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.
April 1995 (rev Jan 1998)