The real experience with women's hysterectomy: A meta-synthesis of qualitative research evidence.

AIM: The aim of this meta-synthesis was to identify and synthesize qualitative research evaluating the real feelings, inner needs and emotional experience of women undergoing hysterectomy. DESIGN: Meta-synthesis. METHODS: The PubMed, Web of Science, Cochrane Library, CINAHL, Embase, Ovid Medline and Sino Med were systematically searched until November 2021 and updated until June 2022. Two reviewers independently extracted data into a Microsoft Excel sheet. Qualitative meta-synthesis was performed by coding relevant citations, organizing codes into descriptive themes and developing analytical themes. RESULTS: Qualitative meta-synthesis yielded three themes and nine sub-themes: comprehensive consideration before hysterectomy (a. disease factors; b. fertility factors; c. opinions of others); emotions and experience after hysterectomy (a. postoperative physical condition; b. psychological resilience to the loss of the uterus; c. changes in the couple's relationship); coping strategies (a. self-denial and avoidance; b. change of perception and self-adjustment; c. seek help from others).

Patient-Reported Health Outcomes and Quality of Life after Peripartum Hysterectomy for Placenta Accreta Spectrum.

OBJECTIVE: Short-term morbidity of placenta accreta spectrum (PAS) is well described, but few data are available regarding long-term outcomes and quality of life. We aimed to evaluate patient-reported outcomes after hysterectomy for PAS. STUDY DESIGN: This is a prospective cohort study of women with risk factors for PAS who were enrolled antenatally. Exposed women were defined as those who underwent cesarean hysterectomy due to PAS. Unexposed women were those with three or more prior cesareans or placenta previa, but no PAS, who underwent cesarean delivery without hysterectomy. Two surveys were sent to patients at 6, 12, 24, and 36 months postpartum: (1) a general health questionnaire and (2) the SF-36, a validated quality of life survey. Aggregate scores for each questionnaire were calculated and responses were analyzed. RESULTS: At 6 months postpartum, women with PAS were more likely to report rehospitalization (odds ratio [OR] 5.83, 95% confidence interval [CI] 1.40-24.3), painful intercourse (OR 2.50, 95% CI 1.04-6.02), and anxiety/worry (OR 3.77, 95% CI 1.43-9.93), but were not statistically more likely to report additional surgeries (OR 3.39, 95% CI 0.99-11.7) or grief and depression (OR 2.45, 95% CI 0.87-6.95). At 12 months, women with PAS were more likely to report painful intercourse, grief/depression, and anxiety/worry. At 36 months, women with PAS were more likely to report grief/depression, anxiety/worry, and additional surgeries. Women with PAS reported significantly lower quality of life in physical functioning, role functioning, social functioning, and pain at 6 months postpartum, but not in other quality of life domains. Decreased quality of life was also reported at 12 and 36 months in the PAS group. CONCLUSION: Women with PAS are more likely to report ongoing long-term health issues and decreased quality of life for up to 3 years following surgery than those undergoing cesarean for other indications. KEY POINTS: · Long-term placenta accreta spectrum data to guide peripartum patient education.. · This study addresses a critical knowledge gap.. · Women affected by PAS report long-term morbidity..

Uterine transplantation: legal and regulatory implications in England.

Uterus transplantation (UTx) is fast evolving from an experimental to a clinical procedure, combining solid organ transplantation with assisted reproductive technology. The commencement of the first human uterus transplant trial in the United Kingdom leads us to examine and reflect upon the legal and regulatory aspects closely intertwined with UTx from the process of donation to potential implications for fertility treatment and the birth of the resultant child. As the world's first ephemeral transplant, the possibility of organ restitution requires consideration and is discussed herein. TWEETABLE ABSTRACT: Uterine transplantation warrants a closer look at the legal frameworks on fertility treatment and transplantation in England.

The Life Quality and Sexual Function of Women Underwent Radical Hysterectomy.

BACKGROUND: Up to date, there no studies were conducted on the quality of life (QL) and sexual function (SF) of women from Kazakhstan treated for cervical cancer. The study was aimed at the assessment of the QL and SF of women of the Kazakh population who underwent radical hysterectomy compared with chemo-radiotherapy group. METHODS: The study was conducted prospectively on 157 women of the Kazakh population. 92 women underwent radical hysterectomy (RH) and 65 underwent chemo-radiotherapy (CRT). The information was collected before treatment (T1), 6 months (T2) and 12 months (T3) after treatment. RESULTS: The women's average age was 41.12 ± 5.4 in the RH group and 47.24 ± 6.1 in the CRT group (p = 0.2). We did not detect significant differences between both groups according to the QLQ C-30 questionnaire (T1). The differences between the RH and CRT groups (p≤0,05) were observed in terms of physical functioning, fatigue, nausea and vomiting, pain during the T2 period. High rates of emotional functioning (p = 0.03), global health and QL (p = 0.02), and symptoms of fatigue (p = 0.04) were detected in the RH group compared to the CRT group during T3. However, pain symptoms (p = 0.001), nausea and vomiting and loss of appetite (p = 0.03) were dominated the CRT group. According to the results of FSFI-6 in the RH group, indicators for the domains "desire" (p = 0.02), "excitement" (p = 0.03), and "orgasm" (p = 0.05) were high, unlike in the CRT group during the T3 period. Nevertheless, the number of complains on the 'pain during intercourse' in the CRT group was higher than in the RH group (p = 0.001). CONCLUSION: Women who underwent RH had better health scores, global health status, and SF compared with patients treated with CRT.

Patient Preferences and Knowledge Regarding Hysterectomy: A Study from the Fellows' Pelvic Research Network (FPRN)®.

OBJECTIVE: The purpose of this study was to describe preference for and knowledge of hysterectomy routes in women presenting to urogynecology/gynecology clinics throughout the United States and to determine association with health literacy. Our primary aim was preference for hysterectomy route, and secondary aims were knowledge of basic pelvic structures and function, knowledge of various hysterectomy routes, and baseline health literacy level. METHODS: This multicenter, cross-sectional study was conducted through the Fellows' Pelvic Research Network. Patients' preference and knowledge for hysterectomy routes were assessed at initial presentation to the urogynecology/gynecology clinic with an anonymous, voluntary, self-administered questionnaire along with a validated health literacy test (Medical Term Recognition Test). RESULTS: Two hundred four women participated. Forty-five percent of patients were unsure which hysterectomy modality they would choose. Of patients who selected a preferred modality, 50% selected laparoscopic and 33% selected vaginal. Patients indicated that safety was considered highest priority when selecting route. The mean score for "knowledge about gynecology/hysterectomy" was 68%, with the high literacy group scoring higher compared with the low health literacy group (70% vs 60.1%, P = 0.01). More than 50% of patients incorrectly answered knowledge questions related to vaginal hysterectomy. Majority of the respondents had high health literacy (79.4%). CONCLUSIONS: Patients prefer laparoscopic hysterectomy approach, although have limited understanding of vaginal hysterectomy. Higher health literacy levels are associated with increased knowledge of gynecology and hysterectomy routes, but were not found to influence patient preference for hysterectomy route. Overall, patients have limited knowledge of vaginal hysterectomy.

Comparison of the Effects of Total Laparoscopic Hysterectomy and Total Abdominal Hysterectomy on Sexual Function and Quality of Life.

It is known that benign gynecological diseases negatively affect sexual function. For this reason, hysterectomy provides improvement in sexual function as well as symptoms such as bleeding and pain. The effects of abdominal hysterectomy (TAH) and laparoscopic hysterectomy (TLH), which are the two most common types of hysterectomy today, are not clear. In our study, we investigated the effects of TAH and TLH on sexual function and quality of life as well as intraoperative and postoperative results. In 329 TLH and 126 TAH patients, we compared both and between themselves preoperatively and postoperatively by using the standardized and validated female sexual function index (FSFI) and European quality of life five-dimension scale (EQ-5D). In conclusion, we found that both types of hysterectomy were effective in improving sexual function, and we concluded that improvement in the laparoscopy group was statistically higher. Patients who require hysterectomy for benign gynecological reasons should be informed that TLH has a more positive effect on sexual function as well as other advantages, and if the patients' main complaint is sexual dysfunction, TLH should be preferred compared to TAH.

Women's experiences following emergency Peripartum hysterectomy at St. Francis hospital Nsambya. A qualitative study.

BACKGROUND: Emergency peripartum hysterectomy (EPH) is a known remedy for saving women's lives when faced with the challenging situation of severe post partum hemorrhage not responsive to conservative management. However, EPH by its nature is also a traumatic birth event that causes serious physical, emotional and psychological harm. Unfortunately at St. Francis Hospital Nsambya nothing much is known about these experiences since no study has been undertaken and these women are not routinely followed up. The purpose of this study was to explore these emotional experiences. METHODS: This was a qualitative phenomenological study carried out between August and December 2018. All those women who had undergone EPH between January 2015 and August 2018 were eligible to participate in the study. Purposive sampling was used. 18 women were interviewed before saturation was reached. All interviews were audio-recorded and then transcribed verbatim. Thematic analysis was used to analyze the data. RESULTS: Three major themes were identified as the main experiences of these women in this study and they were; Loss of Womanhood, Joy for being alive and Loss of marital safety. CONCLUSION: Women experience serious emotional consequences following EPH. We recommend routine follow-up to help appreciate these experiences and advise them on appropriate mitigating measures.

Vida sexual tras histerectomía por motivos benignos. Una revisión sistemática / Sex life after a hysterectomy for benign reasons. A systematic review

La histerectomía es una de las intervenciones ginecológicas más frecuentes en todo el mundo. En ocasiones, esta cirugía puede generar importantes cambios en los aspectos emocionales, psíquicos, anatómicos y sociales, lo que puede alterar el funcionamiento sexual en las mujeres que la padezcan. El objetivo de esta búsqueda es analizar el impacto sobre la función sexual en mujeres histerectomizadas por motivos benignos. Durante el mes de enero de 2018 se llevó a cabo una búsqueda sistemática en las bases de datos Medline, Cinahl, PubMed, LILACS, Scopus y Web of Science. Tras aplicar los criterios de inclusión y exclusión seleccionados, se obtuvieron un total de 15 artículos en los cuales se analizaron entre otros la enfermedad de base, el tipo de intervención y el ítem alterado en la función sexual. Como conclusión, existe cierta controversia sobre los efectos de la histerectomía sobre la sexualidad, aunque la mayoría determina que tras la cirugía se produce una mejora en la función sexual

Hysterectomy is one of the most frequent gynaecological interventions in the world. This surgery can sometimes generate important changes in the emotional, psychic, anatomical and social aspects, including alterations of sexual functioning in women who suffer from it. The aim of this study is to analyse the impact on sexual function in women hysterectomised for benign reasons. During the month of January 2018 a systematic search was carried out in the databases Medline, Cinahl, PubMed, LILACS, Scopus, and Web of Science. After applying the selected inclusion and exclusion criteria, a total of 15 articles were obtained. An analysis was performed on variables such as the basic pathology, type of intervention, and altered items in sexual function. As a conclusion, there is some controversy over the effects of hysterectomy on sexuality, although most determine that an improvement in sexual function occurs after the surgery

¿Cambia la función sexual tras la histerectomía? / Does Sexual Function Change after Hysterectomy?

OBJETIVO: El posible impacto de la histerectomía sobre la función sexual genera ansiedad a las mujeres. Los estudios han mostrado controversia. Dada la frecuencia de esta intervención, nuestro objetivo es saber si la función sexual cambia tras la misma. MATERIAL Y MÉTODOS: Comparamos la función sexual antes de la histerectomía, a los 3 meses tras la misma y a los 9 meses, de las 299 mujeres a las que se les programa dicha intervención entre el 1 de noviembre de 2012 y el 31 de noviembre de 2014 en el Complejo Hospitalario Universitario de Albacete. Finalmente forman parte de nuestro estudio 166 mujeres. Se estudia la función sexual con el Cuestionario de Función Sexual de la Mujer (FSM ®). RESULTADOS: Encontramos que, tras la histerectomía, la función sexual de la mujer mejora en algunos aspectos y no cambia en otros. Las menores de 55 años presentan mejoría en el Deseo, en la Excitación y en la Frecuencia de la actividad sexual, y disminución de Problemas con la penetración vaginal; todo esto es ya manifiesto a los 3 meses de la intervención, sin cambios posteriores. La Ansiedad anticipatoria también mejora entre el tercer y noveno mes. Observamos tendencia a la mejoría en el dominio de Capacidad para disfrutar de su vida sexual en general. En mayores de 55 años solo encontramos aumento en la Frecuencia de actividad sexual a los 9 meses de la cirugía. CONCLUSIONES: Tras la histerectomía, la función sexual de la mujer mejora o no cambia. La mejoría se encuentra principalmente en menores de 55 años

OBJECTIVE: Women may experience anxiety because of the possible effects of hysterectomy on sexual function, but studies have shown conflicting results on this topic. Given the frequency of this procedure, the aim of this study is to determine whether sexual function changes after hysterectomy. MATERIAL AND METHODS: A comparison was made of sexual function before hysterectomy to sexual function at 3 and 9 months after the procedure in 299 women who underwent hysterectomy between 1 November 2012 and 30 November 2014, at the Hospital and University Complex of Albacete, Spain. A total of 166 women were finally included in the study. Sexual function was studied using the Women's Sexual Function Questionnaire (Cuestionario de Función Sexual de la Mujer, FSM ®). RESULTS: It was found that some aspects of female sexual function improved after hysterectomy, whereas others did not change. Those younger than 55 years old experience improvements in sexual desire, excitement, and frequency of sexual activity, and had a decrease in problems with vaginal penetration. These changes were all evident 3 months post-intervention, and no changes occurred thereafter. Anticipatory anxiety also improved between the third and ninth month. An upward trend was observed in the general enjoyment of sex life. In those older than 55 years, an increase was only found in the frequency of sexual activity at 9 months post-operation. CONCLUSIONS: After hysterectomy, female sexual function either improves or remains unchanged. Improvement is primarily found in women younger than 55 years old

Evaluation of quality of life, body image and surgical outcomes of robotic total laparoscopic hysterectomy and sentinel lymph node mapping in low-risk endometrial cancer patients - A Robotic Gyne Club study.

INTRODUCTION: The aims of the study were to evaluate quality of life, cosmetic results and surgical outcomes of robotic single-site and robotic multiport total laparoscopic hysterectomy with sentinel lymph node mapping in women treated for low-risk endometrial cancer. MATERIAL AND METHODS: The study is a prospective, multicenter, case-control study conducted at Ospedale Santa Chiara in Trento and Novara and Pavia University Hospitals. Seventy-six consecutive patients with a biopsy-confirmed diagnosis of low-risk endometrial cancer or atypical endometrial hyperplasia who between January 2017 and January 2019 had undergone robotic total laparoscopic hysterectomy and sentinel lymph node mapping were included. Data on surgical outcomes, quality of life and cosmetic results were prospectively collected and analyzed based on the surgical approach with robotic single-site vs robotic multiport assistance. Patients' clinical characteristics, intra-operative parameters, sentinel lymph node mapping results and postoperative findings were prospectively recorded. Clinical follow up was performed 4 weeks and 6 and 12 months after surgery. Fifty-one patients underwent a robotic multiport procedure and 25 patients a robotic single-site surgery. RESULTS: There was one significant difference between the two groups in terms of patient characteristics: mean body mass index (BMI) in the multiport group was 29 kg/m2 vs 24.8 kg/m2 in the single-site group (P value <.001). After univariate and multivariate analysis on intraoperative and postoperative findings, a shorter surgical time was observed in the single-site cohort than in the multiport group (148.7 vs 158.2 minutes, P value .0182). BMI also had a significant effect on surgical time (P = .022). No differences were seen in terms of sentinel lymph node detection: the bilateral detection rate was 96.1% for multiport (66.7% bilateral, 29.4% monolateral) and 96% for single-site (76% bilateral, 20% monolateral) procedures. No differences between the two approaches were identified with regard to postoperative complications, pain, cosmetic results or quality of life comparisons. CONCLUSIONS: For the treatment of low-risk endometrial cancer and atypical endometrial hyperplasia with total hysterectomy and sentinel lymph node mapping, the robotic single-port approach is comparable to the multiport procedure in terms of intraoperative and postoperative findings, and has an advantage in terms of shorter surgical times. Further studies are required to identify possible differences in quality of life and cosmetic results.

Hysterectomy and sexual (dys)function: An analysis of sexual dysfunction after hysterectomy and a search for predictive factors.

OBJECTIVES: Research about sexual function after hysterectomy is inconclusive. Possible predictive factors for sexual (dys)function are yet to be identified. The aim of this study is to assess the effect of hysterectomy on sexual function in women 3 and 12 months after hysterectomy for benign indications. Furthermore hypothesized predictive factors will be evaluated. STUDY DESIGN: A prospective multicentre cohort study with follow-up at 3 and 12 months after hysterectomy was performed. To assess sexual function a short-form FSFI was used, a score ≤ 19 means sexual dysfunction). Linear mixed model repeated measure analysis was used to assess changes in sexual function in women who were sexually active at all three measure points (N = 260). Linear mixed model analyses were also used for the predictor analyses. RESULTS: The FSFI score increased from 20.94 at baseline to 23.81 at 12 months post hysterectomy. The number of women experiencing sexual dysfunction was 86 (33.1 %). Women without preoperative sexual dysfunction had a significantly higher FSFI score 4.5 (95 % CI 3.5-5.6) one year after the operation than women indicating sexual dysfunction before surgery. Women who were living alone had a significantly higher FSFI score of 2.31 (0.7-4.0) when compared to women who were married or living together. CONCLUSION: FSFI score increases significantly after hysterectomy, which indicates a better sexual function after the operation. Sexual dysfunction before hysterectomy (FSFI score ≤ 19) and being married or living together are predictive factors for a lower FSFI score post hysterectomy.

Factors associated with decision-making on prophylactic hysterectomy and attitudes towards gynecological surveillance among women with Lynch syndrome (LS): a descriptive study.

To prevent endometrial carcinoma in Lynch syndrome (LS), regular gynecological surveillance visits and prophylactic surgery are recommended. Previous data have shown that prophylactic hysterectomy is an effective means of cancer prevention, while the advantages and disadvantages of surveillance are somewhat unclear. We aimed to evaluate female LS carriers' attitudes towards regular gynecological surveillance and factors influencing their decision-making on prophylactic surgery that have not been well documented. Pain experienced during endometrial biopsies was also evaluated. Postal questionnaires were sent to LS carriers undergoing regular gynecological surveillance. Questionnaires were sent to 112 women with LS, of whom 76 responded (68%). Forty-two (55%) had undergone prophylactic hysterectomy by the time of the study. The majority of responders (64/76; 84.2%) considered surveillance appointments beneficial. Pain level during endometrial biopsy was not associated with the decision to undergo prophylactic surgery. The level of satisfaction the women had with the information and advice provided during surveillance was significantly associated with the history of prophylactic hysterectomy (satisfaction rate of 73.2% versus 31.8% of nonoperated women, p = 0.003). The women who had undergone prophylactic surgery were older than the nonoperated women both at mutation testing (median of 42.3 years versus 31.6 years, p < 0.001) and at the time of the study (median of 56.9 years versus 46.0 years, respectively, p < 0.001). Women with LS pathogenic variants have positive experiences with gynecological surveillance visits, and their perception of the quality of the information and advice obtained plays an important role in their decision-making concerning prophylactic surgery.

The Association Between Mindfulness and Postoperative Pain: A Prospective Cohort Study of Gynecologic Oncology Patients Undergoing Minimally Invasive Hysterectomy.

STUDY OBJECTIVE: To describe the association between preoperative dispositional mindfulness (the personality trait of being mindful) and postoperative pain in gynecologic oncology patients undergoing minimally invasive hysterectomy. DESIGN: Prospective cohort study. SETTING: University-affiliated teaching hospital. PATIENTS: Gynecologic oncology patients (n = 126) planning minimally invasive hysterectomy. INTERVENTIONS: Minimally invasive hysterectomy. MEASUREMENTS AND MAIN RESULTS: Baseline mindfulness was assessed at the preoperative visit using the Five Facet Mindfulness Questionnaire (FFMQ). Postoperative pain and opioid usage were evaluated via chart review and surveys at postoperative visits at 1 to 2 weeks and 4 to 6 weeks. Higher baseline mindfulness was correlated with lower postoperative pain as measured by both the average and highest numeric pain scores during the inpatient stay (r = -.23, p = .020; r = -.21, p = .034). At the initial postoperative visit, pain score was also inversely correlated with preoperative mindfulness score (r = -.26, p = .008). This relationship was not observed at the final postoperative visit (r = -.08, p = .406). Pre-operative mindfulness and opioid usage were also inversely associated, though this relationship did not reach statistical significance (r = -.18, p = .066). CONCLUSION: Mindfulness was previously shown to be a promising intervention for chronic pain treatment. Our study demonstrates that higher preoperative dispositional mindfulness is associated with more favorable postoperative pain outcomes, including lower pain scores but not lower opioid consumption. This relationship provides an opportunity to target the modifiable personality characteristic of mindfulness, to reduce postoperative pain in patients following gynecologic surgery.

Effect of psychological care given to the women who underwent hysterectomy before and after the surgery on depressive symptoms, anxiety and the body image levels.

This study was conducted for the purpose of evaluating the effect of the psychological care given to women before and after hysterectomy surgery on depression levels, anxiety and body image. This experimental study was conducted in the gynecological oncology surgery clinic of Samsun Education and Research Hospital in Turkey between the dates of January 2018 and June 2018. Those who meet the sample selection criterion and agreed to participation to the study among the women who were admitted to the clinic for hysterectomy were assigned randomly to the experimental and control groups. 42 women in total including 21 women in each of experimental and control groups formed the sample of the study. The effect of the psychological care was evaluated through Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and Body Catherix Scale (BCS). The evaluation measurements were conducted as pre-test, post-test and follow-up (2-months post-test). The BDI and STAI scores of the women who receive psychological care have decreased and their BPS scores have increased. On the contrary, BDI and STAI scores of the women who receive psychological care in the experimental group have increased and their BCS scores have decreased. These findings show that psychological care has positive effects on depressive symptoms, anxiety and the body image in the women who underwent hysterectomy.IMPACT STATEMENTWhat is already known on this subject? Having a hysterectomy impacts a woman's life in a significant manner. As such, deciding to undergo a hysterectomy is a difficult process for women, especially from a psychological perspective. Following a hysterectomy, women commonly experience changes in body perception, such as perceiving the body as different, feeling disabled, feeling hollow, believing they are different than other women and feeling that their body is attracting notice. The literature reports that women perceive themselves as different, alienated, impaired and changed after a hysterectomy and that they have difficulty making contact with the environment; furthermore, the more changes in body perception increase, the more depression increases.What the results of this study add? This study revealed that psychological care given to women before and after undergoing a hysterectomy decreases anxiety and increases positive body perception. For this reason, psychological care for women undergoing hysterectomies should be part of routine nursing care and should be started upon the hospitalisation of the patient.What are the implications of these findings for clinical practice and/or further research? The findings of this study indicate that after a hysterectomy, women experience not only physiological disease symptoms but also psychological problems. Therefore, women who have undergone or will undergo a hysterectomy also have psychological needs. Further study is suggested to determine what can be done with a professional team to meet the demands for psychological care.

Evaluating the Prevalence of Regret With the Decision to Proceed With a Hysterectomy in Women Younger than Age 35.

OBJECTIVE: This study sought to evaluate prevalence of regret with the decision to undergo a hysterectomy at a young age. METHODS: A retrospective cohort study was performed at two centres and included patients who underwent an elective hysterectomy for benign indications under age 35, between January 1, 2008 and December 31, 2015. Eligible patients were contacted and completed a validated decision regret survey and patient health questionnaire. RESULTS: A total of 189 patients met the study criteria. Of the 95 patients who could be contacted, 71 consented to participate (response rate, 75%). The most common indications for surgery were menorrhagia (35.2%), uterine fibroids (22.5%), endometriosis (19.7%), and pain (15.5%). Overall, 91.5% of patients agreed that having this surgery was the right decision for them, and 90% said that they would make the same choice in the future. A total of 2.8% regretted the choice that they made, and 14% responded that this caused them harm. Over 95% of patients reported that the decision was either mostly patient driven or shared with the physician. CONCLUSION: This is the first evaluation of regret after hysterectomy specifically examining a younger patient population. The study results suggest that patients who are appropriately counselled do not regret their decision to proceed with hysterectomy.

Unindicated hysterectomies in India: the aftermath.

Unindicated hysterectomy is a disturbing problem in India. Women are counselled into the procedure by the fear of cancer, and by reinforcing their notion that unrelated somatic problems are solved by the removal of the uterus. This is a case of a woman from the state of Bihar, India, who was referred to us after an unindicated hysterectomy at the age of 24, performed as a first-line treatment for lower abdominal pain. This highlights the problem of rising hysterectomy in India and the lack of integrated treatment for women with the debilitating condition of chronic pelvic pain. Pelvic pain and vaginal discharge are often not indicative of pelvic inflammatory disease, and need a more considerate and broad-minded approach. Public health initiatives should take more account of women's lack of knowledge of reproductive health and make efforts to disseminate such information by the use of television, radio and newspapers in local languages.

From decision to incision: Ideologies of gender in surgical cancer care.

In this paper, I draw on the narratives of 57 individuals whose gender identities and decisions about their bodies trouble the medical protocols for breast and gynecological cancer care. I focus here on the decision-making process for three groups of elective surgeries: hysterectomy, prophylactic bilateral and contralateral mastectomy, and breast reconstruction. These elective surgeries illustrate places in medical interactions where patients and providers rely on frames of gender to determine whether a given surgery is an appropriate option for cancer prevention or care. These cases also explain how patient experiences of medical interactions are shaped by and thus reproduce ideologies of gender through the bodies of patients. While clinical practice and medical decisions are supposedly determined through the principles of evidence-based medicine and patient-centered care, I show that ideas about gender can actually supersede both medical evidence and patient desires for their bodies in the care of gynecological and breast cancers.

Prevalence, sociodemographic determinants and self-reported reasons for hysterectomy in India.

BACKGROUND: Evidence of hysterectomy in India is limited mainly due to lack of information in large-scale nationally representative health surveys. In 2015-16, the fourth National Family Health Survey (NFHS-4) - a cross-sectional survey - collected for the first time direct information on hysterectomy and self-reported reasons for undergoing the procedure among women in the reproductive age group. This paper examines the prevalence and determinants of hysterectomy in India among women aged 30-49 years in 29 states and seven union territories (UTs) of India using the NFHS-4 dataset. METHODS: Percentage weighted by sampling weights was used for estimating the prevalence of hysterectomy. The paper used crosstabulations and percentage distributions to estimate the prevalence of hysterectomy across different socioeconomic backgrounds and reasons for undergoing hysterectomy respectively. A multivariate binary logistic regression model was also used to find statistically significant determinants of hysterectomy. RESULTS: In India as a whole, 6 % of women aged 30-49 years had undergone a hysterectomy. The percentage of women who had undergone the procedure was found to vary considerably across the states and the UTs (from a minimum of 2% in Lakshadweep to a maximum of 16% in Andhra Pradesh). A noticeable fact that emerged was that the majority of the hysterectomies were performed in the private sector except in the northeast region. Years of schooling, caste, religion, geographic region, place of residence, wealth quintiles, age, parity, age at first cohabitation, marital status, and body mass index of women were found to be the sociodemographic determinants statistically associated with hysterectomy in India. The reasons reported frequently for hysterectomy were excessive menstrual bleeding/pain (56%), followed by fibroids/cysts (20%). CONCLUSION: The percentage and likelihood of undergoing hysterectomy are relatively high among women from older age groups (45-49), those who reside in rural areas, those without schooling, those who are obese, those having high parity, those with a low age at first marriage, and those who reside in the eastern and southern parts of India. The policy implication of these findings is that the reproductive health program managers should ensure regular screening and timely treatment of the problems resulting in hysterectomy.

Cuidado Humanizado en el Postoperatorio Inmediato de Pacientes Histerectomizadas / Humanized Care in the Immediate Postoperative Period of Hysterectomized Patients / Cuidado Humanizado no Período Pós-Operatório Imediato de Pacientes Histerectomizados

OBJETIVO: Analizar el cuidado humanizado en el postoperatorio inmediato de pacientes histerectomizadas, en edades de 25 a 40, de la Clínica Olympus, durante el período marzo-agosto 2017. MÉTODO: El estudio se enmarca en un enfoque cuantitativo, con un nivel descriptivo, apoyado en una investigación de campo. La recolección de información se realizó a través de la técnica de la encuesta, con la aplicación de un cuestionario de 11 ítems a 18 enfermeras, para obtener los datos requeridos. RESULTADOS: La aplicación del cuidado humanizado se evidencia parcialmente en la atención de necesidades biológicas en las pacientes. La mayoría de los encuestados se comunican efectivamente, sin embargo, se manifiesta un alto nivel de indiferencia, por parte del personal de enfermería, en la atención del dolor como necesidad básica en el postoperatorio de histerectomía. Así también, es una debilidad la ausencia de un instrumento de evaluación de la satisfacción del usuario. CONCLUSIONES: El cuidado humanizado es un proceso complejo pero indispensable durante la asistencia de postoperatorio en histerectomías. Dentro de la institución de salud abordada, este cuidado se desarrolla de manera fragmentada, no obstante, existe una apertura en los profesionales de enfermería para la humanización de la atención

OBJECTIVE: To analyze the humanized care in the immediate postoperative period of hysterectomized patients, from 25's to 40's, of the Olympus Clinic, during the period March-August 2017. METHOD: The study is carried out under a quantitative approach, with a descriptive level, supported by a field investigation. The information was based on a 11 items questionnaire, which was applied to 18 nurses in order to obtain the required data. RESULTS: The application of humanized care is evidenced partially in the attention of biological needs in PATIENTS: It is noted that most of the respondents communicate effectively, however, a high level of indifference is manifested, on the part of nursing staff, in the pain attention as a basic need in the postoperative hysterectomy. Likewise, the absence of an instrument for evaluating user satisfaction is a weakness. CONCLUSIONS: Humanized care is a complex but essential process during post-operative care in hysterectomies. Within the health institution addressed, it is developed in a fragmented manner, however, there is an opening in nursing professionals for the humanization of care

OBJETIVO: Analisar o atendimento humanizado no pós-operatório imediato de pacientes histerectomizados, de 25 a 40 anos, da Clínica Olympus, durante o período de março a agosto de 2017. MÉTODO: O estudo é realizado de forma quantitativa, com nível descritivo, apoiado em uma investigação de campo. As informações foram baseadas em um questionário de 11 itens, aplicado a 18 enfermeiros para obter os dados necessários. RESULTADOS: A aplicação do cuidado humanizado é evidenciada parcialmente na atenção das necessidades biológicas nos pacientes. Nota-se que a maioria dos entrevistados se comunica de forma eficaz, entretanto, manifesta-se um alto grau de indiferença, por parte da equipe de enfermagem, na atenção à dor como uma necessidade básica na histerectomia pós-operatória. Da mesma forma, a ausência de um instrumento para avaliar a satisfação do usuário é uma fraqueza. CONCLUSÕES: O cuidado humanizado é um processo complexo, mas essencial, durante os cuidados pós-operatórios nas histerectomias. Dentro da instituição de saúde abordada, desenvolve-se de forma fragmentada, no entanto, há uma abertura nos profissionais de enfermagem para a humanização do cuidado