Does ovary removal impact sexual function in older women?
Ovary removal (oophorectomy) is often performed along with a hysterectomy in older women to avoid the risk of developing ovarian cancer. Researchers at Yale University conducted a study to determine whether removal of the ovaries impacted sexual function in older women. They published their findings in the October issue of the journal Obstetrics & Gynecology.
The researchers note that that hysterectomy is the most commonly performed gynecologic surgical procedure; more than 600,000 hysterectomies performed annually in the US. The majority of hysterectomies are performed for benign indications. Thus, the choice of whether to remove the ovaries at the time of hysterectomy is between a woman and her surgeon. At present, 25-55% of benign hysterectomies are performed with concomitant elective oophorectomy. Although elective oophorectomy removes the risk of ovarian cancer, studies have reported that ovarian conservation has been demonstrated to increase overall life-expectancy and decrease coronary heart disease.
Postmenopausal ovaries have been demonstrated to produce both testosterone and androstenedione, which are converted to estrogens in adipose (fat) cells. Even two or three decades after the menopause, women maintain serum testosterone levels. In postmenopausal women, removal of the postmenopausal ovaries generally results in a 50% decline in circulating androgen levels. The study authors note that serum androgens are believed to be important in the maintenance of libido and sexual function in postmenopausal women; however, the effect of elective oophorectomy on sexual function, including ideation, partnerships, activity, frequency, attitudes, and problems in older women, has not been well-studied. Therefore, the researchers designed a study was to compare sexual ideation and function of older women who underwent bilateral oophorectomy with that of older women who had retained their ovaries.
The study group comprised 1,352 women aged 57 to 85 years who were enrolled in the National Social Life, Health, and Aging Project. Women with previous bilateral oophorectomy were compared with women who retained their ovaries. The primary outcome measurement was self-reported interest in sexual function.
Of the study group, 356 (25.8%) women reported previous bilateral oophorectomy. The researchers noted that their analysis achieved 90% power to detect a difference of 10% in sexual ideation. The investigators found no significant difference in the report of sexual ideation between women with previous bilateral oophorectomy and women who retained their ovaries (54.5% vs. 49.9%), even after adjusting for current hormone therapy, age, education, and race.
The researchers concluded that bilateral oophorectomy may not play a pivotal role in sexual ideation and function among older women.
Take home message:
Sexual function is important for quality of life. This study demonstrates that bilateral oophorectomy does not impact sexual function. As the authors note, the decision of whether to remove the ovaries should be between the patient and her physician. Women with a family history of ovarian cancer would definitely benefit from ovary removal. It is important that a woman should remember that she should take an active role in any surgical option. If a physician adopts the position of “My dear, I know what’s best for you,” it would be prudent to seek a second opinion.
Reference: Obstetrics & Gynecology
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