| Summary: | In North America, hysterectomy is the most common major surgery for benign non-obstetric reasons (e.g., uterine fibroids, endometriosis, abnormal bleeding) in premenopausal women. Many of these conditions may result in pelvic pain, sexual and psychological difficulties. However, the capacity of hysterectomy to relieve these problems has not been adequately evaluated. Recently, there has been controversy as to whether less invasive surgeries such as subtotal hysterectomy, in which the uterus is removed and the cervix is left intact, are less detrimental than total hysterectomy, in which both the uterus and the cervix are excised. === The first part of this thesis consists of a comprehensive review of the literature on the psychosocial outcomes of hysterectomy published within the past 30 years. Controversial theories, empirical studies, and review articles are discussed with regard to sexual, pain, and psychological outcomes. Findings suggest that while hysterectomy results in reduced pain, there are no strong effects on sexual or psychological functioning. Nevertheless, many studies reported adverse psychosocial outcomes in a subgroup of 10-20% of women post-hysterectomy. === The second part of this thesis presents findings from a randomized controlled trial investigating the psychosocial outcomes of total versus subtotal hysterectomy. Premenopausal patients with benign gynecological conditions were randomly assigned to either total hysterectomy, i.e., laparoscopic assisted vaginal hysterectomy (N=32), or subtotal hysterectomy, i.e., supra-cervical laparoscopic hysterectomy (N=31). In addition, two control groups of premenopausal women undergoing minor gynecological surgery (N=30) and healthy women undergoing no surgery (N=40) were recruited. For the two hysterectomy groups, abdominal pain was significantly reduced post-surgery. There was some evidence for positive effects of hysterectomy on sexual functioning, while psychological functioning did not significantly change. The study indicated that total and subtotal hysterectomy produced equally beneficial outcomes. Although 3-16% of women reported various adverse effects in psychosocial functioning post-hysterectomy, similar percentages of the two control groups reported such changes.
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