Dyspareunia after total abdominal hysterectomy. Anatomical relation

Blanca Estela Monroy-Lozano; Eduardo Motta-Martínez; Rafael Huitrón-García; Felipe Rafael Zaldívar-Ramírez; Luis Mauricio Hurtado-López

2006, Number 4

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Cir Cir 2006; 74 (4)

Dyspareunia after total abdominal hysterectomy. Anatomical relation

Monroy-Lozano BE, Motta-Martínez E, Huitrón-García R, Zaldívar-Ramírez FR, Hurtado-López LM

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Language: Spanish
References: 24
Page: 257-261
PDF size: 76.47 Kb.

ABSTRACT

Objective: We undertook this study to determine whether anatomic changes after total abdominal hysterectomy are a cause of dyspareunia in premenopausal women.
Methods: This is a comparative, prospective and longitudinal study in 50 premenopausal women with benign uterine disease without dyspareunia treated with total abdominal hysterectomy. Primary variable was presence of postsurgical dyspareunia. Secondary variables are presurgical and assessment 3 months after surgery of left, right, anterior and posterior vaginal longitude (VLL, VRL, VAL and VPL, respectively) expressed in centimeters, as well as of the vaginal volume (VV). Statistical analysis for mean, central tendency and T-test. Group 1 (G1) is comprised of patients with postsurgical dyspareunia and Group 2 (G2) is comprised of patients without dyspareunia. Results: In G1, three patients (mean age: 42 years) had dyspareunia, pre- and postsurgical mean values were VV 146.6 and 100, VLL 8 and 7.3, VPL 9.16 and 7.3, VLL 8 and 7.3, VRL 8 and 7.3. In G2, 47 patients (mean age: 40.36 years) were without dyspareunia, pre- and postsurgical values were VV 150.6 and 121.57, VLL 8.81 and 8.12, VPL 9.7 and 8.69, VLL 9.24 and 8.3, VRL 9.28 and 8.33. We did not find significant differences between the groups. Two of the three patients with dyspareunia had a vaginal granuloma, but the third case did not show an anatomical cause. Conclusions: There is no relationship between total abdominal hysterectomy in premenopausal women and anatomical vaginal changes after surgery as assessed by vaginal volume and longitude. Presence of vaginal granuloma was responsible for dyspareunia in 4% of cases. Dyspareunia was found in 2% of premenopausal women without posthysterectomy anatomical cause.

REFERENCES

1. Clarke A, Blanck N, Rowe P, Mott S, Howle K. Indications for and outcome of total abdominal hysterectomy for benign disease: a prospective cohort study. Br J Obstet Gynecol 1995;102:611-620.
2. Wilcox LS, Koonin LM, Pokras SR, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States 1988-1990. Obstet Gynecol 1994;83:549-555.
3. Carlson KJ, Miller BA, Fowler F. The Maine Women’s Health Study. I. Outcome of hysterectomy. Obstet Gynecol 1994;83:556-564.
4. Amias AG. Sexual life after gynaecological operations. I. Br Med J 1975;2:608-609.
5. Harris WJ. Complications of hysterectomy. Clin Obstet Gynecol 1997;40:928-938.
6. Rhodes JC, Kjerulff KH, Langenberg PW, Guzinski GM. Hysterectomy and sexual functioning. JAMA 1999;282:1934-1941.
7. Richards DH. Depression after hysterectomy. Lancet 1973;2:430-433.
8. Virtanen H, Makinen J, Tenho T, Kiilholma P, Pitkanen Y, Hirvonen T. Effects of abdominal hysterectomy on urinary and sexual symptoms. Br J Urol 1993;72:868-872.
9. Helstrom L, Sorbom D, Backstrom T. Influence of partner relationship on sexuality after subtotal hysterectomy. Acta Obstet Gynecol Scand 1995;74:142-146.
10. Helstrom L. Sexuality after hysterectomy: a model based on quantitative and qualitative analysis of 104 women before and after subtotal hysterectomy. J Psychoosom Obstet Gynaecol 1994;15:219-229.
11. Kjerulff KH, Langenberg PW, Rhodes JC, Harvey LA, Guzinski GM, Stolley PD. Effectiveness of hysterectomy. Obstet Gynecol 2000;
95:319-326.
12. Helstrom L, Weiner E, Sorbom D, Backstrom T. Predictive value of psychiatric history, genital pain and menstrual symptoms for sexuality after hysterectomy. Acta Obstet Gynecol Scand 1994;73:575-580.
13. Khastgir G, Studd JW, Catalan J. The psychological outcome of hysterectomy. Gynecol Endocrinol 2000;14:132-141.
14. Eicher W. Total and subtotal hysterectomy-psychosexual aspects. Arch Gynecol Obstet 1994;255:S359-366.
15. Weber AM, Walters MD, Schouer LR, Church JM, Piedmonte MR. Functional outcome and satisfaction after abdominal hysterectomy. Am J Obstet Gynecol 1999;181:530-535.
16. Nathorst-Boos J, Von Schoultz B. Psychological reactions and sexual life after hysterectomy with and without oophorectomy. Gynecol Obstet Invest 1992;34:97-101.
17. Galavotti C, Richter DL. Talking about hysterectomy: the experiences of women from four cultural groups. J Womens Health Gend Based Med 2000;9:S63-67.
18. Helstrom L, Backstrom T, Sorbom D, Lundberg PO. Sacral nervous function, hormonal levels and sexuality in premenopausal women before and after hysterectomy. Acta Obstet Gynecol Scand 1994;
73:570-574.
19. Helstrom L, Lundberg PO, Sorbom D, Backstrom T. Sexuality after hysterectomy: a factor analysis of women’s sexual lives before and after subtotal hysterectomy. Obstet Gynecol 1993;81:357-362.
20. Popov I, Stoiko US, Khristova P. Disorders in sexual function after hysterectomy Akush Ginekol (Sofia) 2000;39:33-36.
21. Farrell SA, Kleser K. Sexuality after hysterectomy. Obstet Gynecol 2000;95(6pt2):1045-1951.
22. Thompson JD. Histerectomía. En: Rock JA, Thompson JD, editores. Te Linde Ginecología quirúrgica. 7a ed. Buenos Aires: Médica Panamericana. pp. 609-675.