Perimenopausal androgen decline after oophorectomy does not influence sexuality or psychological well-being

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1 Perimenopausal androgen decline after oophorectomy does not influence sexuality or psychological well-being Adel Aziz, M.D., Mats Brännström, M.D., Ph.D., Christer Bergquist, M.D., Ph.D., and Gunnar Silfverstolpe, M.D., Ph.D. Department of Obstetrics and Gynecology, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden Objective: To determine whether oophorectomy during the perimenopause, with the associated decline in ovarian androgens, affects sexual function and psychological well-being negatively. Design: Prospective, observational study comparing sexuality and psychological well-being in women after hysterectomy only (HYST) vs. hysterectomy and concomitant oophorectomy (HYST BSO). Setting: University hospital and district general hospital. Patient(s): Three hundred sixty-two perimenopausal women scheduled for elective hysterectomy on benign indication were recruited and 323 (89%) completed the 1-year follow-up (217 in the HYST group and 106 in the HYST BSO group). Intervention(s): The patients were evaluated preoperatively and 1 year after surgery. Postoperatively, estrogen replacement therapy was recommended to all women in the HYST BSO group and to HYST group subjects with climacteric symptoms. Main Outcome Measure(s): Sex steroids (T, androstenedione, DHEA-S, and E 2 ) and sex hormone-binding globulin (SHBG) were measured. Free androgen index and free E 2 index were calculated. Sexuality (McCoy s Female Sex Questionnaire) and psychological well-being (Psychological General Well-Being Index) were evaluated. Results(s): ly, no hormonal differences were found between the two groups. At 1-year follow-up, all sex steroid levels and indices were decreased and SHBG was increased in the HYST BSO group. Ovarian sex steroids were decreased in the HYST group, whereas DHEA-S and SHBG were unaltered. Sexuality was unaltered in the HYST BSO group, whereas decreased scores were found in 3 of 14 sexual variables in the HYST group. Psychological well-being was improved in both groups. There were no correlations between the observed changes (data 1 year after surgery, compared with preoperative data) in androgen levels and index and the observed changes in any aspect of sexuality or psychological well-being. Conclusion(s): Hormonal changes after oophorectomy in conjunction with perimenopausal hysterectomy do not significantly change postoperative (1-year) sexual or psychological well-being. (Fertil Steril 2005;83: by American Society for Reproductive Medicine.) Key Words: Adrenal, hysterectomy, ovary, prophylactic oophorectomy, psychological general well-being, sex steroids, sexuality Received June 2, 2004; revised and accepted December 8, Supported by grants from the Health and Medical Care Executive Board of the Västra Götaland Region, the Göteborg Medical Association, the Swedish Research Council (no to M.B.), and the Medical Faculty at the Sahlgrenska Academy. Reprint requests: Adel Aziz, M.D., Salgrenska Academy, University of Göteborg, Department of Obstetrics and Gynecology, Borås Hospital, , Borås, Sweden (FAX: ; Several biological, psychological, social, and interpersonal changes occur during the perimenopausal transition, and these events might directly or indirectly affect women s psychological general well-being and sexuality. Hysterectomy due to menorrhagia, uterine fibroids, or other benign causes is a common procedure at this stage of life. There are some studies indicating improvement in quality-of-life aspects, such as sexuality (1, 2) and psychological well-being (3, 4), after hysterectomy. However, the effects of concomitant oophorectomy at hysterectomy are controversial and unclear. Sex steroids are assumed to play a central role in maintaining sexual function and psychological well-being (5, 6). Estrogen (E) insufficiency is assumed to contribute to impaired sexual function by causing vaginal dryness and decreased genital sensation (7). Estrogen insufficiency can be treated with E therapy; however, no standard androgen replacement therapy is as yet available. During the last decade, a limited number of studies have addressed the question of whether oophorectomy during the perimenopause affects sexuality and well-being. In an interview/questionnaire study of women who had undergone hysterectomy with or without oophorectomy approximately 5 10 years before the study, women who had undergone concomitant oophorectomy reported a decline in sexuality more often than non-oophorectomized women (8). In the /05/$30.00 Fertility and Sterility Vol. 83, No. 4, April 2005 doi: /j.fertnstert Copyright 2005 American Society for Reproductive Medicine, Published by Elsevier Inc. 1021

2 same study, a negative influence of oophorectomy on coital frequency and satisfaction from intercourse was also found. Another retrospective interview/questionnaire study reported less pleasure from coitus, less libido, and more lubrication problems in women having undergone simultaneous oophorectomy at hysterectomy, compared with those with intact ovaries, regardless of whether estrogens were given (9). These studies suggested that the change in sexuality was due to the loss of ovarian androgens rather than to other aspects of the changed physiologic or psychological state. The results of randomized cross-over trials is another source of information about the role of androgens in sexuality and well-being, demonstrating that exogenous androgens improve some aspects of female sexuality and, in some cases, psychological general well-being as well (10 12). However, because these studies were performed with androgen doses leading to supraphysiologic blood levels or were performed on women with sexual dysfunctions, the data obtained do not necessarily apply to the clinical state after oophorectomy. Thus, the combined experience from the retrospective studies indicating negative effects of prophylactic oophorectomy on sexuality and the pharmacologic androgen treatment trials have led to the established notion that the loss of ovarian androgens after oophorectomy during the perimenopause affects sexuality and psychological well-being negatively (13). However, even if the risk of ovarian cancer after hysterectomy is reported to be lower than in non-hysterectomized women (14), the risk of cancer in retained ovaries might cause concern to many women. Retaining the ovaries at hysterectomy will also lead to a substantial number of these women having to undergo another major surgical procedure later in life for an adnexal mass, a benign and asymptomatic condition in the majority of cases (15). To test whether oophorectomy affects sexuality and psychological well-being negatively, a prospective study with comparisons of changes in hormonal, sexual, and psychological variables after hysterectomy plus bilateral salpingooophorectomy and hysterectomy only was carried out. MATERIALS AND METHODS Study Population and Design The study was approved by the Ethics Committee of Sahlgrenska Academy, and all participants gave their informed consent for participation. The study design and results have been approved by the institutional review board at the Department of Obstetrics and Gynecology, the Sahlgrenska Academy. The inclusion criteria were age years, last menstruation 12 months previously, sexually active (at least one episode of intercourse per month during the past 6 months), being part of a partner relationship, and scheduled for hysterectomy on benign indication. Women with psychiatric or medical conditions that might interfere with the studied parameters and those who had previously sought medical help for sexual problems were excluded. The study population of Swedish women was recruited ( ), operated on, and followed-up at the Sahlgrenska University Hospital or Borås Hospital. The preoperative evaluation was performed within 2 months before surgery. A physical examination was carried out, and blood samples were taken and stored at 20 C until analysis. The women completed the preoperative questionnaires, including questions regarding socioeconomic and health data and hormone replacement therapy (HRT) use, and the McCoy Female Sex Questionnaire (MFSQ, see below) and the Psychological General Well-Being Index (PGWB, see below) were completed. Subjects received written information about the possible advantages and disadvantages of prophylactic oophorectomy and met the surgeon for a preoperative informative discussion. The written information mentioned the possible disadvantages of prophylactic oophorectomy (change in endocrine environment with possible negative effects on sexuality and psychological well-being) and the possible advantages of prophylactic oophorectomy (prevention of ovarian cancer and avoidance of future surgery for benign adnexal mass). The women chose either to undergo hysterectomy only (HYST group) or hysterectomy with concomitant bilateral salpingo-oophorectomy (HYST BSO group). All women in the HYST BSO group and women in the HYST group with climacteric symptoms were advised to take E therapy after surgery. The main indication for hysterectomy was bleeding disorders. In the HYST BSO group, 62% reported irregular menstruations, compared with 42% in the HYST group (P.01). All patients were scheduled for a follow-up visit 1 year after surgery, to which they were invited by mail. Women who did not attend received another mailed invitation and a telephone call if they did not respond to the mailed invitation. At follow-up, a physical examination was performed, and blood samples were taken. The participants received the same questionnaires as before surgery (MFSQ, PGWB, and HRT use) to fill out at home and to return by mail. Of the 362 included women, 323 women (89%) completed the 1-year follow-up. Of these 323, 217 women chose hysterectomy only, and 106 chose hysterectomy with concomitant prophylactic oophorectomy (Fig. 1). Twenty-six women (12%) in the HYST group underwent unilateral salpingo-oophorectomy because ovarian cysts were discovered during surgery, and malignancy could not be ruled out. Histologic evaluation showed that all these adnexal cysts were benign. Subtotal hysterectomy was more common in the HYST group (24%) than in the HYST BSO group (4%). There were no differences between the two groups regarding educational level, smoking habits, employment, occupational 1022 Aziz et al. Oophorectomy, sexuality, and well-being Vol. 83, No. 4, April 2005

3 FIGURE 1 Study population. HYST hysterectomy; BSO bilateral salpingo-oophorectomy. a Significantly different (P.001). well-being or distress. The validity and reliability of this instrument are well documented, and it has previously been used to determine the effect of interventions on the patient s sense of well-being (20). The PGWB has been tested on different patient groups, and reference values have been defined (21, 22). Aziz. Oophorectomy, sexuality, and well-being. Fertil Steril status, medication, previous use of oral contraceptives, onset of menarche, previous pregnancies, deliveries, or gynecologic operations. The preoperative body mass index was similar in the two groups and did not differ from the postoperative body mass index. Of the 39 women who did not complete the study, 6 decided not to undergo hysterectomy, and 9 were lost to follow-up due to incorrectly registered personal identification numbers. Of the remaining 24 women (13 in the HYST group and 11 in the HYST BSO group), 16 declined follow-up, and 8 were excluded after surgery because it became evident at this stage that they did not meet the inclusion criteria. McCoy s Female Sex Questionnaire The Swedish version of the MFSQ (16) was used. A considerable amount of data has become available on the reliability and validity of this questionnaire, which covers sexual experience and responsiveness during the last 30 days (12, 17 19). It contains 10 items with a 7-point scale; a high value indicates a high degree of satisfaction. The items represent different aspects of sexual life: [1] satisfaction with present sexual activity, [2] frequency of sexual fantasies, [3] enjoyment of sexual activity, [4] sexual arousal, [5] orgasmic frequency, [6] lubrication, [7] dyspareunia, [8, 9] relationship to the partner as a lover and as a friend, respectively, and [10] coital frequency. Items 2 and 4 are grouped into the subscale sexual desire, 1 4 and 5 are grouped into the subscale satisfaction and 6 and 7 are grouped into the subscale sexual problem. All scores are combined to yield a total score. Psychological General Well-Being Index The PGWB is used to measure self-representations of intrapersonal affective or emotional states reflecting a sense of Hormonal Assays Venous blood samples, taken preoperatively and at 1-year follow-up, were immediately centrifuged and the plasma stored at 20 C to be analyzed at the end of the study. The samples were taken during office hours and were not specifically standardized to avoid diurnal or menstrual cyclical variations (23, 24). Plasma concentrations of total T, E 2, and sex hormone-binding globulin (SHBG) were determined by time-resolved fluoroimmunoassay with a commercial kit (DELFIA; Wallac Oy, Turku, Finland. Serum concentrations of androstenedione (A) and DHEA-S were determined by RIA with commercial kits (Diagnostic Products, Los Angeles, CA). Free androgen index (FAI) was calculated from the ratio (T 100)/ SHBG and free E 2 index (FEI) was calculated from the ratio (E 2 100)/SHBG. Steroid levels in all subjects were above the assay lower levels. Statistics Student s t-test was used for continuous data when examining within- or between-group changes, whereas the 2 test was used for dichotomous variables between groups. P values are reported only when the comparison reached statistical significance of P.05. Correlations were computed by Spearman rank correlation with the significance level of P.01 to avoid possible mass significance. RESULTS Hormone Status The absolute values of hormone levels, the values, and the P values for comparisons within groups are shown in Table 1. P values for comparison between groups are given in the text. The preoperative sex steroid levels and indices did not differ significantly (P.1 in T, FAI, SHBG, E 2, FEI; P.05 in A and DHEA-S) between the HYST and HYST BSO groups. At 1-year follow-up, the HYST group had significantly higher levels of T (P.05), FAI (P.01), A (P.001), and FEI (P.001) and lower levels of SHBG (P.01), compared with the HYST BSO group. When the preoperative and 1-year follow-up levels in the HYST BSO group were compared, significantly lower levels of all sexsteroid levels and indices and a significant rise in SHBG were seen at follow-up (Table 1). When the preoperative and 1-year follow-up hormone levels in the HYST group were compared, significantly lower levels of FAI, A, E 2, and FEI were seen at follow-up (Table 1). When evaluating the observed changes ( ) be- Fertility and Sterility 1023

4 TABLE 1 Hormone status. HYST group HYST BSO group 1-y follow-up change ( ) HYST BSO P HYST mean (SEM) 1-y follow-up P 1-y follow-up P n n T (nmol/l) (0.08) 1.66 (0.09) NS (0.08) 1.32 (0.08) (0.05) 0.23 (0.05) NS FAI (0.37) 3.04 (0.29) (0.21) 1.91 (0.18) (0.20) 0.91 (0.16) NS A (nmol/l) (0.16) 5.81 (0.17) (0.24) 4.75 (0.21) (0.13) 1.23 (0.20).001 DHEA-S ( mol/l) (0.14) 3.89 (0.15) NS (0.20) 3.46 (0.18) (0.10) 0.43 (0.08).01 SHBG (nmol/l) (2.58) (2.57) NS (2.90) (4.09) (2.21) (4.07).001 E 2 (nmol/l) (0.03) 0.31 (0.02) (0.03) 0.26 (0.02) (0.03) 0.09 (0.04) NS FEI (0.05) 0.49 (0.03) (0.05) 0.33 (0.02) (0.05) 0.25 (0.06) NS Note: HYST hysterectomy; BSO bilateral salpingo-oophorectomy; (data at 1 year preoperative data); SEM standard error of the mean; NS non-significant; FAI free androgen index; A androstenedione; SHBG sex hormone-binding globulin; FEI free E 2 index. Aziz. Oophorectomy, sexuality, and well-being. Fertil Steril tween the preoperative and the 1-year postoperative levels in each group and comparing these values between the two groups, the HYST BSO group showed a significantly larger increase in SHBG, a greater decrease in A, and a decrease in DHEA-S (Table 1). McCoy s Female Sex Questionnaire The absolute values of all MFSQ scores, the values, and the P values for comparisons within groups are shown in Table 2. P values for comparison between groups are given in the text. When the HYST and HYST BSO groups were compared preoperatively, it was found that the HYST group had significantly higher scores in the items sexual satisfaction (P.05), sexual enjoyment (P.05), sexual arousal (P.05), orgasmic frequency (P.05), relationship to partner as a lover (P.05), and coital frequency (P.05). There were also higher preoperative scores in the HYST group in the sexual desire (P.01) and satisfaction (P.01) subscales, and the total score was also higher (P.01). At 1-year follow-up, the HYST group, compared with the HYST BSO, scored significantly higher in the items sexual satisfaction (P.05), sexual enjoyment (P.05), sexual arousal (P.05), orgasmic frequency (P.05), relationship to partner as a lover (P.05), and in the satisfaction (P.01) and total score (P.01) subscales. When comparing the preoperative and 1-year follow-up levels, the HYST group scored significantly lower in 3 of the 14 sexual parameters (sexual enjoyment and coital frequency, as well as total score), whereas no significant differences were seen within the HYST BSO regarding any item or subscale (Table 2). The groups did not differ in terms of changes ( ) between the preoperative and the 1-year postoperative scores, for any item or subscale (Table 2). The numbers of subtotal hysterectomies were unevenly distributed between the two groups. Because this matter has been much debated, we performed a subanalysis in the HYST group and could not find that the cervical preservation had an impact on the sexual outcome. Psychological General Well-Being Index The absolute values of all PGWB scores within the respective group, the values, and the P values for comparisons within groups are shown in Table 3. No significant differences were found in PGWB scores between the two groups, either preoperatively or at 1-year follow-up. The groups did not differ in terms of changes between the preoperative and 1-year postoperative scores ( ). Within both groups, the same three PGWB subscales (depressed mood, general health, and total score) were improved 1 year after surgery. There were also improvements in vitality in the HYST group and a reduction of anxiety in the HYST BSO group (Table 3). Correlations Between Sex Steroids and Sexuality/PGWB Because there were no differences between the HYST and HYST BSO groups in preoperative sex steroid levels, and 1024 Aziz et al. Oophorectomy, sexuality, and well-being Vol. 83, No. 4, April 2005

5 Fertility and Sterility TABLE 2 McCoy Female Sex Questionnaire. HYST group (n 217) HYST BSO group (n 106) 1-y follow-up change ( ) n 1-y follow-up P n 1-y follow-up P HYST Mean (SEM) HYST BSO Mean (SEM) P Items Sexual satisfaction (0.11) 5.04 (0.11) NS (0.16) 4.61 (0.17) NS.04 (0.11) 0.06 (0.16) NS Sexual fantasy (0.09) 3.31 (0.09) NS (0.13) 3.21 (0.13) NS.08 (0.08) 0.10 (0.11) NS Sexual enjoyment (0.08) 5.91 (0.09) (0.15) 5.52 (0.14) NS.17 (0.07) 0.17 (0.11) NS Sexual arousal (0.09) 5.76 (0.10) NS (0.17) 5.39 (0.16) NS.12 (0.08) 0.08 (0.12) NS Orgasmic frequency (0.11) 5.43 (0.11) NS (0.17) 4.95 (0.18) NS.07 (0.07) 0.15 (0.10) NS Lubrication (0.11) 5.79 (0.11) NS (0.16) 5.63 (0.18) NS.09 (0.11) 0.22 (0.15) NS Dyspareunia (0.09) 6.32 (0.09) NS (0.13) 6.35 (0.11) NS.07 (0.08) 0.17 (0.11) NS Partner/lover (0.09) 6.00 (0.09) NS (0.16) 5.65 (0.14) NS.09 (0.07) 0.09 (0.11) NS Partner/friend (0.07) 6.36 (0.08) NS (0.13) 6.11 (0.14) NS.07 (0.01) 0.13 (0.10) NS Coital frequency (0.07) 4.65 (0.08) (0.12) 4.45 (0.12) NS.21 (0.07) 0.11 (0.09) NS Subscales Sexual desire (0.15) 9.09 (0.16) NS (0.24) 8.57 (0.24) NS.20 (0.12) 0.01 (0.18) NS Satisfaction (0.35) (0.38) NS (0.58) (0.59) NS.46 (0.27) 0.38 (0.42) NS Problem (0.16) (0.17) NS (0.22) (0.24) NS.00 (0.15) 0.05 (0.21) NS Total (0.55) (0.59) (0.96) (0.90) NS.80 (0.40) 0.77 (0.63) NS Note: HYST Hysterectomy, BSO bilateral salpingo-oophorectomy, (score at 1 year preoperative score), SEM standard error mean, NS non-significant. Aziz. Oophorectomy, sexuality, and well-being. Fertil Steril

6 TABLE 3 Psychological General Well-Being Index. HYST group (n 217) HYST BSO group (n 106) 1-y follow-up change ( ) HYST BSO Mean (SEM) P HYST Mean (SEM) one-year Mean (SEM) P Mean (SEM) one-year Mean (SEM) P Mean (SEM) Anxiety (0.30) (0.33) NS (0.44) (0.44) (0.29) 0.86 (0.37) NS Depressed mood (0.16) (0.19) (0.24) (0.25) (0.16) 0.82 (0.23) NS Positive well-being (0.24) (0.24) NS (0.35) (0.34) (0.21) 0.64 (0.28) NS Self control (0.17) (0.17) NS (0.26) (0.27) NS 0.17 (0.17) 0.36 (0.24) NS General health (0.18) (0.19) (0.30) (0.30) (0.19) 0.72 (0.27) NS Vitality (0.15) (0.15) (0.23) (0.21) NS 0.30 (0.15) 0.39 (0.22) NS Total Score (1.00) (1.11) (1.57) (1.52) (0.93) 3.62 (1.25) NS Note: HYST hysterectomy, BSO bilateral salpingo-oophorectomy, (data at 1 year preoperative data), SEM standard error of the mean, NS non significant. Aziz. Oophorectomy, sexuality, and well-being. Fertil Steril because the primary aim of the present study was to test whether the hormonal changes after surgery would lead to different sexual or psychological well-being outcome, the observed differences between the preoperative and the 1-year postoperative scores ( ) were compared. Only 1 of 98 possible correlations between changes in hormonal levels and changes in sexual scores was found significant (a correlation between observed changes in E 2 level vs. observed changes in relationship to partner as a lover; r 0.185; P.01). There were no correlations between changes ( ) in hormonal levels and changes ( ) in PGWB scores. Hormone Therapy and Climacteric Symptoms ly, more women in the HYST BSO group (23%) than in the HYST group (10%) were taking HRT (P.01). At 1-year follow-up, 98% of women in the HYST BSO group were taking E therapy, compared with 26% of women in the HYST group (P.001). ly, more women in the HYST BSO group suffered from hot flushes (P.001), headache (P.01), vertigo (P.01), irritability (P.05), and depressed mood (P.05), compared with the HYST group. There were no differences in the prevalence of climacteric symptoms between the two groups at 1-year follow-up. DISCUSSION This study addresses the possible effects of prophylactic oophorectomy on sexuality and well-being in a population of women undergoing hysterectomy during the perimenopause. The design of this prospective study included evaluations of hormone levels as well as data on sexuality and psychological well-being, before and 1 year after surgery, to enable examination of possible associations between the changes in hormone levels and factors related to quality of life. Specifically, we aimed at studying the possible effects of the loss of ovarian androgens. Thus, all women in the HYST BSO group and women with climacteric symptoms in the HYST group were advised to take E therapy to achieve postoperative parity between the two groups in all respects, except androgen levels. The main findings of this study were that, despite the expected decrease in androgens (T, A, DHEA-S, FAI) in the HYST BSO group, there were no changes in subjects sexuality and an improvement in their psychological wellbeing. The HYST group showed similar improvement in psychological well-being, whereas there was a decrease in 3 of 14 sexual variables. Furthermore, there were no correlations between the observed (postoperative preoperative) changes in hormone levels and indices and the corresponding changes in sexuality or psychological well-being scores. In the present study, the HYST group scored higher on sexual variables at the preoperative evaluation, compared with the HYST BSO group. This difference might constitute a possible selection bias and might have several expla Aziz et al. Oophorectomy, sexuality, and well-being Vol. 83, No. 4, April 2005

7 nations. The higher prevalence of irregular bleeding, the more frequent climacteric symptoms, and the lower scores on relationship to the partner in the HYST BSO group might be factors underlying a less satisfying sex life. However, at 1-year follow-up, when the women in the HYST BSO group obviously did not experience bleeding and a majority (98%) were taking E therapy, the sexual scores were still lower in this group, compared with the HYST group. Thus, there might be additional unidentified factors responsible for this difference. The design of this study, for which we collected data both preoperatively and 1 year after surgery, also permitted us to evaluate the changes within each group. It should be noted that there were no differences in the observed changes between the two groups regarding any aspect of sexuality. There is a widespread notion that prophylactic oophorectomy during the perimenopause should be avoided because it might affect the woman s sexual life negatively. The data supporting this assumption are rather limited and generally based on retrospective studies requiring women who had undergone HYST or HYST BSO to recall, several years after surgery, their sexuality status and psychological wellbeing before surgery (8, 25). Thus, in one retrospective study of Swedish women who had undergone hysterectomy with or without oophorectomy, it was concluded that the scores for enjoyment of intercourse and coital frequency were higher in the group of women who had intact ovaries (8). The most reasonable explanation for the discrepancy between the results of our prospective study, which did not demonstrate any adverse effects on sexuality after oophorectomy, and the results of previous retrospective studies (8, 25), which did demonstrate an adverse effect, might be that the women who choose prophylactic oophorectomy have less satisfying quality of sexual life preoperatively, compared with women who elect hysterectomy only. This has obviously been shown in the present study. This finding emphasizes the limitations of retrospective studies when evaluating sexuality. The influence of E therapy on sexuality should be taken into consideration in any study on sexuality in the perimenopause, because an association between E levels and sexuality has been shown in women during the perimenopausal transition (6, 26). In a large cohort study, in which women were monitored annually for approximately 8 years (6), it was shown that the decline in female sexual function during this period was more related to decreasing E 2 levels than to androgen levels. Furthermore, beneficial effects of E therapy on sexuality have been reported in oophorectomized women (26). To avoid a possible influence of differences in E 2 levels among the study population, all women in the HYST BSO group and women with climacteric symptoms in the HYST group were advised to take E therapy. Thus, almost all women (98%) in the HYST BSO group and all women in the HYST group with climacteric complaints (26%) were taking E therapy. The two groups were comparable in E status, as seen by the similar E 2 levels, both preoperatively and at 1-year follow-up. Thus, we managed to keep the two groups equally estrogenized as far as can be evaluated with the present methodology. A difference in postoperative E therapy use between the groups is therefore not likely to be a confounding factor. An interesting finding was that E 2 levels in the HYST group were lower 1 year after surgery than before the operation. This decrease in estrogens occurred despite a quarter of the HYST group being given E therapy and despite a follow-up duration of only 1 year, a rather limited interval in the perimenopausal to postmenopausal transition. A plausible explanation for the decreased E 2 levels after hysterectomy is the reduction in ovarian blood flow caused by cessation of the blood flow from the uterine arteries (27). Thus, a nonsymptomatic ovarian deficiency might be induced by hysterectomy (28, 29). It should be pointed out that only 1 of 98 possible correlations between changes in hormone levels vs. changes in sexual scores was found significant. There was a weak negative correlation between observed changes in E 2 level vs. observed changes in relationship to partner as a lover. We can not find any obvious explanation for this finding and it might be ascribed to chance. Thus, we believe that this finding is of no clinical relevance. It has been postulated that androgens are the hormones most responsible for a well-functioning sexual life in women. This assumption is based on the results of randomized controlled trials in which large doses of exogenous androgens exerted a positive influence on some aspects of female sexuality (5, 30). However, it is important to keep in mind that exogenous androgens mostly yield supraphysiologic androgen levels, and it is questionable whether these results apply to the clinical situation after hysterectomy with or without concomitant oophorectomy. Several observations contradict the assumption that androgens are the dominant influence on female sexuality. For example, from a woman s early twenties to her forties, T levels are halved (31). During the same period, sexual capacity in most women increases, peaking toward the end of the fertile period (32). Another finding that contradicts the theory of androgens as a major influence and supports the idea of social and interpersonal relationships playing a major role in sexuality is the absence of linear relationship between androgens and sexuality; mean marital coital rates are reported to decline to approximately 50% during the first year of marriage and to halve again during the next 20 years (33). Furthermore, several studies have indicated that factors such as relationship to partner, sexual attitudes, and general wellbeing are more important than hormones for sexual function in the perimenopause (34, 35). The strongest indication that androgen is not a prerequisite for well-functioning sexuality is found in individuals with the complete androgen insensitivity Fertility and Sterility 1027

8 syndrome, with mutations in the androgen receptor. Thirteen women with documented complete androgen insensitivity syndrome were followed to adulthood; most of them were satisfied with their psychosexual development and sexual function. Ten of the 13 women reported the ability to experience orgasms (36). In the present study, an increase in psychological general well-being was seen after surgery in both groups. In addition, there were no correlations between the changes in hormones and the changes in any aspect of psychological well-being. This suggests that endogenous androgens are not a decisive factor for psychological well-being in the adequately estrogenized perimenopausal woman. Taken together, the post-oophorectomy state, sometimes referred to as an androgen deficiency syndrome (37), should instead be described as an androgen reduced state, with no negative influence on either sexuality or psychological general well-being. In conclusion, the present study clearly shows that the hormonal changes after prophylactic oophorectomy in conjunction with hysterectomy during the perimenopausal period do not result in significant changes in sexuality or psychological well-being. REFERENCES 1. Farrell SA, Kieser K. Sexuality after hysterectomy. Obstet Gynecol 2000;95: Rhodes JC, Kjerulff KH, Langenberg PW, Guzinski GM. Hysterectomy and sexual functioning. JAMA 1999;282: Ryan MM, Dennerstein L, Pepperell R. Psychological aspects of hysterectomy. A prospective study. Br J Psychiatry 1989;154: Lambden MP, Lambden MP, Bellamy G, Ogburn-Russell L, Preece CK, Moore S, et al. Women s sense of well-being before and after hysterectomy. J Obstet Gynecol Neonatal Nurs 1997;26: Davison SL, Davis SR. Androgens in women. J Steroid Biochem Mol Biol 2003;85: Dennerstein L, Randolph J, Taffe J, Dudley E, Burger H. Hormones, mood, sexuality, and the menopausal transition. Fertil Steril 2002;77: Sarrel PM. Sexuality and menopause. Obstet Gynecol 1990;75:26S 30S; discussion 31S 5S. 8. Nathorst-Boos J, von Schoultz B. Psychological reactions and sexual life after hysterectomy with and without oophorectomy. Gynecol Obstet Invest 1992;34: Nathorst-Boos J, von Schoultz B, Carlstrom K. Elective ovarian removal and estrogen replacement therapy-effects on sexual life, psychological well-being and androgen status. J Psychosom Obstet Gynaecol 1993;14: Sherwin BB, Gelfand MM, Brender W. Androgen enhances sexual motivation in females: a prospective, crossover study of sex steroid administration in the surgical menopause. Psychosom Med 1985;47: Shifren JL, Braunstein GD, Simon JA, Casson PR, Buster JE, Redmond GP, et al. Transdermal testosterone treatment in women with impaired sexual function after oophorectomy. N Engl J Med 2000;343: Floter A, Nathorst-Boos J, Carlstrom K, Von Schoultz B. Addition of testosterone to estrogen replacement therapy in oophorectomized women: effects on sexuality and well-being. Climacteric 2002;5: Shifren JL. Androgen deficiency in the oophorectomized woman. Fertil Steril 2002;77(Suppl 4): Kreiger N, Sloan M, Cotterchio M, Parsons P. Surgical procedures associated with risk of ovarian cancer. Int J Epidemiol 1997;26: Zalel Y, Lurie S, Beyth Y, Goldberger S, Tepper R. Is it necessary to perform a prophylactic oophorectomy during hysterectomy? Eur J Obstet Gynecol Reprod Biol 1997;73: Floter A, Nathorst-Boos J, Carlstrom K, von Schoultz B. Androgen status and sexual life in perimenopausal women. Menopause 1997;4: McCoy N, Davidson JM. A longitudinal study of the effects of menopause on sexuality. Maturitas 1985;7: Dennerstein L, Lehert P, Dudley E. Short scale to measure female sexuality: adapted from McCoy Female Sexuality Questionnaire. J Sex Marital Ther 2001;27: Ellstrom M, Astrom M, Moller A, Olsson JH, Hahlin M. A randomized trial comparing changes in psychological well-being and sexuality after laparoscopic and abdominal hysterectomy. Acta Obstet Gynecol Scand 2003;82: Dupuy H. The psychological general well-being (PGWB) index. In: Wenger NK, Mattson ME, Furber CD, Elinson J, eds. Assessment of quality of life in clinical trials of cardiovascular therapies. New York: Le Jacq Publishing, Inc., 1984: Wiklund I, Holst J, Karlberg J, Mattsson LA, Samsioe G, Sandin K, et al. A new methodological approach to the evaluation of quality of life in postmenopausal women. Maturitas 1992;14: Dimenas E, Carlsson G, Glise H, Israelsson B, Wiklund I. Relevance of norm values as part of the documentation of quality of life instruments for use in upper gastrointestinal disease. Scand J Gastroenterol Suppl 1996;221: Ankarberg C, Norjavaara E. Diurnal rhythm of testosterone secretion before and throughout puberty in healthy girls: correlation with 17betaestradiol and dehydroepiandrosterone sulfate. J Clin Endocrinol Metab 1999;84: Sanders D, Bancroft J. Hormones and the sexuality of women the menstrual cycle. Clin Endocrinol Metab 1982;11: Bellerose SB, Binik YM. Body image and sexuality in oophorectomized women. Arch Sex Behav 1993;22: Dennerstein L, Burrows GD, Wood C, Hyman Gl. Hormones and sexuality: effect of estrogen and progestogen. Obstet Gynecol 1980;56: Janson PO, Jansson I. The acute effect of hysterectomy on ovarian blood flow. Am J Obstet Gynecol 1977;127: Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review. Fertil Steril 1987; 47: Ahn E, Bai SW, Song CH, Kim JY, Jeong KA, Kim SK, et al. Effect of hysterectomy on conserved ovarian function. Yonsei Med J 2002; 43: Sherwin BB, Gelfand MM. The role of androgen in the maintenance of sexual functioning in oophorectomized women. Psychosom Med 1987; 49: Zumoff B, Strain GW, Miller LK, Rosner W. Twenty-four-hour mean plasma testosterone concentration declines with age in normal premenopausal women. J Clin Endocrinol Metab 1995;80: Master W, Jonson V. Human sexual response. Boston: Little Brown & Company, James WH. Decline in coital rates with spouses ages and duration of marriage. J Biosoc Sci 1983;15: Cawood EH, Bancroft J. Steroid hormones, the menopause, sexuality and well-being of women. Psychol Med 1996;26: Dennerstein L, Lehert P, Burger H, Dudley E. Factors affecting sexual functioning of women in the mid-life years. Climacteric 199;2: Wisniewski AB, Migeon CJ, Meyer-Bahlburg HF, Gearhart JP, Berkovitz GD, Brown TR, et al. Complete androgen insensitivity syndrome: long-term medical, surgical, and psychosexual outcome. J Clin Endocrinol Metab 2000;85: Kaplan HS, Owett T. The female androgen deficiency syndrome. J Sex Marital Ther 1993;19: Aziz et al. Oophorectomy, sexuality, and well-being Vol. 83, No. 4, April 2005

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