The Impact of Hysterectomy on Sexual Life of Women

May, 2001. The American College of Obstetricians and Gynecologists (ACOG) held its 49th Annual Clinical Meeting (ACM) in Chicago, IL.,at the Hilton Hotel. The meeting began Monday, April 30 and ran through Wednesday, May 2. ACOG is a national medical organization which represents over 40,000 obstetricians and gynecologists throughout the United States. ACOG’s ACM is one of the largest gatherings of women’s health care practitioners, drawing thousands of physicians, experts, poster exhibitors, researchers, and guests.

Authors of several recent studies have concluded that hysterectomy improves the sexual life of women^1,2. Such studies have compared data of the reported sexual behavior occurring in the few weeks before surgery to reports gathered 2 years after surgery. Such conclusions may be incorrect due to an erroneously chosen baseline period. We hypothesize that the elevation in several measures of sexual behavior 2 years after--compared to 30 days before--surgery^1,2 provides evidence that the immediate presurgical period is a time of suppressed sexual life.

Sexual stimulation of the clitoris is well established as a trigger for orgasm for most women³. Vaginal stimulation also has been reported to trigger orgasmic inevitability if the rhythm and pressure are individualized⁴.

Work in rats has established a significant role of cervical stimulation in triggering hypothalamic-pituitary neural pathways that trigger GNRH release. Work in spinal-injured women with intact uteri has demonstrated that cervical and vaginal stimulation applied differentially triggered disparate orgasmic perceptions in these women⁵.

Our own questionnaire studies of populations of intact well women and those with myomata uteri confirmed that women experience differences between clitoral, vaginal and cervical sources of sexual stimulation⁶.

We present evidence to show how a simple error of logic has lead to misleading conclusions.

We arrayed the most widely cited pre and post hysterectomy data from JAMA¹ and compared them to our samples of well women, and women with myomata uteri.

Consecutive patients undergoing comprehensive executive physical exams were asked to complete medical history forms, extensive questionnaires on genitourinary experience of incontinence and sexual response including coital and orgasmic frequency. Women using either oral contraceptives or Prozac were excluded from our final data analysis because of recent studies showing sexual response deficiencies in these groups^8,9. Informed consent was obtained to use their data. An unaffiliated gynecologist interested in contributing a separate pool of data provided the same questionnaires to 37 patients whom she had diagnosed with myomata uteri.

Group	Total Number	Sexually Active
1. Intact Uterus Athena	121	78%
2. Intact Uterus with Fibroids Smith	36	78%
3. Post Hysterectomy .5-20 yrs Athena	23	83%
4. Post Hysterectomy @ 2 yrs Rhodes et al.	1101	77%
5. Scheduled for Hysterectomy Rhodes et al.	1101	70%

Group	Total Number	Sexual Activity > 5 Times/Month
1. Intact Uterus Athena	81	58%
2. Intact Uterus with Fibroids Smith	30	57%
3. Post Hysterectomy .5-20 yrs Athena	22	45%
4. Post Hysterectomy @ 2 yrs Rhodes et al.	1101	41%
5. Scheduled for Hysterectomy Rhodes et al.	1101	31%

Group	Total Number	Frequent Orgasm
1. Intact Uterus Athena	118	61%
2. Intact Uterus with Fibroids Smith	34	58%
3. Post Hysterectomy .5-20 yrs Athena	21	61%
4. Post Hysterectomy @ 2 yrs. Rhodes et al	1095	55%
5. Scheduled for Hysterectomy Rhodes et al.	1095	46%

Group	Clitoral Stimulation	Vaginal Stimulation	Cervical Tapping
Intact Uterus Athena	82% (of 110)	39% (of 109)	17% (of 106)
Intact Uterus with Fibroids Smith	74% (of 35)	48% (of 33)	33% (of 30)
Post Hysterectomy .5-20 yrs Athena	86% (of 21)	19% (of 21)	10% (of 20)

1)	Sexual life is apparently suppressed in women scheduled for hysterectomy. Our data show that not only are women less likely to engage in frequent sexual activity before hysterectomy, but when they do have sexual relations they are less likely to experience orgasm.

2)	In women who consent to hysterectomy, a combination of unstudied factors (e.g. pain, bleeding, fear of surgery) apparently combine to reduce their sexual activity.

3)	The current practice^1,2 of comparing immediate pre-surgery baselines of reduced sexual activity with data collected 1 to 2 year post surgery gives rise to an inherently erroneous conclusion.

4)	Future outcome studies after hysterectomy must correct the design errors of previous research. While a woman's prior healthy sexual life history would provide an ideal baseline, such data from distant recall have questionable validity. Hence a valid presurgical baseline is practically impossible to obtain.

5)	Future studies of sexual life should compare women after healing from hysterectomy to groups of women with comparable conditions who have not undergone reproductive surgery. Because both groups could provide prospective current information of relatively healthy patterns of sexual behavior, such measures could explore further the effect of hysterectomy on sexual life of women.

6)	Hysterectomy does not seem to impair clitoral sensation but does result in reports of reduced vaginal and cervical sensation

7)	Women undergoing hysterectomy because of myomata uteri, should be told that the surgery may reduce their genital sensitivity since this condition is associated with enhanced genital sensitivity

Background

METHODS

Results

Table 1: Proportion of Women Reporting They Are Sexually Active

Group Total Number Sexually Active

1. Intact Uterus
Athena 121 78%

2. Intact Uterus with Fibroids
Smith 36 78%

3. Post Hysterectomy .5-20 yrs
Athena 23 83%

4. Post Hysterectomy @ 2 yrs
Rhodes et al. 1101 77%

5. Scheduled for Hysterectomy
Rhodes et al. 1101 70%

Table 2: Proportion of Women Reporting Frequent Sexual Activity

Table 3: Proportion of Women Reporting Frequent Orgasm

Group Total Number Frequent Orgasm

1. Intact Uterus
Athena 118 61%

2. Intact Uterus with Fibroids
Smith 34 58%

3. Post Hysterectomy .5-20 yrs
Athena 21 61%

4. Post Hysterectomy @ 2 yrs.
Rhodes et al 1095 55%

5. Scheduled for Hysterectomy
Rhodes et al. 1095 46%

Table 4: Frequent Contribution to Orgasm by Site

Conclusions:

REFERENCES

AUTHORS’ AFFILIATIONS

A Poster Presentation by Athena Institute at the American College of Obstetricians and Gynecologists 2001 meeting.
	Winnifred B. Cutler^a, Ph.D., Norma L. McCoy^b, Ph.D., Millicent G. Zacher^c M.Ed.,D.O., F.A.C.O.G., Elizabeth Genovese^dM.D., and Erika Friedmann^ePh.D.	View Complete list of Dr. Cutler's published works

1.	Rhodes JC, Kjerulff KH, Langenberg PW, Guzinski GM (1999) Hysterectomy and sexual functioning. JAMA 282:1934-1941

2.	Carlson KJ, Miller BA, Fowler FJ (1994) The Maine Women'sHealth Study: I. Outcomes of hysterectomy. Obstet Gynecol 83:556-65.

3.	Master WH and Johnson VE (1966) Human Sexual Response Little, Brown, Boston

4.	Alzate H (1985) Vaginal eroticism: a replication study. ArchSexBehav 14:529-537. and for example, Alzate H (1985) Vaginal eroticism and female orgasm: a current appraisal. Journal of Sex and Marital Therapy 11:271-284.

5.	Komisaruk B, Whipple B (1986) Vaginal stimulation - produced analgesia in rats and women. Annals NY Acad. Sciences 467:30-39. and Komisaruk BR, Gerdes C, Whipple B (1997) Complete spinal cord injury does not block perceptual responses to genital self stimulation in women. Archives of Neurology 54:1513-1520.

6.	Cutler WB, McCoy NL, Friedmann E, Genovese-Stone E, Zacher MJ (2000) Sexual response in women. ObstetGyncol 95:4(Supplement) April 2000, 198.

7.	Cutler WB, Friedmann E, Genovese-Stone E, and Felmet K (1992) Urinary stress incontinence: a pervasive problem among well women. J Wmns Health Vol 1:259-266.

8.	McCoy NL and Matyas JR (1996) Oral contraceptives and sexuality in university women. ArchSexBehav 25:73-90.

9.	PROZAC (fluoxetine HCL) prescribing information by Dista/Eli Lilly, pp. 859-863, PHYSICIANS DESK REFERENCE 52nd Ed (1998), Medical Economics Company, Inc. Montvale, NJ 07645.