yes 14 41.71 305.000 .174 no 56 33.95 Role limitations due to emotional health problems yes 14 34.93 384.000 .896 no 56 35.64 General mental health yes 14 22.71 213.000 .008 no 56 38.70 Vitality, energy, fatigue yes 14 29.43 307.000 .207 no 56 37.02 Bodily pain yes 14 36.39 379.500 .853 no 56 35.28 General health yes 14 33.36 362.000 .658 no 56 36.04 Physical health yes 14 35.18 387.500 .947 no 56 35.58 Mental health yes 14 25.57 253.000 .041 no 56 37.98 Self-rated health yes 14 37.04 370.500 .721 no 56 35.12 MR-mean rank; U-Mann-Whitney test. distressing for women who had not yet had children and younger women [ 7, 14]. Some women who have undergone hysterectomy do not achieve their desired family size and report regret at the loss of fertility [ 3, 5, 14]. Such feelings of regret and distress at the loss of fertility are often cited as a potential explanation of the association between hysterectomy and subsequent psychological health [ 3, 15]. When comparing the impact of different types of hysterectomy on individual quality of life dimensions, we found that respondents, who underwent abdominal hysterectomy tent to achieve worse scores in the pain and role limitations due to emotional problems. A prospective controlled study found that approximately 90% of women felt physically unattractive because of the scars following abdominal hysterectomy, and that 25% of patients would not elect to undergo an abdominal hysterectomy again versus 11% in the vaginal 7 SHS Web of Conferences 51, 02009 (2018) https://doi.org/10.1051/shsconf/20185102009 Int. Conf. SOCIETY. HEALTH. WELF ARE. 2016 Table 4. Quality of life by type of hysterectomy. Abdominal Laparoscopic/ p hysterectomy Vaginal hysterectomy N = 70 N = 49 N = 19 M SD M SD Physical functioning 87.6 12.70 88.68 15.26 .443 Social functioning 72.45 24.08 80.26 19.24 .276 Role limitations due to physical health problems 68.37 33.80 77.63 33.22 .253 Role limitations due to emotional health problems 70.04 33.84 87.71 25.36 .041 Mental health 62.14 16.81 66.53 12.02 .587 Vitality, energy, fatigue 51.22 17.77 54.21 10.84 .516 Bodily pain 41.27 24.02 58.79 25.14 .004 General health 62.14 16.81 62.37 20.57 .752 Table 5. The influence of oophorectomy on the quality of life dimension. Bilateral oophorectomy Unilateral oophorectomy Without oophorectomy N = 70 N = 29 N = 8 N = 33 p M SD M SD M SD Physical functioning 86.90 12.55 82.50 18.20 90.45 11.70 .205 Social functioning 72.41 22.11 82.81 29.27 75.00 21.09 .249 Role limitations due to physical health problems 68.10 34.05 71.88 38.40 75.00 31.38 .611 Role limitations due to emotional health problems 70.09 35.39 83.31 23.60 75.74 33.11 .507 Mental health 60.34 16.24 63.75 21.18 61.67 17.65 .834 Vitality. energy. fatigue 54.14 12.74 48.75 18.99 52.88 17.63 .863 Bodily pain 46.55 21.65 35.63 23.18 50.33 28.11 .293 General health 60.34 16.24 63.75 21.18 61.67 17.65 .662 M-mean; SD-standard deviation. group [ 16]. Tan et al. [ 9] present data showing that in patients with debilitating symptoms, particularly pain, total abdominal hysterectomy and bilateral salpingo-oophorectomy result in significant improvement in health-related quality of life (HRQoL). Radosa et al. [ 17] state that hysterectomy, performed due to benign uterine pathologies, had significant positive effects on postoperative sexual function and quality of life, regardless of the surgical technique used. One of the factors closely related to the quality of life is social support. Positive support has been shown to enhance self-esteem, confidence, and coping ability; conversely, negative support makes coping more difficult by eroding these perceptions [18, 19]. In our study, social 8 SHS Web of Conferences 51, 02009 (2018) https://doi.org/10.1051/shsconf/20185102009 Int. Conf. SOCIETY. HEALTH. WELF ARE. 2016 Table 6. Multidimensional scale of perceived social support. Mean SD Range Social support – Family 23.37 4.11 12–28 Social support – Friends 22.07 4.21 10–28 Social support – Significant others 24.66 3.48 11–28 Table 7. Spearman correlation between dimensions of quality of life and sources of social support. Perceived social support family friends significant others total Physical functioning .136 .186 .146 .177 Social functioning − .058 .087 .071 .036 Role limitations due to physical health problems − .039 − .097 − .131 − .098 Role limitations due to emotional health problems .015 − .028 − .016 − .011 Mental health .263* .278* .155 .267* Vitality, energy, fatigue .280* .183 .127 .226 Bodily pain − .007 .099 − .017 .032 General health .209 .199 .147 .211 Physical health .184 .092 .105 .180 Mental health .248* .237* .149 .240* Self-rated health .255* .157 .134 .208 * Correlation is significant at the 0.05 level (2-tailed). support was perceived by respondents in equal amounts from all three sources (family, friends and significant others). Study carried out by Cabness [ 20] found that women have reported greater interaction with family and friends after hysterectomies because of an increased desire for socialization and improved energy levels. Positive correlation was found between social support and mental health components. Perceived social support from family was also significantly associated with vitality dimension as well as self-rated health. According to Gomez-Campelo et al. [ 5] social support has been widely acknowledged as a protective factor for psychological distress and mental well-being and lower levels of social support have been associated with high levels of depression, and the lower support received can contribute to increased psychological problems for women. Despite the many positive results of the surgery, a number of physical, psychological and social problems arise after hysterectomy. In order to help women to minimize deficits, we need to know which aspects of quality of life are most markedly disrupted [ 21]. In situations in which hysterectomy is the only medically indicated treatment or a last resort treatment after other treatments have failed, clinicians must be aware of the association between loss of fertility and psychological distress in some women, especially younger women and nulliparous women [14]. 9 SHS Web of Conferences 51, 02009 (2018) https://doi.org/10.1051/shsconf/20185102009 Int. Conf. SOCIETY. HEALTH. WELF ARE. 2016 5 Conclusions The main aim of our study was to examine the subjective perceptions of life among women after hysterectomy. It was found that, despite some negative effects, women perceive their life after the surgery positively. They were also satisfied with support mainly from husband/partner and their children. Since the social support is one of the important factors affecting women’s good recovery and mental health after surgery as well as their quality of life, healthcare professionals should also focus on building and strengthening patient’s support network when working with these groups of women.

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