Psychological well-being, marital adjustment and quality of life after hysterectomy: a comparative study

Kusum Lata Mathur, Manu Sharma, Mohua Mazumdar, Shikha Talati, Siddharth Srivastav


Background: Hysterectomy is the most common major gynecological surgery often performed for benign lesions. Many studies have reported adverse psychosocial outcomes post-hysterectomy. There is a paucity of studies from India addressing psychiatric morbidity after hysterectomy. To evaluate psychological wellbeing, marital adjustment and quality of life in patients undergoing hysterectomy for non-malignant conditions, in comparison with patients undergoing surgery other than hysterectomy.

Methods: A cross-sectional study was conducted on 100 consecutive out-patients who underwent hysterectomy for non-malignant indications at least 6 months ago. The comparison group comprised of 50 consecutive out-patients who underwent gynecological surgery other than hysterectomy at least 6 months ago formed the comparison group. The study participants were evaluated on Hospital Anxiety and Depression Scale (HADS), Psychological General Well-being Index (PGWBI), Marital Adjustment Test (MAT) and Women’s Quality of Life Questionnaire (WOMQOL).

Results: The indications for hysterectomy were: uterine leiomyoma (69%), uterovaginal prolapse (18%), dysfunctional uterine bleeding (12%), and endometriosis (1%). Abdominal hysterectomy was performed in 92 patients while 8 patients underwent vaginal hysterectomy. There were no significant differences in the study groups on scores of HADS, PGWBI, MAT and WOMQOL (p>0.05). Both the study groups had good marital adjustment and majority reported no depression and anxiety.

Conclusions: There is no major psychiatric morbidity, decline in marital adjustment and quality of life after hysterectomy for benign conditions among Indian women. Future research on the ethno-cultural implications and effect of hysterectomy on mental health will be a significant addition to the available evidence in India.


Hysterectomy, Marital adjustment, Psychological well-being, Quality of life

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Nathorst-Boos J, Fuchs T, von Schoultz B. Consumer’s attitude to hysterectomy. The experience of 678 women. Acta Obstet Gynecol Scand 1992;71(3):230-4.

Polivy J. Psychological reactions to hysterectomy: a critical review. Am J Obstet Gynecol 1974;118(3):417-26.

Bachmann GA. Psychosexual aspects of hysterectomy. Womens Health Issues 1990;1(1):41- 9.

Rhodes JC, Kjerulff KH, Langenberg PW, Guzinski GM. Hysterectomy and sexual functioning. JAMA 1999;282(20):1934-41.

Roovers JP, van der Bom JG, van der Vaart CH, Heintz AP. Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. BMJ 2003;327(7418):774-8.

Williamson ML. Sexual adjustment after hysterectomy. J Obstet Gynecol Neonatal Nurs. 1992;21(1):42-7.

Vomvolaki E, Kalmantis K, Kioses E, Antsaklis A. The effect of hysterectomy on sexuality and psychological changes. The European Journal of Contraception and Reproductive Health Care. 2006;11(1):23-7.

Farquhar CM, Sadler L, Harvey S, McDougall J, Yazdi G, Meuli KA. Prospective study of the short-term outcomes of hysterectomy with and without oophorectomy. Aust NZJ Obstet Gynaecol 2002;42(2):197-204.

Carlson KJ, Miller BA, Fowler FJ. The Maine Women’s Health Study: II. Outcomes of nonsurgical management of leiomyomas Abnormal bleeding, and chronic pelvic pain. Obstet Gynecol. 1994;83(4):566-72.

Rannestad T, Eikeland OJ, Helland H, Qvarnström U. Quality of life, pain, and psychological well-being in women suffering from gynecological disorders. J Women's Health Gender Med. 2000;9(8):897-903.

Richards DH. A post-hysterectomy syndrome. The Lancet. 1974;304(7887):983-5.

Drellich MC, Bieber I. The psychological importance of the uterus and its functions. J Nerv Ment Dis. 1958;126(4):322-36.

Zervos SK, Papaloucas AL. Psychosomatic disturbances following hysterectomy performed at a premenopausal age. Int Surg. 1972;57(10):802-4.

Lambden MP, Bellamy G, Ogburn‐Russell L, Preece CK, Moore S, Pepin T, et al. Women’s sense of well‐being before and after hysterectomy. J Obstet Gynecol Neonatal Nurs 1997;26(5):540-8.

Ryan MM. Hysterectomy: social and psychosexual aspects. Baillieres Clin Obstet Gynaecol. 1997;11(1):23-36.

Vyas JN, Rathore RS, Sharma P, Singhal AK. A study of psychiatric aspects of hysterectomy. Indian J Psychia. 1989;31(1):83-9.

Subramaniam D, Subramaniam SK, Charles SX, Verghese A. Psychiatric aspects of hysterectomy. Indian J Psychia. 1982;24(1):75.

Bhatia MS, Kaur N, Goyal U. Psychiatric reactions in hysterectomy. Indian J Psychia. 1990;32(1):52-6.

Col SC, Col TB. Psychiatric effects of hysterectomy. Medical Journal Armed Forces India. 1995 Jan 1;51(1):27-30.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67(6): 361-70.

Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes 2003;1(1):29.

Smith AB, Selby PJ, Velikova G, Stark D, Wright EP, Gould A, et al. Factor analysis of the hospital anxiety and depression scale from a large cancer population. Psychol Psychother 2002;75(2):165-76.

Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The hospital anxiety and depression scale (HADS): translation and validation study of the Iranian version. Health Qual Life Outcomes 2003;1: 14.

Chaturvedi SK, Chandra PS, Channabasavanna SM, Beena MB, Pandian RD, Chandra PS. Detection of anxiety and depression in cancer patients. NIMHANS J. 1994;12:141-4.

Locke HJ, Wallace KM. Short marital-adjustment and prediction tests: Their reliability and validity. Marriage and Family Living. 1959;21(3):251-5.

Gehlert S, Chang CH, Bock RD, Hartlage SA. The WOMQOL instrument measured quality of life in women of reproductive age with no known pathology. J clinic epidemiol. 2006;59(5):525-33.

Dupuy H. The Psychological General Well-Being (PGWB) Index. In: Wenger NK, Mattson ME, Furber CD, Elinson J, eds. Assessment of quality of life in clinical trials of cardiovascular therapies. New York: LeJacq Publishing Inc, 1984:170-83.

Kluivers KB, Johnson NP, Chien P, Vierhout ME, Bongers M, Mol BW. Comparison of laparoscopic and abdominal hysterectomy in terms of quality of life: a systematic review. Europe J Obstet Gynecol Reproduct Biol. 2008;136(1):3-8.

Leung PL, Tsang SW, Yuen PM. An audit on hysterectomy for benign diseases in public hospitals in Hong Kong. Hong Kong Med J. 2007;13(3):187- 93.

El-Toukhy TA, Hefni M, Davies A, Mahadevan S. The effect of different types of hysterectomy on urinary and sexual functions: A prospective study. J Obstet Gynaecol. 2004;24(4):420-5.

Helmy YA, Hassanin IMA, Elraheem TA, Bedaiwy AA, Peterson RS, Bedaiwy, MA. Psychiatric morbidity following hysterectomy in Egypt. Int J Gynecol Obstet.2008;102(1):60-4.

Okunlola MA, Umuerri C, Omigbodun OO, Morhason-Bello IO, Okonkwo SN, Ojengbede OA. Pattern of mental ill health morbidities following hysterectomy for benign gynaecological disorders among Nigerian women. Int J Mental Health Syst. 2009;3(1):18.

Ackner B. Emotional aspects of hysterectomy. A follow-up study of fifty patients under the age of 40. In: European Conference on Psychosomatic Research 1960 (Vol. 1, pp. 248-252). Karger Publishers.

Gath D, Cooper P, Day A. Hysterectomy and psychiatric disorder, I: levels of psychiatric disorder before and after hysterectomy. Br J Psychiatry 1982;140(4):335-42.

Thakar R, Ayers S, Georgakapolou A, Clarkson P, Stanton S, Manyonda I. Hysterectomy improves quality of life and decreases psychiatric symptoms: a prospective and randomised comparison of total versus subtotal hysterectomy. BJOG 2004;111(10):1115-20.

Sung MH, Lim YM. Factors affecting sexual satisfaction in Korean women who have undergone a hysterectomy. Austra J Advance Nurs, The. 2009;27(2):46.

Jawor M, Dimter A, Marek K, Dudek D, Wojtys A, Szproch A. Anxiety-depressive disorder in women after hysterectomy. Own study. [In Polish]. Psychiatr Pol 2001;35(5):771-80.

Flory N, Bissonnette F, Binik YM. Psychosocial effects of hysterectomy: literature review. J Psychosom Res. 2005;59(3):117-29.

Persson P, Wijma K, Hammar M, Kjolhede P. Psychological wellbeing after laparoscopic and abdominal hysterectomy-a randomised controlled multicentre study. BJOG 2006;113(9):1023-30.

Weber AM, Walters MD, Schover LR, Church JM, Piedmonte MR. Functional outcomes and satisfaction after abdominal hysterectomy. Prim Care Update Obstet Gynecols. 1998;5(4):203.