Mokate Tefo, Wright Caroline, Mander Tony
Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester, UK.
J Br Menopause Soc. 2006 Dec;12(4):153-7. doi: 10.1258/136218006779160607.
Hysterectomy is one of the most common major gynaecological operations performed in the UK and the USA. Its impact on sexual function is a major cause of preoperative anxiety. Unfortunately, this anxiety is seldom articulated by patients, nor recognized and discussed by clinicians. Reports about the impact of hysterectomy on sexual function have been conflicting, partly due to the use of different and often unsatisfactory parameters to assess sexual function. The aim of this review is to assess the current evidence about the effect of hysterectomy on sexual function. Female sexual function is governed by psychological, social and physiological factors. A new model of 'the sexual response cycle', comprising physical, emotional and cognitive feedback, helps explain the sexual difficulties that arise before and after hysterectomy. Evidence is lacking for sexual dysfunction caused by the disruption of local nerve and blood supply, or by changing anatomical relationships. Removal of the ovaries at hysterectomy is associated with no change or even an improvement in sexual function, particularly in women on hormone replacement therapy. Thus, overall, hysterectomy improves sexual function, regardless of surgical method or removal of the cervix. This is probably due to the amelioration of the symptoms that have previously had a negative effect on sexual function.
子宫切除术是英国和美国最常见的大型妇科手术之一。其对性功能的影响是术前焦虑的主要原因。不幸的是，这种焦虑很少被患者表达出来，临床医生也很少认识到并进行讨论。关于子宫切除术对性功能影响的报道一直存在矛盾，部分原因是使用了不同且往往不尽人意的参数来评估性功能。本综述的目的是评估目前关于子宫切除术对性功能影响的证据。女性性功能受心理、社会和生理因素支配。一种新的“性反应周期”模型，包括身体、情感和认知反馈，有助于解释子宫切除术前和术后出现的性困难。缺乏证据表明性功能障碍是由局部神经和血液供应中断或解剖关系改变引起的。子宫切除术中切除卵巢与性功能无变化甚至改善有关，尤其是在接受激素替代疗法的女性中。因此，总体而言，子宫切除术可改善性功能，无论手术方法或宫颈是否切除。这可能是由于之前对性功能有负面影响的症状得到了改善。
