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.
This work is © 2005 copyrighted and unpublished.
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