Pelvic organ prolapse patients’ attitudes and preferences regarding their uterus: comparing German- and Russian-speaking women

Abstract

Introduction and hypothesisThe aim of this study was to compare preferences of patients with pelvic organ prolapse (POP) regarding their uterus between German- and Russian-speaking areas.MethodsSix urogynecologic tertiary referral centers participated in this prospective study: three centers from German-speaking countries and three from different regions of Russia. To assess the uterus-related preferences as well as the attitude toward hysterectomy versus uterus-sparing prolapse surgery, we developed a structured questionnaire that included 5-point Likert scales related to benefit of uterus (BOU) and benefit of not having uterus (BNU). Each scale consisted of 12 items (range of possible scores: 12–60). Finally, patients were asked if they preferred uterus removal or preservation when undergoing prolapse surgery.ResultsOne hundred and seventy-eight German-speaking and 206 Russian-speaking patients were included in the study. There was no significant difference in patients’ preference before undergoing POP surgery regarding uterus preservation versus hysterectomy between German- and Russian-speaking patients: 40% of German-speaking and 54% of Russian-speaking patients preferred to retain their uterus before undergoing POP surgery.Comparison of BOU mean scores showed a significant difference between groups: 20.6 ± 6.7 for German-speaking compared with 32.5 ± 9.1 for Russian-speaking patients (p < 0.01). The Russian-speaking group had significantly higher mean scores on domains sexuality, body image, and partnership of the BOU scale (2.6 ± 1.0 vs. 1.8 ± 0.9 for sexuality; 2.4 ± 1.1 vs. 1.5 ± 0.7 for body image, and 2.6 ± 0.9 vs. 1.6 ± 0.7 for partnership domains; p < 0.05).ConclusionsAlthough a large proportion of German- and Russian-speaking patients prefers uterus preservation when undergoing prolapse surgery, the uterus was more important for sexuality, partnership, and body image in Russian-speaking patients.Electronic supplementary materialThe online version of this article (10.1007/s00192-019-03918-9) contains supplementary material, which is available to authorized users.

Impact on sexual functioning: total versus subtotal hysterectomy

“…In fact, this operation can be considered as an "organ amputation", which makes it di cult to accept, in addition to the symbolic value of the uterus. Indeed, its loss would be synonymous with the loss of femininity and reproductive capacity, which would have a heavy psychological impact [36]. On the other hand, the disappearance of menstruation after surgery can be experienced as a loss of sexual identity.…”

“…Vaginal dryness is frequently described in patients. It is explained by estrogen de ciency and by iatrogenic lesions of the autonomic innervation pathways responsible for the innervation of the vagina [5,36]. Its frequency is much greater in postmenopausal patients or those who have had bilateral adnexectomy [22,28].…”

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“… 17 In addition, when non-inferior outcomes are guaranteed, it is widely accepted how women do prefer to avoid concomitant hysterectomy. 18 , 19 Third, treating uterine prolapse by removing the organ could be detrimental, as it may raise the complications rate, while it just represents a passive element of POP pathogenesis, rather than its cause. 20 In our experience, uterus-sparing RSCP provided perioperative and functional outcomes consistent with those reported in current literature.…”

Reproductive Results in Cancer Survivors after Fertility Sparing Management: The Need for the Standardization of Definitions

“…Reasons for the rejection of a hysterectomy included a sense of feeling older, plus sadness about losing fertility and body image due to the removal of the uterus. Different preferences regarding uterine preservation were found among populations: 31% among Hispanics, 40% among Germans, and 54% among Russians [59,60]. It was found that being older was a positive predictor of the decision to undergo a hysterectomy: compared with younger women below 40 years of age, women aged 45 to 49 years were less likely to use alternative treatments prior to a hysterectomy (OR 0.41; 95% CI: 0.21-0.76) [61].…”