Hysterectomy and lack of libido
One study looked at body image and sexuality in three groups, a control group with no surgery, a hysterectomy group and women having removal of the ovaries with and without hormone replacement.
They found NO differences in mood (measured by patient questions) or vaginal blood flow (measured by instruments) and a woman's subjective arousal to an erotic stimulus. They did however find that women who had had an oophorectomy and either had no estrogen replacement or estrogen replacement without testosterone had significantly lower self-reported desire and arousal than any of the remaining groups.
This study and others imply that the main problem after hysterectomy is lack of desire (libido) if the ovaries are removed, but not the ability to undergo sexual arousal in response to an erotic stimulus. This may be able to be overcome by adequate testosterone replacement along with estrogen replacement. (See also testosterone article)
Another factor often forgotten in clinical studies is what was the degree of satisfaction with one's sexual partner and sexual desire prior to the surgery. An interesting Scandinavian study looked at 104 women having subtotal hysterectomies.
Sexual desire, activity, satisfaction and dysfunction were compared between women without, with a poor, and with a good partner relationship prior to the surgery.
They found an improved sexuality, one year post hysterectomy, in 61% of women with a good partner relationship, in 17% of those with a poor relationship but no improvement was seen in women who had no regular partner relationship.
Therefore it is extremely important in your judging of medical data that purports to show either positive or negative change with hysterectomy, that the study took into account preoperative partner satisfaction.
This study concluded that "women with no or with ambivalent partner relationships are more at risk for deterioration of sexuality after hysterectomy. "
Does the uterus help support the pelvic structures and its removal cause prolapse?
The uterus and top of the vagina are supported in the pelvis by several attachments to the strong tendons and ligaments of the pelvis bone. I do not know if the scientific names of these areas are important to you -- pubovesicocervical fascia, rectovaginal fascia, uterosacral ligaments and cardinal ligaments -- but the concept is important to grasp.
All of these attachments are cut during hysterectomy and as long as they are reattached to the end of the vagina, prolapse should not occur very frequently.
You would think that this is a very easy task surgically but those support ligaments are not visable most of the time. They are below a layer(s) of tissue and there may be breaks in those connections at invisible places other than their attachments to the uterus and vagina.
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