Copyright 2000 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
To the Editor: The study reported by Dr Rhodes and colleagues,1 like previous studies evaluating the effect of hysterectomy on sexual behavior,2 - 4 focused on the quantity rather than the quality of sexual activity. Rhodes et al measured sexual function with closed response and multiple-choice questions rather than standardized sexual response questionnaires or interviews that would have brought greater meaning and specificity to the results.
Questions regarding the subjective experience of sexual arousal before and following hysterectomy were not asked. An attempt was made to quantify strength of orgasm, but how does one measure and compare "very strong" vs "strong" orgasms? No questions addressed whether orgasm was experienced in a qualitatively different way (eg, noting uterine contractions).
The authors state that "few women who were having orgasms before hysterectomy stopped having them after hysterectomy." It would be valuable to learn more about this group and which factors predict women most likely to experience sexual difficulties following surgery. Similarly, the authors claim that "[i]ncreased sexual activity after hysterectomy may be the strongest evidence of a positive effect of hysterectomy on sexual functioning." Clinical experience indicates that increased frequency is not directly related to satisfaction. The frequency of intercourse after hysterectomy can increase because the underlying cause that prevented it has been eliminated (eg, bleeding). However, the intensity and multidimensional nature of orgasm may have changed compared with the preoperative state, and this was not measured. Also, frequency of intercourse is affected by many factors, including relationship dynamics.
Many women were not sexually active either before or after surgery (Table 3), a finding that requires further explanation. Table 3 in the original article also reveals that 10% to 16% of the women who had no sexual problems before hysterectomy either reported a sexual problem or stopped being sexually active after surgery. Considering the half a million hysterectomies performed in the United States each year, this represents a large number of women and is reason for concern.5
In light of the complexity of the determinants and mechanisms of sexual response in women, and the limited focus of this study on short-term and behavioral measures, we are left with an incomplete picture of the effect of hysterectomy on the quality of women's sexual lives.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Instructions
Comments are moderated and will appear on the site at the discretion of the Journal of American Medical Association editors. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest* Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Register Now
Enter your username and email address. We'll send you a reminder to the email address on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.