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Citation
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Ryan GL, Mengeling MA, Summers KM, Booth BM, Torner JC, Syrop CH, Sadler AG. Am. J. Obstet. Gynecol. 2015; 214(3): 352.e1-352.e13. |
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Affiliation
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Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa; Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, Iowa. |
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Abstract
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BACKGROUND: Several gynecologic conditions associated with hysterectomy, including abnormal bleeding and pelvic pain, have been observed at increased rates in women who have experienced sexual assault. Previous findings have suggested that one of the unique healthcare needs for female military veterans may be an increased prevalence of hysterectomy, and that this increase may be partially due to their higher risk of sexual assault history and posttraumatic stress disorder (PTSD). While associations between trauma, PTSD, and gynecologic symptoms have been identified, little work has been done to date to directly examine the relationship between sexual assault, PTSD, and hysterectomy within the rapidly growing female veteran population.
OBJECTIVES: To assess prevalence of hysterectomy in premenopausal-aged female veterans, compare to general population prevalence, and examine associations between hysterectomy and sexual assault, posttraumatic stress disorder (PTSD), and gynecologic symptoms in this veteran population STUDY DESIGN: We performed a computer-assisted telephone interview between July 2005 and August 2008 of 1004 female VA-enrolled veterans ≤52 years old from 2 Midwestern US Veterans Affairs medical centers and associated community based outreach clinics. Within the veteran study population, associations between hysterectomy and sexual assault, PTSD, and gynecologic symptoms were assessed with bivariate analyses using chi-square, Wilcoxon-Mann-Whitney, and t-tests; multivariate logistic regression analyses were used to look for independent associations. Hysterectomy prevalence and ages were compared to large civilian populations represented in the BRFSS and ACS NSQIP databases from the similar timeframes using chi-square and t-tests.
RESULTS: Prevalence of hysterectomy was significantly higher (16.8% vs 13.3%, p=.0002), and mean age at hysterectomy significantly lower (35 yo vs 43 yo, p<.0001), in this VA-enrolled sample of female veterans compared to civilian population-based datasets. Sixty-two percent of subjects had experienced attempted or completed sexual assault in their lifetimes. A history of completed lifetime sexual assault with vaginal penetration (LSA-V) was a significant risk factor for hysterectomy (age-adjusted OR 1.85), with those experiencing their first LSA-V in childhood or in military at particular risk. A history of PTSD was also associated with hysterectomy (age-adjusted OR 1.83), even when controlling for LSA-V. These associations were no longer significant when controlling for the increased rates of gynecologic pain, abnormal gynecologic bleeding, and pelvic inflammatory disease seen in those veterans with a history of LSA-V.
CONCLUSIONS: Premenopausal-aged veterans may be at higher overall risk for hysterectomy, and for hysterectomy at younger ages, than their civilian counterparts. Veterans who have experienced completed sexual assault with vaginal penetration in childhood or in military and those with a history of PTSD may be at particularly high risk for hysterectomy, potentially related to their higher risk of gynecologic symptoms. If confirmed in future studies, these findings have important implications for women's healthcare providers and policy makers within both the VA and civilian healthcare systems related to primary and secondary prevention, costs, and the potential for increased chronic disease and mortality.
Language: en |