Sexual life after gynaecological operations-I.

Abstract

In a reveiw of sexual problems after gynecological operations, social, cultural, and psychological overtones beyond the immediate physical effect were discussed. Sexual difficulty may occur unless sympathetic advice has been made available before and after a procedure. Hysterectomy, either abdominal or vaginal, results in only temporary restriction of 6 weeks, although 3-4 months may be necessary to return to normal. Difficulties may arise in postoperative recovery; however, coitus will help tissues to stretch. Continuing maladjustment may be due to psychological factors preceeding the operation or fears fostered by erroneous notions. Subtotal hysterectomy was considered an obsolete procedure and removal of the cervix as in total hysterectomy allows the full cycle of sexual response. Complete oophectomy results in a lack of estrogen and will reduce libido, lubrication and sensation in the lower genital tract. A daily oral estrogen supplement should be considered. The treatment of uterine cancer has profound effects on the sexual activity. Wertheim's hysterectomy necessitates a long recovery and entails removal of the upper 1/3 of the vagina. The resumption of coitus will gradually stretch the vagina. Anxiety, however, may produce a serious loss of libido in husband and wife. Radiotherapy seriously distorts the lower genital tract in 80% of cases. Knowledge of the results of treatment in this disease can help in choosing between alternatives. Explanation and sympathy can help reduce the fear, anxiety and guilt of treatment.