• J Barrat, L Marpeau, and D Léger.
• Service de Gynécologie et d'Obstétrique de l'Hôpital Saint-Antoine--184, Paris.
• B Acad Nat Med Paris. 1995 Dec 1;179(9):1855-69; discussion 1869-70.

AbstractStatistical surveys have established that, in France, hysterectomy was carried out too frequently: 50 to 70,000 hysterectomies (perhaps only 40,000) are carried out each year in our country. This fact, together with the deleterious psychological effects of this operation, have urged the authors to express some remarks on the current practice of hysterectomy in France. The currently approved indications are the following: invasive cancer, benign lesions with intractable disabling symptoms and technical requirements (e.g. cure of prolapse in the elderly). Bleeding due to fibromyomas should be managed with conservative means as much as possible. Infections are within the scope of medical treatment. When an hysterectomy is indicated, the vaginal route should be preferred whenever possible, due the lesser impact on the body image and personality. The adverse psychological effects of hysterectomy are due to several factors: fear of the operation, pain, possible complications, breach of the femininity, alteration of the body image, fear of menopause and ageing. These effects could be reduced by an accurate information of the patient on the actual consequences of the operation, which are far from considerable, specially if the hormonal secretion is preserved. Also, a certain period of time between the decision and the operation might help to further reduce this psychological impact.

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