Recovery time period and quality of life after hysterectomy.

Background: Women who had undergone hysterectomy have to overcome problems related to sexual and reproductive health. They often suffer a decline in self-esteem due to sexual dysfunction and the inability to give birth, along with their quality of recovery. This study aims to describe the relationships between recovery time and the components of quality of life after hysterectomy. D esign and methods: 103 women post-hysterectomy from several community-integrated health center in Surabaya were selected using the total sampling technique.
Results: Findings show that there is relationship between recovery time period and sexual activity (P=0.000). However, no significant relationship exists between recovery time period personal relationships and social support. Conclusions: It is recommended that nurses should improve their social support for women and families during recovering, to avoid pathological stress and improve quality of life. ©Copyright: the Author(s).

Introduction

Hysterectomy is the most common uterine removal procedure for women. Every year, more than half a million women undergo hysterectomy for different reasons in the US alone.[1,2] The procedure is performed once several indicators of risk are visible, including fibroids or myoma, which is one of the most common risk factors for women’s health. Although it is not the only way of overcoming problems in the reproductive organs, it is the best strategy to deal with many diseases permanently.[3,4] The uterus is a very critical reproductive organ, especially for married women.[5,6]

The results of initial data collection at the Wonokromo Health Center on January 12th, 2019, showed that there were 15 posthysterectomy women out of 20 reproductive health cadres in Wonokromo. In Jagir and Kebonsari, there were 8 and 7 posthysterectomy respectively. Hysterectomy is mainly experienced by women in childbearing age, specifically 15-49 years. Among the social interactions that might be impacted by the operation, sexual relations is especially affected.

An international survey, including 4,507 women aged 18-59 who underwent a hysterectomy revealed that 34% of participants experienced a decrease in sexual interest, and 19% did not consider sexual relations necessary. A survey by Chinese University - Hong Kong in 2002 established that out of 1,656 women, 50% suffered sexual dysfunction. A study by Urology Subdivision FKUI / RSCM in 2001 shows that out of 560 healthy female respondents (not patients), data that 15% suffered sexual dysfunction. However, only 15% felt they needed help.

Hysterectomy has several impacts on women, affecting the quality of life.[7-9] This is effects include physical, psychological, environmental and social relations.[10,11] Social relationships refer to the interactions between different individuals and how it affects them. It includes personal relationships, social support and sexual activity.[12,13] In the personal relations post-hysterectomy women experience changes as they adapt to the environment, such as eating and drinking, obeying regulations, building a shared commitment in a group or community, personal beliefs about strength when facing difficulties and even confidence in themselves.[14,15] Some post-hysterectomy women receive social support from friends and family.[16]

Different length of recovery time period may affect quality of life after hysterectomy. Adequate help and support from friends, family and health care professionals, could improve their quality of life after surgery.[17,18] They also had more opportunities to meet their friends and family.[19] This study aims to describe the relationships between recovery time period and the components of quality of life after hysterectomy.

Design and methods

This is an analytical observational study, with 103 women post-hysterectomy were selected using the total sampling technique from three community-integrated health center in Wonokromo, Jagir and Kebonsari. Questionnaires were used to measure recovery time period and quality of life of hysterectomized women by The Indonesian version of the WHOQL-BREF (World Health Organization Quality of life). SPSS 22.0 was used to analyze the relationship between variables.

Result and discussion

The quality of life aspects include personal relationships, social support and sexual activities. Findings show that there is relationship between recovery time period and sexual activity (P=0.000) (Table 1). The results show that out of the three aspects of quality of life, post-hysterectomy women experienced a significant decrease in sexual activity. This may happen as they had passed the adaptation time after losing one of their essential organs. However, no significant relationship exists between recovery time period and personal relationships and social support. Additionally, their personal relationship was quite well after 12 to 24 months. They can resume their activities and obligations as housewives. Women can adapt to maintain their integrity in personal relationships. Difficulties in maintaining personal relationships are characterized by insecurity, not daring to try new things, fearing failure, pessimism, and feeling worthless: only a few individuals can get through it. The positive individuals are always optimistic,[20] dare to try new things, confident, set life goals, and behave and think positively to be meaningful in the surrounding.[21,22] The most significant support received is from the family, especially their husband and children. During the posthysterectomy adjustment,[23] their family needs to help them cope with discouragement.[24] Family and social support from the surrounding environment affect the quality of life. One aspect of social support is instrumental support,[25] which involves direct assistance and financial help. According post-hysterectomy women report received social support from friends and family. [26]

Table 1.

Relationships between recovery time period and quality of life.

Quality of life	Recovery time period (N= 103)						P value
	6-24 months		25-48 months		>49 monthsResult and discussion
	n	%	n	%	n	%
Personal relationships
Satisfy	15	14.5	15	14.5	45	43.7	0.083
Moderate	16	15.5	12	11.6	0	0
Social support
Satisfy	8	7.7	8	7.7	10	9.7	0.402
Moderate	15	14.5	20	19.4	35	33.9
Not satisfy	0	0	0	0	7	6.7
Sexual activity
Moderate	0	0	7	6.8	8	7.8	0.000
Not satisfy	0	0	10	9.7	40	38.8
Very dissatified	20	19.4	10	9.7	8	7.8

Meanwhile, regarding sexual activity, post-hysterectomy women often refuse to have sexual relations due to anxiety and depression. Based on in-depth interviews with it is necessary to improve the integrity of the structure and function of defending themselves with the initial adaptation of sexuality after hysterectomy. [27,28] Some respondents stated that after the hysterectomy, sexual activity was different. Respondents often consulted doctors on sexual activity, and even some had hormone therapy for sexual stimulation. [29,30]

Conclusions

It is recommended that nurses should improve their social support for women and families during recovering, to avoid pathological stress and improve quality of life.