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KMID : 0381219750070110733
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Journal of RIMSK
1975 Volume.7 No. 11 p.733 ~ p.748
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The Psychiatric Study of Post-hysterectomy Nental Disorders
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Abstract
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In this study, it was attempted to investigate psychological reaction before or after hysterectomy and tubal ligation for the purpose of prevention of postoperative mental sequele.
Ten cases of post- hysterectomy mental disorders and fourteen cases of post-tubal ligation mental disorders, who visited to department of neuropsychiatry, Chung-Ang University, College of Medicine from Jan. 1973 to Oct. 1975, were selected in this study. The result is followings;
1. In the age distribution at the time of operation, the hysterectomy cases undertook operation at 41. 1 years and their mean duration of onset is 12.8 months, but the tubal ligation cases undertook operation at 35.6 years, and their mean duration of onset is 20.8 months.
2. About half of the hysterectomy cases had episode of previous mental illness history such as depression(30. 0%), but they showed depression(60. 0%), anxiety neuroses(20. 0%), and schizophrenia(20.0%) after operation. About 70% of the tubal ligation cases had episode of previous mental illness such as hysteria, but they showed hysterical neurosses(42.9%), anxiety neurosis(35.7%), depression(14.3%), and schizophrenia(7.1%) after operation.
3. The following clinical datas were predominantly observed in hysterectomy cases comparing with tubal ligation cases:
A) They showed lower educational level, more loss of interest, more parental invalidism, fewer siblings, more first daughter of their siblings, lower incidence of pregnancy, full-term delivery, abortion, and contraception, fewer children,and anxious attitude toward their child.
B) They showed more familial problems such as frequently cohabit with their parent-in-law, larger age interval with their husband, and more marisal discord with their husband due to pseudomutual tie.
(:) They showed more coital problems such as lesser frequency of coitus due to husband´s avoidance of coitus and patient´s frigidity.
D) Thes eases were supposed to be nervous breakdown due to unable to smooth control of repressed hostility at the face of various stress such as recent economical loss and recent
atic events in the cases of the personality disorders such as the melancholic and the passiv aggressive personality.
E) Thes e aces were also suppos 2d to be nervous breakdown due to misbelief about physoilogic´t
I function of uterus and causes of illness, such as superstitious belief about effects of operation, medically unnecessary operation, overconcern over loss of child-hearing ability or the concern over loss of the husband´s interest because of their loss of feminity. They undertook:- A nonelective operation for treatment of gynecological disorders such as myoma uterus, hemorrhage, chronic pelvic inflammatory disease, or cancer, and treatment of prolongation of menstrual cycle and duration, or diminishing amount of menstrual flow.
4. The following clinical datas were predominantly observed in tubal ligation cases comparing ´d; :
with hysterectomy cases.
A) They showed higher educational level, various kinds of interests, many siblings,
childrens, and higher delivery rate in spite of birth control by condom, etc. B) They showed relatively well adjustment in their marital disharmony due to their lack of
understanding and their shallow age interval with husband.
C) They showed better coital relationship with their husband such as frequent coitus, increased r sexual libido, and voluntary wanted sexual intercouse in each spouse.
D) This cases were supposed to be nevous brreakdown due to unable to meet satisfactorily infantile dependency due to emotional instability in the caws of the hysterical personality.
E) This cases were also supposed to be nervous breakdown due to narcosis anxiety closely related with fear of death, or overvalued expectation to the effects of operation such as free them from the burdens of repeated pregnancies, or enhance their emploiment and community activities. Most of them. undertook tubal ligation for purpose of contraceptive device without demonstrable pelvic disease, and few of them had actively sought surgical sterility in the preoperative interview.
F) The tubal ligation cases had less serious and few Mental sequele comparing with the hysts- 4 rectomy cases.
5. The characteristic psychogical responses to hysterectomy were as follows; A) Concern for loss of child hearing ability
B) Concern over loss of the husband´s interest because of their loss of feminity
C) Concern over loss of feminine strength and possible loss of attractiveness D) Concern over changes of appearance and effects of aging
E) Concern over loss of sexual drive
6. The characteristic important psychological factors, carefully discussed before operation, for purpose of prevention of post-operative mental sequele, were as follows;
A) Superstitious belief about the effect of operation
B) Nonelective operation forced by others
C) Misbelief about physiological function of uterus
D) Recent economical crisis E) Recent traumatic events
F) Non-emergent unnecessary operation G) Overanxious attitude toward operation
H) Castration anxiety (separation anxiety) I) Marital disruption J) Previous post-partun psychiatric illness history
7. Tubal ligation cases easily denied for their loss of fertility, because they believed themselves with the thought that "the tubes may come untied". Also,tubal ligation, in allowing the more gradual acceptance of sterility, may provide necessary time for adaptation to the loss and a slower, or more successful resolving of the problems entailed by the loss. That, author speculated that tubal ligation cases showed more favorable progonsis comparing with post-hysterectomy cases.
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