Attitudes to hysterectomy.

Before the 20th century the dangers of hysterectomy were so great it was limited to removal of life-threatening diseases such as cancer. Recently however the medical profession has suggested it as the procedure of choice for permanent sterilization since studies have shown that 34-45% of patients had gynecological disease following tubal ligation and 10-25% required further gynecolgical surgery. It can be debated whether this degree of subsequent disease sufficiently balances the increased morbidity associated with hysterectomy enough to make it the choice for primary sterilization. Earlier in this century hysterectomy was associated with severe feelings of loss especially among younger women. this feeling that the uterus is a primary focus of womanhood has abated somewhate with enlarged roles for women. However there are still severe psychological disturbances in women who do not understand the justification for the operation who feel insecure in their sexual identity and who do not have good support from others. Incidence of postoperative maladjustment may be significantly reduced if some time is spent in preoperative counseling so that the patient understands the indications for the operation realizes that recovery is usually rapid and complete and that she should be able to return to a reasonably normal life including sex life within 4-6 weeks after leaving the hospital. She should know that hysterectomy does not include the change of life and if it is necessary to remove the ovaries hormonal replacement therapy is available to prevent menopausal symptoms.