Dissertation Work Completed by
Marcus Plourde, Ph.D.
Elizabeth Plourde, Ph.D., C.L.S.
Our two studies are presented with Marcus’ meta-analysis first because is represents an analysis of the studies that have been published worldwide comparing changes in sexual function for women with oophorohysterectomy (both uterus and ovaries removed) versus women with hysterectomy-only. A meta-analysis utilizes the data from all the available studies collected to perform a statistical analysis on the findings to determine whether trends can be extracted or interpolated from the collective data. This information provides a historic representation of what has been reported to date.
Elizabeth’s study represents new research to determine whether there is a difference in sexual function for women who opt to also have their ovaries removed when a hysterectomy is performed versus those who have a hysterectomy-only. Her study gathered and compared the data from 25 women who had an oophorohysterectomy versus 25 women who had a hysterectomy-only.
The information contained in these dissertations was used to complete our requirements for our doctorial degrees in July and December of 2004, respectively. Posted are the Abstracts as well as each dissertation’s detailed final Conclusions from the body of text. This work is © copyrighted and unpublished.
THE EFFECT OF HYSTERECTOMY AND OOPHORECTOMY ON
WOMEN’S SEXUAL FUNCTION: A META-ANALYSIS
by Marcus Plourde, Ph.D.
Objective: To determine if differences occur in sexual function in women who have their ovaries removed at the time of hysterectomy versus women who have a hysterectomy and retain their ovaries.
Study Design: This study analyzed the results of the currently available studies on sexual function after hysterectomy and oophorohysterectomy using meta-analysis techniques to identify conclusions and trends.
Materials and Methods: A search of the literature published in English between 1964 and 2004 was conducted to identify existing studies relevant to uterus and/or ovary removal in relationship to changes in sexual function. Eight studies differentiated data for the 2 types of surgery, 7 retrospective and 1 prospective. Collectively, 27 individual outcome measures were obtained, grouped into 7 common categories, and converted to chi-square values to determine if significant differences exist between the 2 types of surgeries.
Results: The majority of studies reviewed were poorly designed. Six out of the 8 studies did not utilize outcome measurements that were tested for reliability and validity. Most studies did not consider or control for important confounding factors that could have a positive or negative impact on the participants.
Conclusion: There were differences between women with hysterectomy only and those with ovary removal in the areas frequency of libido, frequency of orgasm and multiple orgasms, and overall sexual satisfaction. Women with ovary preservation had significantly higher desire for sex, achievement of orgasm, multiple orgasms, and overall sexual satisfaction. These data suggest that preserving ovaries is necessary to retain some of the elements that constitute sexual functioning, and removal of ovaries is associated with more sexual dysfunction in these areas.
Measurement of sexual satisfaction for women is difficult. Due to the complexities associated with sexual function, more research needs to be conducted to determine what constitutes satisfactory sexual function for women. Controlling for secondary variance to reduce the number of potential confounds is recommended. The establishment of reliable and validated measurement instruments should be incorporated in the study design of future research. Accurate and appropriate measurement of the long-term impact of hysterectomy and oophorohysterectomy is an important element of sexual function for future research.
(from dissertation text)
Measurement of sexual satisfaction for women is difficult. Due to the complexities associated with sexual function, more research needs to be conducted to determine what constitutes satisfactory sexual function for women before definitive answers can be established. Controlling for secondary variances are recommended to reduce the number of potential confounds. The establishment of reliable and validated measurements should be implemented in the study design of future research. Further comprehension of this complex subject will help to improve future research, theory, and practice in the areas of women’s sexual health.
Even though the results are equivocal, approximately one-half of the data aggregated from the available studies included in this analysis statistically support the conclusion that removing women’s ovaries creates a negative impact in sexual functioning. Additionally, the oophorohysterectomy groups responded negatively more often to 22 of the 27 outcome measurements. In many cases these difference between groups did not reach significance, yet it cannot be overlooked that the oophorohysterectomy group reported greater impaired sexual function. These results indicate that preservation of ovaries may be necessary to retain many of the key elements that constitute satisfactory sexual functioning, and their removal is associated with greater loss of sexual function. Based on the current literature, women who are not facing life-threatening conditions and value the sexual functions of desire, orgasm, ability to achieve multiple orgasms, and maintaining overall sexual satisfaction, preserving their ovaries is highly recommended.
Women who have a hysterectomy-only were also affected by this surgery and the research community may want to reconsider the possibility that many aspects of women’s sexual function were negatively impacted. There may be a misconception that women have better sex after a hysterectomy. It appears that as many women are negatively impacted as those who are helped in both groups. Carlson and colleagues (1994) reported, “Our study of a population with fairly high levels of symptoms demonstrated that, for a wide range of conditions, hysterectomy results in a marked improvement in quality of life” (p. 563). This may be one of the most quoted articles on the subject, yet this dearth of quantifiable data fails to support this statement. Additionally, this study found that improved quality of life after hysterectomy may be a misconception as many women in both groups reported both positive and negative outcomes. Some reported that their conditions improved, while others reported symptoms they did not have before surgery. These results support the idea of reconsidering the risks and benefits for the hysterectomy-only group, and it appears that the risks are compounded for those who have their ovaries also removed.
Women who have hysterectomies and oophorohysterectomies also risk other conditions not included within the scope of this analysis. Oldenhave and associates (1993) studied hysterectomy and concluded that participants showed more incidences of osteoporosis, cardiovascular disease, osteoarthritis, depression, and sexual problems. These conditions can only be exacerbated by also removing the ovaries. This study provides sufficient evidence to warrant retaining the uteri and ovaries in the women who have the option to elect keeping these vital-to-life organs. Women should not have to function without vital-to-life organs that produce life-sustaining hormones that protect women from osteoporosis, cardiovascular disease, osteoarthritis, depression, and sexual problems.
Carlson, K. J., Miller, B. A., & Fowler, F. L. Jr. (1994). The Maine Women’s Health Study: I. Outcomes of hysterectomy. Obstetrics & Gynecology, 83, 556-565.
Oldenhave, A., Jaszmann, L. J. B., Everaerd, W., & Haspels, A. A. (1993). Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age. American Journal of Obstetrics and Gynecology, 168(3 pt 1), 765-771.
THE IMPACT OF HYSTERECTOMY VERSUS OOPHOROHYSTERECTOMY
ON WOMEN’S SEXUALITY
by Elizabeth Plourde, Ph.D., C.L.S.
Objective: To determine if there are differences in overall sexual function between women who have a hysterectomy-only compared to women who also have their ovaries removed at the time of hysterectomy. If there are overall differences, to determine the subscale aspects of sexual functioning involved, and whether women’s level of interest in sex before surgery influences sexual functioning outcomes.
Materials and Methods: A total of 50 women, 25 hysterectomy only and 25 oophorohysterectomy, who were operated on for benign gynecological conditions and were not menopausal at the time of surgery, were enrolled in this retrospective study. The Changes in Sexual Functioning Questionnaire–Female (CSFQ-F) and the Sexual Response Questionnaire–Hysterectomy (SRQ-H) were completed in a self-report format by participants.
Results: ANOVAs detected statistical differences between groups in total sexual functioning scores after surgery, and within the subscales of pleasure, desire/frequency, desire/interest, and orgasm/completion. The subscale of sexual arousal/excitement did not reach a statistically significant difference between groups, but approached significance. The hysterectomy-only women had statistically significant higher scores in strength of sex drive, overall sexual satisfaction, and in the number who were orgasmic compared to the oophorohysterectomy women.
Conclusion: Ovary removal at time of hysterectomy was found to be associated with overall decreased sexual functioning compared to hysterectomy-only. Women should be advised that ovary removal led to significant differences in total scores, and in 4 of the 5 sexual functioning subscales measured in this study. The potential for decreases in sexual functioning should be discussed and reviewed when recommending prophylactic ovary removal.
(from dissertation text)
The majority of studies investigating sexual functioning following hysterectomy published to date have not focused on examining the differences between how women respond sexually with and without ovarian function. There has also been little focus on whether the ovaries remain functional and produce hormones at optimal levels after a hysterectomy, creating some variability in sexual functioning. The lack of clear demarcation of ovarian function could be one reason for the lack of significant findings in previous studies. By identifying and eliminating the hysterectomy-only women who experienced a decrease in ovarian function after surgery, this study detected significant differences between women with hysterectomy-only and those with oophorohysterectomy in total scores and four out of the five subscales of sexual functioning with the CSFQ-F questionnaire. Utilizing the SRQ-H questionnaire, significant differences were detected across all aspects of sexual functioning measured. This study’s findings revealed decreased sexual functioning in women with oophorohysterectomies compared to women with hysterectomies. More women in this study had an average or high interest in sex compared to the general population. This finding may indicate that these women are impacted more severely because ovary removal results in a decreased ability to function sexually.
The extreme outcomes that appear throughout the medical literature were replicated in this study. The complexity and multifaceted nature of the human sexual response is demonstrated by the fact that not all the women who had their ovaries removed lost their interest in sex or ability to respond sexually, and not all of the women who retained their ovaries maintained their sexual functioning. These conflicting results indicate there are other factors that influence sexual functioning and need further research.
A clearer determination of the origin of women’s sexual responses, in conjunction with a better understanding of what constitutes women’s sexual function and satisfaction, need to be developed and incorporated in the future studies. More research needs to be conducted to confirm these findings and to identify other possible causes for improvement or deterioration in sexual functioning following ovary removal. The profound loss women expressed in this study, as well as the problems created within their relationships that arise from deteriorations in sexual functioning, necessitates this area be explored more rigorously before more women face the decision of prophylactic ovary removal with a hysterectomy.
This work is © copyrighted and unpublished.
Both study abstracts and dissertation conclusions are available to print individually at:
This page was last updated October 25, 2005
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