Sexual Dysfunction Can Follow Hysterectomy

Cancer patients report increased problems after surgery

WEDNESDAY, Nov. 26, 2003 (HealthDayNews) -- Having a radical hysterectomy increases the risk of sexual dysfunction for women with cervical cancer, a new study says.

Sexual dysfunction appeared most pronounced within six months of the surgery, according to the report from Danish researchers, but some problems persisted even two years later. The findings are published in the Jan. 1, 2004, issue of Cancer.

The researchers surveyed 178 women who had had hysterectomies because of early-stage cervical cancer and 328 women in a control group who had neither cervical cancer nor hysterectomies. The women who had had a radical hysterectomy -- which involves removal of the uterus, the cervix, the upper part of the vagina and supporting tissues -- experienced higher rates of pain during or after intercourse, severe lack of lubrication, diminished interest in sex and fewer or no orgasms.

"I think the main message that is most important for me is that these women have a high risk of experiencing severe sexual problems during the first three to six months after surgery," says Dr. Pernille Jensen, the study's lead author who works in the department of gynecology at Rigshospitalet in Copenhagen.

Most of the sexual problems don't last more than a year, Jensen adds.

The survey found, however, that women who'd had a radical hysterectomy faced about a three times greater risk of lack of lubrication than the control group for two years after the surgery.

Five weeks after surgery, these women had twice the risk of never or rarely having orgasm, compared with the control group. But that risk decreased to 40 percent by three months after surgery, 30 percent after six months and 10 percent after two years.

Women with hysterectomies had 3½ times the risk of pain during or after intercourse five weeks after surgery. The risk dropped to 2½ times greater at three months and 50 percent greater after two years.

They also reported greater likelihood that the vagina felt "too small" during sex, the study says. Three months after surgery, this risk was more than three times greater than for the women who had not had a hysterectomy or cervical cancer, but it dropped to 20 percent greater after two years.

Dr. Stephanie Blank, a gynecological oncologist at the New York University Cancer Institute, says the study looks at "very important" questions for cancer patients.

But she adds that it's difficult to establish a direct link between radical hysterectomy and sexual dysfunction among cancer patients and notes that the control group did not consist of cancer patients.

"A cancer diagnosis, especially of the female organs, certainly does have an impact on women's sexuality," Blank says. "The subject of sexual function is so subjective, and a woman going through cancer treatment always looks back and says sex was 'great before.' "

Blank says it's "very hard defining something very subjective and trying to make it objective."

The study also acknowledged that sexual problems in the first three months after a radical hysterectomy could be attributed, in part, to the "surgical trauma" and "psychological and physical factors related to the cancer diagnosis and the surgery."

Other researchers have suggested sexual dysfunction after hysterectomy could result not from the surgery itself, but from the problems that led to the procedure. That was the conclusion of a study that appeared last month in the British Medical Journal.

And an ongoing study at Ohio State University suggests sexual adjustment after cancer treatment can be difficult. Researchers there who followed women for 12 months after cancer treatment found that loss of desire, arousal difficulties and orgasmic difficulties were common.

Other research also has linked hysterectomies and sexual dysfunction.

In a survey of more than 600 hysterectomy patients by the HERS Foundation (Hysterectomy Educational Resources and Services), nearly 75 percent cited a loss of sexual desire they did not anticipate, while more than half experienced loss of sensuality and sexuality.

Hysterectomy is the second most common major surgery among women in the United States, says the National Women's Health Information Center. Each year, more than 600,000 hysterectomies are performed, the center says, and about a third of women in the United States have had a hysterectomy by age 60.

More information

The National Women's Health Information Center has more on hysterectomy, or try the Mayo Clinic.

SOURCES: Pernille Jensen, M.D., department of gynecology, Rigshospitalet, Copenhagen, Denmark; Stephanie Blank, M.D., gynecological oncologist, New York University Cancer Institute, and assistant professor, NYU School of Medicine, New York City; Jan. 1, 2004, Cancer
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