Quality of life and sexual function after hysterectomy in women with preoperative pain and depression.

OBJECTIVE: We sought to examine differences in quality of life and sexual function after hysterectomy among women with preoperative pain and depression.

METHODS: We analyzed data from a cohort study of 1,249 women who had hysterectomies for benign conditions. Participants were interviewed, before surgery and at 5 intervals after, regarding pelvic pain, depression, quality of life, and sexual function. We compared quality of life and sexual function at 6 and 24 months among women with preoperative pelvic pain alone, depression alone, both pelvic pain and depression, or neither.

RESULTS: At 24 months, women with pain and depression had reduced prevalence of pelvic pain (96.7% decreased to 19.4%), limited physical function (66.1% to 34.3%), impaired mental health (93.3% to 38.1%), and limited social function (41.1% to 15.1%). Women with pain only improved in pelvic pain (95.1% to 9.3%) and limited activity level (74.3% to 24.2%). The group with depression only had improvement in impaired mental health (85.1% to 33.1%). Dyspareunia decreased in all groups. Compared with women who had neither pain nor depression, women with depression and pain had 3 to 5 times the odds of continued impaired quality of life: odds ratio (OR) 2.73, 95% confidence interval (CI) 1.78-4.19 for limited physical function; OR 3.41, 95% CI 2.13-5.46 for impaired mental health; OR 5.76, 95% CI 2.79-11.87 for limited social function; OR 4.91, 95% CI 2.63-9.16 for continued pelvic pain; and OR 2.41, 95% CI 1.26-4.62 for dyspareunia.

CONCLUSION: Women with pelvic pain and depression fare less well 24 months after hysterectomy than women who have either disorder alone or neither. Nevertheless, these women improve substantially over their preoperative baseline in all the quality of life and sexual function areas assessed.

LEVEL OF EVIDENCE: II-2