Patient Views and Values Placed on the Uterus

To understand women's views of and values placed on the uterus.

This was a multicenter, mixed methods, prospective cohort study at seven medical centers across the United States involved with the Society of Gynecologic Surgeons' Collaborative Research in Pelvic Surgery Consortium network. Adults with a uterus and a benign gynecologic condition with no intention for pregnancy were recruited. Chart review and patient questionnaires, including the validated VALUS (Value of Uterus) instrument, were completed. Semi-structured audio interviews were performed in a subset of participants to identify themes associated with values of the uterus. Interview transcripts were thematically analyzed using the grounded theory approach until saturation was reached.

Qualitative data were collected from 40 participants; 36 (90.0%) completed the VALUS questionnaire, and 20 (50.0%) completed semi-structured interviews. The median age was 51 years, and patients mostly identified as White race (75.0%). Participants' gynecologic conditions included urinary incontinence (57.5%), pelvic pain (42.5%), pelvic organ prolapse (40.0%), and various other gynecologic conditions. Based on the VALUS score, 55.6% (20/36) placed a high value on the uterus and 44.4% (16/36) placed a low value on the uterus. When asked about the value of the uterus, some participants viewed it as an organ for reproduction and fertility and their personhood or womanhood, whereas others thought of it as an organ of no value. Recurring themes around considerations before a hysterectomy procedure included a lack of knowledge regarding the physiologic role of the uterus beyond reproduction, the desire for more knowledge to make informed decisions and to understand the purpose of the hysterectomy procedure and alternatives.

In this multicenter, mixed methods analysis, more than half the participants placed a high value on the uterus. The values of the uterus included fertility, personhood, and womanhood, which often was described as changing with patient's age or life circumstances. Our findings highlight the need to include the patient's values of the uterus to foster person-centered care in the treatment of gynecologic disorders when uterine preservation is an option.