Sexual dysfunction following hysterectomy.

The incidence of sexual dysfunction following hysterectomy is reported to be 38% in the United Kingdom 39% in South Africa and 28% in Australia. Few physicians are aware of any psychiatric sequelae. To many women hysterectomy means: 1) relief from physical suffering 2) a major operation 3) loss of sexual response and attractiveness 4) loss of femininity 5) loss of childbearing ability 6) loss of menstruation 7) weight gain 8) detection of cancer and 9) early menopause. Women at risk of a poor sexual response are those who: 1) perceive it as a loss of valued organs 2) have poor relationships with a sexual partner and 3) have negative expectations of the operations effect on their femininity and sexual relationships. Psychological preparation is the most effective prevention of sexual deterioration after hysterectomy. It is desirable if the sexual partner can also be interviewed and prepared. Prophylactic hormone replacement therapy may prevent dyspareunia due to atropic changes and relieve hot flushes and fatigue. The management of sexual dysfunction includes a detailed physical psychological and pelvic examination. Conjoint interviews education supportive psychotherapy counseling and arousal techniques may all be necessary in treatment. Hormonal therapy may also be used.