Objective: The availability of alternative therapies for abnormal gynecologic bleeding has prompted a reexamination of the impact of total hysterectomy on a woman's quality of life. This paper examines the evidence about the impact of hysterectomy on one aspect of quality of life, sexuality.
Data sources: A systematic review of the English and German language literature was conducted using the search terms "sexuality," "hysterectomy," "libido," "orgasm," and "outcomes." Additional papers found in the bibliographies of theses papers were reviewed.
Methods of study selection: Eighteen studies were found, eight prospective and ten retrospective. With a few exceptions, the methodologic quality of the studies was poor, but we opted to review all of the studies given the paucity of data on this important subject.
Tabulation, integration, and results: The studies were evaluated for methodologic quality using a scoring system described in the paper and for their findings concerning the impact of hysterectomy on sexuality. chi(2) and Fischer exact test were used to analyze nominal variables. Outcome measures were usually not validated and most studies did not consider important confounding factors. Most studies in this review showed either no change or an enhancement of sexuality in women who had a hysterectomy.
Conclusion: The majority of research evaluating the effect of hysterectomy on sexuality was poorly designed. The available evidence shows that quality of life is improved for most women who had hysterectomy and that hysterectomy did not adversely affect sexuality. A number of confounding factors with the potential to have either a positive or negative impact on sexuality, independent of hysterectomy, should be taken into account in future studies.