Patient Attitudes Towards Uterine Preservation with Pelvic Organ Prolapse

Objectives: The objective of this study was to determine whether knowledge of pelvic organ prolapse treatment options and attitudes regarding the uterus are correlated to preference for uterine preservation in women seeking care for prolapse symptoms.

Methods: This was a multi-center, cross-sectional pilot study of an ethnically diverse patient population presenting for surgical counseling for prolapse symptoms. Patients completed a self-administered questionnaire that assessed knowledge of prolapse management options, perception of the role of uterus and preference for uterine preservation. Patient demographics and characteristics associated with preferences were obtained from electronic medical records. The data was analyzed using descriptive statistics.

Results: A total of 30 women participated in this pilot study. The average age of participants was 63 years old with the majority in menopause (83%) and of Asian (40%) and Latino (33.3%) descent. Participants correctly responded that surgery (77%), pessary (67%), pelvic floor therapy (47%) and expectant management (17%) are treatment options for prolapse. Almost half of the women were unaware that prolapse can improve without treatment. For perception items, 70% of women disagreed with the statement that the uterus is important for sexual function, however a minority were concerned that a hysterectomy would worsen their partner’s sexual experience (13%) over their own (7%). A total of 97% believed that the uterus is important for a sense of self. A majority of patients felt that a hysterectomy would make them feel less whole (76.6%), but not less feminine (88%). Consequently, if equal efficacy of treatment modalities, over half of the women (53.3%) preferred uterine preservation; 13% preferred hysterectomy and 33% were undecided.

Conclusions: Patients lack knowledge regarding the range of treatment options available for pelvic organ prolapse. The majority of patients, regardless of ethnicity, associated the uterus with a strong sense of self and a feeling of completeness that could impact preference for uterine preservation over hysterectomy.