Prophylactic oophorectomy at elective hysterectomy. Effects on sexuality and psychological well-being

Abstract: Background: Ovarian stromal androgens in perimenopausal women are supposed to be of importancefor sexuality and psychological well-being. This notion is based on findings from studies after theadministration of exogenous androgens and retrospectively designed studies on the outcome afteroophorectomy.Aims: 1. To determine effects of oophorectomy, entailing androgen reduction, during hysterectomy atthe perimenopausal transition on sexual function and psychological well-being (PGWB). 2. Toelucidate possible correlations between sexuality and PGWB. 3. To evaluate the characteristics ofwomen who choose hysterectomy only (HYST group) vs. hysterectomy+oophorectomy (HYST+BSOgroup).Study design and population: A prospective observational study was done. Peri- andpostmenopausal sexually active women, age 45-55, scheduled for elective hysterectomy wereinvestigated preoperatively and one-year after surgery. A total of 491 were included and 441 (98%)women completed the one-year follow-up. In the perimenopausal population (n=323), 217 womenunderwent HYST and 106 women underwent HYST+BSO. In the postmenopausal population(n=118), 54 women underwent HYST and 64 underwent HYST+BSO.Methods: Sexuality (McCoy s Female Sex Questionnaire) and psychological well-being(Psychological General Well-being Index) were evaluated. The modified Kupperman s climactericindex was used to indicate the prevalence of climacteric symptoms. Hormone replacement therapy(HRT) and estrogen replacement therapy (ERT) use was reported. Sex steroids were measured andfree androgen/estrogen indices were calculated. Postoperatively, ERT was recommended to all womenin the HYST+BSO group and to HYST group subjects with climacteric symptoms.Results: Sexuality: There were no substantial preoperative to one year follow-up changes in eithergroup in both populations. Preoperatively, perimenopausal women who chose to undergosimultaneous oophorectomy had significantly lower sexuality scores, compared to the HYST group; adifference which prevailed postoperatively. PGWB: Postoperatively, both groups in both populationsshowed improvement in psychological well-being to the same extent. Systematic positive correlationswere found between PGWB and sexual variables. Sex steroids: Preoperatively, no differences werefound between the HYST vs. HYST+BSO group, in either population. Postoperatively, a decrease inandrogen levels was observed in both groups, most pronounced in the HYST+BSO groups. Therewere no correlations between the observed changes in androgens and observed changes in sexual orPGWB variables. Stepwise multiple regression analyses demonstrated that the predictor variables(age, sex steroids, ERT) only explained a small fraction of the variance (1 4.7%).Conclusions: 1. Prophylactic oophorectomy, entailing androgen reduction, in peri- post-menopausalwomen, undergoing hysterectomy, neither adversely affects sexuality nor negatively influences theexpected positive changes in PGWB, provided that patients take ERT. 2. Sexuality and PGWB arepositively systematically correlated. 3. There are differences in preoperative characteristics betweenwomen who choose hysterectomy only vs. women who choose hysterectomy-oophorectomy.