Fearing their sex lives will deteriorate, many women with painful gynecologic conditions put off hysterectomies. But in the largest study of its kind, researchers at the University of Maryland School of Medicine have found that women's sex lives greatly improve after the operation.
The report, published in today's edition of the Journal of the American Medical Association, showed that women who had hysterectomies had more sex and that it was more satisfying. And the pain many of these women previously experienced during intercourse disappeared.
"If women are hesitating to have hysterectomies because they're afraid it will damage their sexual function, then it looks like that's unlikely," said Dr. Kristen H. Kjerulff, an epidemiologist and the study's principal investigator.
The explanation may be as simple as this: The women feel better.
A hysterectomy is one of the most common surgeries women undergo. By age 65, experts say, one in three women have had the operation to remove the uterus. A small percentage of patientshave the surgery because of cancer. But the vast majority of patients who have hysterectomies do so because they are suffering from several conditions that can cause excessive bleeding and pain, including fibroid tumors, endometriosis and uterine prolapse.
Some smaller studies have produced similar results, but the Maryland study is the best designed to date and involves a diverse group of women, experts said.
"It's going to be the gold standard," said Dr. Barbara S. Levy, a Seattle gynecologist and spokeswoman for the American College of Obstetricians and Gynecologists. "It's very significant."
Maryland researchers studied nearly 1,300 women from 28 hospitals statewide over two years, interviewing them before hysterectomy surgery and at several intervals up to 24 months after the surgery.
On average, these women dealt with their gynecologic condition for two years before seeking out a doctor. Then, they tried a series of treatments that didn't work. Julia Rhodes, the study's lead author, said that most of the women underwent a hysterectomy as a last resort.
Afterward, the number of women having sex at least five times a month increased by 10 percent. The number who reported experiencing orgasms increased from 63 percent before surgery to 72 percent. And the number of women who said they had strong orgasms rose from 45 percent before hysterectomy to 57 percent after.
The rate of painful sex dropped from 40 percent before the surgery to about 15 percent two years later.
Still, researchers say only a fraction of women with painful and other gynecologic conditions end up having hysterectomies. Experts hypothesize that many women may be discouraged from surgery by accounts from women who had bad experiences. Up to 15 percent of women may have some problem, doctors say.
"It's a big issue that looms in front of a woman who is deciding to have a hysterectomy, and many times women are reluctant to talk about it, but that thought is always there: 'Will it affect my libido? Will it affect my sexual function?' " said Dr. Marian Damewood, a reproductive endocrinologist, gynecologist and director of Greater Baltimore Medical Center's Midlife Center.
While doctors say it is rare for women to notice any change in sensation after a hysterectomy, some critics argue that almost all these patients are permanently damaged.
"How can you remove a sex organ and be improved? You may have your pain relieved, but what have you traded it for? No sensation, no feeling, that's what most women report," said Nora Coffey, director of the Hysterectomy Educational Resources and Services Foundation outside Philadelphia. HERS has counseled 200,000 women over the past 17 years.
Coffey said her group is releasing a report in January that says hysterectomies ruin women's sex lives. She claimed that Maryland's work may be skewed because of the type of questions and the way they were asked, and because doctors selected the patients who would participate.
For years, Coffey and others have charged that many hysterectomies are unnecessary, putting otherwise healthy women in danger of serious complications. But several physicians say while that might have been the case years ago, a woman must now have a "very pressing" gynecologic condition to get the operation.
In the new study, researchers tested a list of factors -- including race, number of ovaries removed and use of hormone replacement therapy -- to see which might be associated with a poorer outcome. They were surprised to discover only one association: Women who were depressed beforehand were less likely to experience improvements.
Janet Harris, 39, said she suffered for four years from fibroid tumors. She had painful cramps and periods that lasted half the month. The East Baltimore woman eventually became anemic. But she didn't want to have the surgery because of what other women had told her.
"They said, 'You won't feel like a woman anymore, your man is going to leave you,' " said Harris, who was not in the study. Finally, she had a hysterectomy in September and said her sex life has improved in every way.
"It's nothing like they said. I didn't even want my boyfriend to sleep near me before because I was so irritable," Harris said. "But now I'm snuggled up like a little bunny."