Hysterectomy in women with disabilities: a systematic review

Hysterectomy is the most frequently performed nonobstetric surgery in women. Women with disabilities face barriers to reproductive health care, and little is known about their hysterectomy risk. The objective of this systematic review was to compare hysterectomy risk among women with and without disabilities. We searched the MEDLINE, Embase, PsycInfo, and CINAHL Plus databases from inception to May 2024 using validated search strategies. We included peer-reviewed observational studies that compared hysterectomy in women with physical, sensory, cognitive, and intellectual or developmental disabilities with those without disabilities. Study characteristics and data were extracted using a standardized form; the Newcastle-Ottawa Scale (NOS) was used for quality assessment. Study findings were summarized narratively following Synthesis Without Meta-analysis guidelines. The search yielded 3686 unique records, of which 5 met our criteria. These included 1 retrospective cohort and 4 cross-sectional studies, which were conducted in the United States (n = 3), Canada (n = 1), and South Korea (n = 1), and ranged in size from 881 to 42 842 participants. Evidence from 4 studies indicated hysterectomy frequency was higher among women with disabilities (range: 6.1% to 22.8%) compared with those without disabilities (range: 2.2% to 18.6%). Three studies suggested the disparity in hysterectomy was greatest among premenopausal women. Quality assessment scores on the NOS ranged from 0 to 8 (median, 3), with limitations mostly related to measurement of the exposure and outcome. The limited research on this topic points to the need for more studies on hysterectomy among women with disabilities, given historical reproductive injustices faced by this population.