Factores determinantes de la participación laboral

M any retrospective studies have investigated the notion that ‘because o f the

sym bolic significance o f the uterus, hysterectom y could be followed by a higher

incidence o f psychological and sexual disorders’ (D ennerstein & van H all, 1986).

For exam ple, higher psychiatric-hospital adm ission rates com pared with other

surgery or with expected com m unity rates (mainly depression)^ an increased

occurrence o f treatm ent with antidepressants in a general-practitioner setting;

and sexual dysfunction o f many hysterectom ized patients.

B arker (1968) exam ined the case histories o f 729 D undee w om en who underw ent

hysterectom y from 1960 to 1964. Fifty-three o f the hysterectom y patients (7% )

received psychiatric treatm ent five years post-operatively, 45 (85% ) were

Psychological Sequelae o f Hysterectomy

60

com m on am ong patients who had no significant underlying pathological

abnorm ality com pared to those w ho had significant pelvic disease. M arital

p roblem s w ere show n to be m ore clearly related to psychiatric referral than was

a stable m arital background. In his control group consisting o f 780

cholecystectom y patients, only 9 (3% ) received psychiatric treatm ent follow ing

their operation. There could be several reasons to account for the variance o f

depression between the hysterectom ized patients and cholecystectom y patients.

The m ean age o f the hysterectom y group was m uch younger (44 years-old)

com pared to the cholecystectom y group (55 years-old) and considering the m ean

age for m enopause is 50 years-old, it could be assum ed that the latter group

w ould have gone through m enopause. Furtherm ore w hether or not the

hysterectom ized w om en in this study had their ovaries rem oved, after

hysterectom y m enopause is speeded up by three years (Siddle, 1987) and it is not

uncom m on to experience depression at the perim enopausal stage or at m enopause

w hich could account for these w om en s’ depressive sym ptom s. B allinger (1975)

show ed that there was a peak o f mild depressive illness and anxiety am ong

w om en who w ere perim enopausal. It is also highly probable that m arital

problem s and a background o f psychiatric disorder would increase the chances

o f depression after hysterectom y. How ever, this study illustrates the im portance

o f considering a patien t’s and her p artn er’s expectations o f hysterectom y and to

note that the psychological significance o f the operation was not realized until a

w hile after the patient had recovered from surgery (Turpin & H eath, 1979).

Steiner & A leksandrowicz (1970) investigated the ‘em otion al’ response in 133

w om en who had undergone gynaecological operations. Their control group

any m alignancies. O ver thirty-four per cent o f the gynaecological patients

m anifested depression, anxiety, loss o f libido, or physical sym ptom s. N early h a lf

(48.8% ) o f those adversely affected postoperatively w ere hysterectom y patients.

In the control group only 16.2% o f patients show ed psychiatric sequelae. Steiner

& A leksandrow icz (1970) suggested that losing the uterus could cause a patient

to go through a m ourning process.

A lthough m ost o f these studies reflect a general state o f depression in

hysterectom y patients, som e researchers believe in a existence o f a hysterectom y

syndrom e. R ichards (1973, 1974) describes the frequent occurrence o f a ‘post

hysterectom y syndrom e’ (headaches^ dizziness, insomnia, tiredness, hot flushes, and

urinary symptoms) with depression as its m ost salient feature. O ther researchers claim there is no specific psychological hysterectom y syndrom e and that

R ich ard s’ findings on post-operative depression m ay have been influenced by his

m ethodology (G itlin & Pasnau, 1989). For exam ple, several w om en suffered

from m alignancy (K av-V enaki & Zakham , 1983) and it is not unreasonable to

expect diff’erent psychiatric sequelae follow ing surgery for cancer com pared with

surgery for benign conditions.

K av-V enaki & Zakham (1983) exam ined the psychological effects o f hysterectom y

in prem enopausal wom en. The study included three groups o f patients: 19 post­

hysterectom y patients; 24 post-hystero-oophorectom y ; and 14 post­

cholecystectom y. No m alignancy was found am ong these patients. A

questionnaire included: pre- and post operative com plaints, the w om an ’s attitude

to the operation; the husband’s attitude to the operation and to his wife; a

Psychological Sequelae o f Hysterectomy

62

operation she had undergone. T he results show ed that both groups o f

hysterectom y patients saw them selves as less fem inine after the operation than

the cholecystectom y group. T here w ere no differences in levels o f depression

betw een the three groups o f patients, how ever, depression was found to be

associated w ith the degree o f pre-operative com plaints; w om en w ho suffered m ore

sym ptom s pre-surgery, reported m ore depression post-surgery. R oeske (1969)

also found that w om en who had m ore physical com plaints prior to surgery w ere

m ore depressed post-surgery. B oth K av-V enaki & Zakham (1983) and R oeske

(1969) suggest that these findings im ply that the * com plaints related to the uterus

increased the w om en’s aw areness o f it, and this salience o f the uterus m ake its

loss m ore traum atic’ (K av-V enaki & Zakham , 1983) It is also possible that the

physical com plaints gave rise to depression before the operation.

K av-V enaki & Zakham (1983) also reported a negative correlation betw een

depression and education, for exam ple the higher the p atien t’s educational level,

the less depression reported; and betw een depression and the influence o f the

operation on sex-life, the m ore positive the influence o f the operation on sexual

satisfaction, the less depression was reported (K av-V enaki & Z akham , 1983).

T he results o f the study thus suggest that hysterectom y per se does not

necessarily cause depression.

Because the above studies were retrospective they cannot offer conclusive

evidence as to whether there are adverse sequelae o f hysterectom y, as details

about the patients psychological profile before the operation is not available