1. ADDRESSING DEPRESSIVE MOOD SYMPTOMS AFTER HYSTERECTOMY Nicole Kuntz

2. CASE STUDY 55 year-old, obese female, post-op day 3 after a total abdominal hysterectomy and salpingo oophorectomy after discovery of a large pelvic mass. Nulligravida, underwent unsuccessful fertility treatment. Flat affect, tearful at times. Meeting discharge criteria. Lives at home with husband, has family nearby. Resistant to go home, becomes angry and hostile when approached about discharge plans

3. HYSTERECTOMY 101

4. “People make hysterectomies seem so normal and nothing that should be so hard. But let me tell you, that is so not true. I have not had a good experience at all. My hysterectomy complications have really thrown a wrench into my life…” https://hysterectomy4dysmenorrhea.wordpress.com/2016/03/10/another-patients-perspective-on-hysterectomy/

6. A HYSTERECTOMY IS A BIG DEAL Gender identity connected to uterus Symbolic meaning attached to uterus Diminished sexuality Anxiety, depression, and guilt related to removal of reproductive organs Misinformed ideas about hysterectomy

7. RISK FACTORS FOR DYSPHORIA AFTER HYSTERECTOMY Preexisting psychiatric morbidities Young age Emergency hysterectomy Desire to bear children Lack of education about procedure and reproductive organs Denial of significance of impaired femininity Lack of uterine pathology

8. MANIFESTATIONS OF DYSPHORIA AFTER HYSTERECTOMY Psychological discomfort Somatic pain Sexual malfunctioning

9. IT HAPPENS, BUT IT DOESN'T HAVE TO Women who were informed about the expected outcomes of their hysterectomy and about the physiologic role of the uterus and ovaries reported enhanced femininity, increased sexual arousal and overall more positive outcomes, than their uneducated counterparts.

10. SO, WHY AREN’T WE TALKING ABOUT IT IN THE HOSPITAL? It’s awkward…

11. LET’S TALK ABOUT IT Promote discussion Identify needs and gaps in knowledge Normalize depression and anxiety Physiological changes

12. REFERENCES Chou, Po-Han, Lin, Ching-Heng, Cheng, Chin, Chang, Chia-Li, Tsai, Chia-Jui, Tsai, Ching-Pei,... Chan, Chin-Hong. (2015). Risk of depressive disorders in women undergoing hysterectomy: A population-based follow-up study. Journal of Psychiatric Research, 68, 186-91. Hirvonen, T., Kvist, M., Lertola, K., & Niemelä, P. (2005). Depression, anxiety, hostility and hysterectomy. Journal of Psychosomatic Obstetrics and Gynecology, 26(3), 193-204. Khastgir, G., Studd, J., & Catalan, J. (2000). The psychological outcome of hysterectomy. Gynecological Endocrinology : The Official Journal of the International Society of Gynecological Endocrinology, 14(2), 132-41. Thornton, E., Mcqueen, C., Rosser, R., Kneale, T., & Dixon, K. (1997). A prospective study of changes in negative mood states of women undergoing surgical hysterectomy: The relationship to cognitive predisposition and familial support. Journal of Psychosomatic Obstetrics and Gynaecology, 18(1), 22-30.