Hysterectomy is the second most frequently performed major surgery in the United States. Both positive and negative changes in sexuality have been reported in women following hysterectomy, but how and why these changes have occurred has not been systematically studied. The question addressed in this investigation was: What is the relationship between the expectations women have about the effect of hysterectomy on their sexuality and the actual sexuality outcomes they experience?.

The design was exploratory and longitudinal. The participants were 63 lower socioeconomic premenopausal women who were having hysterectomies for a benign problem. Indepth interviews were conducted in the hospital on the day before hysterectomy, at the first postoperative checkup, and in the woman's home three months after hysterectomy. After each interview the Derogatis Sexual Functioning Inventory (DSFI), a measure of overall sexual functioning, was completed. Adequate reliability and validity data for the DSFI are available.

There were a variety of expectations and outcomes, but most women had mixed (positive and negative) expectations and outcomes. The relationship between expectations and outcomes was described as moving positively.

Sexuality expectations and outcomes were conceptualized in four areas: personal appearance, femininity/womanhood, engaging in sexual activity, and sexual partner. Sexuality was not the primary concern before hysterectomy; the women were more concerned about their health.

Before hysterectomy the women seemed to be afraid of being different postoperatively, and seemed to rationalize their fears by suggesting that "everyone is different." After hysterectomy, when they realized they had not changed, they were relieved and happy.

The overall DSFI results, subtests, and individual items supported the qualitative findings. A significant improvement (F = 11.39, p = .0001) in sexual functioning was demonstrated.

The findings of the study are important for women having hysterectomies. Implications for nursing include the need to identify what women's expectations are preoperatively, so that misconceptions can be clarified and better outcomes can ensue.

Implications for research include the need for a better understanding of the development of women's expectations. Further study of women's sexuality using the newer women-centered definitions of sexuality is also needed.