Marchant-Haycox, Susan Elizabeth; (1996) Psychological aspects of hysterectomy. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Psychological research into hysterectomy has focused on negative effects of the procedure such as depression. Although it is commonly performed in the absence of physical pathology, there is very little information about why this occurs. This thesis explores possible reasons. Chapter One examines the role of the uterus, reproductive organs and hysteria and explores the historical, medical and psychological background of menstruation and menstrual disorders. Chapter Two looks at the psychological sequelae of hysterectomy by considering methodological issues, retrospective and prospective studies, expectations and satisfaction and women's knowledge of the reproductive system, the uterus and sexuality. In Study 1 and Study 2 (Chapter Three) explores patients' expectations of Psychological Aspects of treatment. This was done by developing a standardized measurement of women's expectations of treatment (ETQ), In Study 1 it was found that women who expect hysterectomy as part of the treatment process have high expectations of benefit and harm, whereas women' expectations in of other treatments were not so extreme. In Study 2, women were randomly assigned to provide expectations of specific treatment. The results showed that the expectations of women in the hysterectomy group were the same as those in study 1. The study in Chapter Four explored factors - physical and sexual abuse, depression, anxiety, somatization, hypochondriasis, feelings towards the womb, past and present menstrual problems - which might influence patients' desire for hysterectomy and their expectations regarding outcome of treatment. The results show that patients who have experienced sexual and physical abuse report higher levels of depression, anxiety and somatization and have more negative feelings towards their womb than patients who have not experienced abuse. There was however no difference between abused and non-abused patients in their desire for hysterectomy. Menstrual pain was found to have a greater influence on patients outcome expectations of treatment than menstrual blood loss and depression. Also the women who desired hysterectomy had high expectations of benefit/harm as in studies 1 and 2. The final study in Chapter Five explored how gynaecologists negotiate with patients presenting with menstrual problems and who had already undergone an investigative procedure. The results indicate that patients who are offered hysterectomy use specific strategies in their negotiation for treatment and they are perceived by the doctor as having a considerable influence on the outcome of the consultation. Patients who are offered other treatments are not outstanding in their strategies nor are they perceived as having a major influence on the outcome of the consultation. It is reasonable to assume that there are a number of different factors such as high positive and negative expectations of treatment outcome, depression and negative feelings towards the womb, that influence patients to desire hysterectomy. Furthermore, in doctor-patient interactions, patients who are offered hysterectomy often use specific strategies in order to have this operation.

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