In this study, Key concepts and categorization of initial codes were conducted and reported based on the predicted categorization in the interdependence mode of RAM. The demographic characteristics of the participants have been summarized in Table 1. Data analysis led to the product of 537 initial codes from the participants’ experiences, by merging the similar codes, 124 codes were obtained. Finally, the theme of increasing interdependence was emerged, which includes two categories and six sub-categories (Table 2).
Table 1 Sociodemographic characteristics of the participants
Table 2 Main categories and subcategories of interdependence after hysterectomy
Evolution in dependence and interaction with important people in life
Most participants in this study reported experiencing a sense of loss after a hysterectomy, which affected their emotional state and emotional relationships. In the present study, participants experienced a change in their relationships with people who were important in their lives after hysterectomy. These changes ranged from increasing to decreasing relationships. This category consists of three subcategories.
Evolution in spiritual relation
Most participants experienced fear and unreliability after a hysterectomy. Most participants reported that they sought refuge in a source of power to overcome this fear and uncertainty. They often improved their spiritual relationship with God as absolute power. A participant stated that:
“My communication with God has been increased. I feel as if he was on my side during this difficult time. I talk to him more. I relied on God.” (P16)
A small number of participants decreased their relationship with God and complained to God about the loss of their uterus. One of the participants said:
“I had so many problems after the hysterectomy. I complained to God. I was ungrateful… I lost my relationship with God…” (P21)
Fluctuation in emotional dependency on offspring
Most participants reported losing their fertility after uterine surgery. Therefore, they became emotionally dependent on their children. They described knowing that current children are the only possible children for them to increase their dependence, intimacy with their children, and described their close relationship with their children. One of the participants said:
“I missed the opportunity to have children so my dependence on my children increased greatly. I had only these two children.” (P22)
A small group of participants described their negative psychological experiences after hysterectomy and said that these experiences reduced their dependence on their children. Participants described decreased attachment, efforts to reduce dependency, and reduced intimacy with children. A participant said:
“I have blame others, even my children in my hysterectomy. If I had not become pregnant, I would have remained a healthy and complete person. I am no longer as attached to my children as I used to be.” (P28)
For many participants in this study, hysterectomy was the main stimulus for dependence on children So they were more committed to caring for their children. Taking every opportunity to express love and affection for her children was a behavior that these women displayed due to the loss of their fertility. They said they were more sensitive to their children’s future and health. One participant said:
“I can no longer have a child, so I have to take more care of my children so that nothing happens to them…” (P1)
Change in emotional relationship from the spouse
Most of the participants stated that hysterectomy affected their emotional relationship with their spouses. Most of the participants described the improvement in their emotional relationship with their spouses because of the support that they received from their spouses after the hysterectomy. Some said that being with their spouse can calm them down. Others indicated that the presence of their spouse during the illness and treatment enhanced their interest. A group also described the need to be with their spouse. Some also wanted to have a more intimate relationship with their spouse. One participant said:
“After the hysterectomy, I had a better relationship with my husband than before. I have peace by his side. We spend more time together.” (P14)
Some of participant stated that the loss of the uterus made women feel void and deficient. They were concerned about their spouses’ reaction to their condition. This concern led some of these women to describe problems in their relationship with their husbands. They were reluctant to talk about their personal issues with their spouses. They did not accompany their spouses for work and leisure, they felt disinterested in their spouses, and some said they wanted to be independent of their spouses. One participant said:
“After the hysterectomy, I try to distance myself from him… I’m worried about what he thinks of me. I will not talk to him about myself anymore.” (p13)
Some women did not receive enough support from their husbands after hysterectomy, and as a result, they felt lonely and abandoned. Lack of support from the spouse harmed women’s emotional relationships with their husbands and caused an emotional breakdown between them. One participant said:
“If I had not been emotionally attached to my husband, his absence after hysterectomy would not have upset me. I’m disappointed in him. I cannot communicate with him easily.” (P7)
Some participants owed themselves to their spouse’s loving behavior. They tried to compensate for the loving behavior of their wives. They strengthened their emotional relationship with their spouse. They tried to improve their emotional relationship with their spouse. They stated that the relationship between them has become friendlier than in the past. One of the participants said:
“I am owing to my husband’s behavior. He was committed to me during the difficult surgical conditions. Now I appreciate my husband more. I like him more.” (P15)
Reinforced support system
In this study, a support system including family, colleagues, friends, and health care providers were described that supported participants in the areas of physical, care, emotional, and informational support. This category consists of three sub-categories.
The family as a refuge to receive emotional support and care
For most participants, the family served as a refuge for emotional support and care. Many participants said that their family members comforted them. Some women stated that after hysterectomy, they welcomed their husbands’ supportive-caring behaviors. Some participants also described the spouses’ financial support. A group of women described receiving family care, including their husbands, parents, sisters, and even relatives. They stated that when they felt lonely, they found their spouse by their side. Some participants stated that they sought refuge with their families when they experienced complications such as anxiety and stress after a hysterectomy. Being with family members calms them down. They trusted to receive support from their family in times of trouble. Although they were reluctant to attend public gatherings, they preferred to attend family gatherings. One participant said:
“I have been stressed and anxious since the hysterectomy. So I take refuge in my family (father, mother, and sisters). I am at peace with them. They comfort me.” (P28)
Supportive friends and peers
Many women after hysterectomy describe physical limitations, especially in the workplace and in life. They stated that after facing these limitations, they enjoyed the support, encouragement, and help of colleagues, friends, and others to overcome these limitations. Some participants explained that because talking to men about female genitals was taboo, they tried hard to hide the type of operation in their work environment. They stated that when co-workers realized the difficulty of moving and doing work, they helped a lot in doing hard work without asking why. Also, some participants described their experience of being encouraged by colleagues and workplace officials to pursue treatment. One participant said:
“After the hysterectomy, I couldn’t do hard work. Since most of my colleagues were men, I could not talk to them about my surgery. But they helped me. They were careful that I do not get pressured while doing work.” (P6)
Many participants were concerned about limited information on hysterectomy and its complications. In this regard, they communicated with women who had previously had a hysterectomy. They became a source of information support for the participants. One participant said:
“I faced a lot of problems after my hysterectomy. I met several hysterectomized women. They guided me. I still get help from them.” (P8)
Some participants introduced their friends as a source of support. They said their friends gave them emotional support and care after the hysterectomy. A group of women stated that they took refuge in their friends and spent more time with them. One participant said:
“I hid my Surgery from my family, only my friend came with me. She took care of me.” (P13)
Supportive health providers
A group of health care providers and several physicians provided emotional support to participants during treatment and follow-up visits. During care for post-hysterectomy, receiving clinical care with expressions of affection from health personnel, including pain relief, nutritional assistance, and mobility, were some of the items described by participants. Some participants experienced severe pain. They said they had no hope of recovery at the time, but the information and guidance provided by the nurses were promising and alleviated their suffering. Some of the participants experienced fear combined with the feeling of loneliness in the recovery room. The fear and do not being aware of what had happened caused a feeling of insecurity in some participants in the early hours after the operation. The affection behavior of the doctor and the nurse made them feel safe. A group of participants described receiving emotional support and encouragement from health personnel. They stated that the support was beyond the physiological care expected of a physician or nurse during an illness. Some said that the kind behavior of the doctor and the health staff at the hospital motivated them to cope with the situation. One participant said:
“After hysterectomy, I was hospitalized in the ICU. That atmosphere was scary for me. But the ICU staff was excellent. I will not forget the energy I took from them in those days.” (P7)
Source: https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-022-01615-2