This is one of the most common operations, and is performed in about 10 per cent of women. It would not be surprising if the loss of the womb had psychological effects on feminine identity. In younger women, the loss of fertility can be a source of discontent.

There have been claims that hysterectomy leads to depression, an idea that has been supported by the studies of Richards (8) on 'post-hysterectomy depression'. However, this idea has since been thoroughly and systematically refuted. Several prospective investigations have shown that mental health improves after hysterectomy. Three comparable Oxford studies, conducted between 1975 and 1990, have addressed this problem: the first two showed that psychiatric morbidity fell to half its preoperative level, and the third and most recent showed that it remained at a low level (4 per cent). (9) The ranks of women with 'post-hysterectomy' depression are swollen by those who seek a surgical remedy for psychosomatic complaints; for instance the uterus has often been removed to relieve symptoms of fatigue, irritability, headache, or nervousness, in the absence of any demonstrable pelvic abnormality.

Hysterectomy may also have an effect on libido, but this is probably also a myth. Prospective studies from St Louis (10) and Oxford(9) showed an increase in the frequency of intercourse, and of enjoyment.

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