Women’s perceptions of hysterectomy and alternative surgical treatments for benign pelvic pathologies: A Literature Review

Abstract

Background: The evolving landscape of new technologies offering minimally invasive options for the treatment of benign pelvic diseases present with varying effectiveness and safety profiles. This raises questions regarding how patients make treatment decisions. Patients may perceive risk or benefits of a device/treatment differently than physicians or regulators responsible for determining whether a new device can be marketed. Methods: We reviewed publications in PubMed investigating patients’ perceptions of surgical treatments for benign pelvic pathology, including perceived benefits and risks. In addition, we explored the social and cultural factors influencing these perceptions and treatment decisions. Results: We included 16 studies in our literature review. Factors which were identified to influence women’s perceptions include:  symptom relief; surgical complications and recovery times; impact on periods; child-bearing capacity; femininity; sexual desire and sexual dysfunction; cosmetic effects; emotional effects and risk of cancer. Our review revealed some heterogeneity in patients’ perspectives on factors (including benefits and risks) associated with surgical treatments for benign pelvic pathology. Women’s intrinsic factors including age, race, sexuality and child-bearing status may influence how they perceive the potential effects of their surgical options and influence their treatment decision. Conclusions: It is important to understand the trade-offs patients make as they consider competing surgical treatment options. Patient preference information from future patient studies could quantify patient perspective thereby providing additional information to patients, clinicians, current and prospective device developers.  In addition, it may be used by regulators in their evaluation of surgical devices for the treatment of benign pelvic disease.