They also found no evidence from these trials that removal of the cervix impaired sexual function. Satisfaction with sex, prevalence of painful intercourse and rates of sexual problems in the year or two following surgery did not differ significantly according to the type of hysterectomy.
"Early studies taught that subtotal hysterectomy was better than total hysterectomy in terms of sexual function, urinary function, and GI function, but these studies were not well done," said Howard Sharp, M.D., of the University of Utah School of Medicine. "Now that we've had a few studies that have been done with a much higher degree of scientific rigor, they're showing us that there's really no difference in terms of these outcomes."
The reviewers did find that women having total hysterectomy had a greater risk of fever during surgery. Operating time was about 11 minutes shorter for subtotal hysterectomy in the two trials that measured this, and women who underwent subtotal hysterectomy in these studies also lost less blood, on average, than women having total hysterectomy. However, there was no significant difference in the need for blood transfusions according to type of surgery.
"An 11-minute difference in the operating room is statistically significant, but I think it's clinically irrelevant," said Sharp. "And while we would all like to hang on to every drop of blood we can get, what really matters to me is whether I have to transfuse a patient."
Another potential disadvantage of total hysterectomy, an increased risk of vaginal vault prolapse, was not confirmed in the review. The authors noted that to assess this risk properly, longer follow-up of trials would be needed.
One significant difference of possible relevance to some women was the greater likelihood of ongoi
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Contact: Anne Lethaby
a.lethaby@auckland.ac.nz
Center for the Advancement of Health
12-May-2006