Why do people sometimes get
depressed after hysterectomy?
If performed in a young age group there is the obvious major factor of
loss of fertility, but there are also other factors which apply in any age
group including women of child-bearing age who have had a sterilisation
procedure or have chosen not to have more children.
It is rarely due to hormonal disturbance and in most instances the
ovaries are conserved.
For an older woman who is
childless - for whatever reason - there is the significance of having her
'final' chance taken away from her, and of losing the organ that she would have
liked to have borne her children. For a
woman who has - again for many reasons - not married, there may be the grief
associated with saying goodbye to the dream of marriage and motherhood.
Thus hysterectomy represents a
watershed or dividing line in a person's life.
There may be griefs associated with the children that they have had, or
the children that they have not had but wanted. It represents a very sharp demarcation between life before with
its associated griefs and lost opportunities and the life that is to come. It is a sharp reminder of ageing and that
there are things they may not be able to experience in life.
Some women worry about their
sexuality and the difference that hysterectomy might make. In brief it is safe to say that there need
be no difference in sexual relationships after hysterectomy. Indeed women are frequently free of pain
that they have previously experienced and it allows for a 'freeing up' of
sexual relationships, free of pain and free of risk and therefore results in an
enhancement of the relationship.
Female climax seems to be more
commonly associated with surface anatomy rather than deep, and the quality not
usually affected. In any event, for
those women in whom cervical pressure is part of climax, disease processes
associated with the cervix and uterus - and for which the operation is being
done - have commonly interfered with this part of the experience for many
years.
More subtle is the threat of
interfering with a woman's 'sexual identity' and not feeling as much of a woman
as previously. Although understandable,
this is also a groundless fear as sexuality is built into the genetic structure
and even if the ovaries also need to be removed, this in no way alters a
woman's sexual identity. She is still
as much female as she was before. But
there may still be grief at the loss of a significant sexual organ, and saying
goodbye to 'completeness.'
For some there may be the feeling
of 'invasion' - that they have been 'desecrated' in some way by an 'assault' on
what is precious and sacred and private.
It is in understanding these
aspects and fears that benefits come and the possibility of depression
occurring is minimised. Depression can
still occur because a major operative procedure has been performed and an
anaesthetic given, as much as for any other procedure, but understanding of
these factors is important in the prevention of depression.
Lachlan Dunjey
April
1995 (rev Jan 1998)