Radical hysterectomy unavoidably damages pelvic floor tissues [2]. Early postoperative rehabilitation can effectively restore pelvic floor functions and reduce the incidence of PFD [15]. Perception is to use self-cognition to explain sensory signals across multiple spatial and temporal scales; thus, perception leads to action [16]. Therefore, perceptions of PFD and rehabilitation care are the key to the recovery of pelvic floor functions for women after radical hysterectomy.
The participants in this study had a serious lack of knowledge of PFD and rehabilitation care. Most of them did not know that radical hysterectomy would result in PFD. The first reason might be that all participants had a malignant tumor. They focused on the treatment and surgical removal of tumor and neglected the impact of the procedure on pelvic floor functions. This observation was consistent with the rule of perception, that is, humans focus on more important tasks in a complex environment [17]. The second reason might be the poor public awareness of PFD that seriously influenced the attitudes and behaviors of the women toward rehabilitation care of PFD. A low social popularization of diseases would lead to misconceptions about the disease among patients and other people in their social circle [18]. A study showed that discussing PFD symptoms among friends is one of the factors that prevent women from actively seeking medical treatment [19]. The third reason might be insufficient health education about PFD in hospitals and the society. Health education from professionals is one of the most economical and effective ways for improving awareness of diseases among patients and the public [20, 21]. However, a systematic review noted a huge gap in knowledge of PFD among most women [22]. Therefore, knowledge of PFD and rehabilitation care should be popularized and strengthened in hospitals and the society via multiple channels, such as brochures, posters, internet, television, and radio.
The occurrence of PFD after radical hysterectomy brings women not only great physical suffering but also huge psychological trauma. In this study, the women feared their diseases and postoperative changes in their body. Given that they lost their uterus after the operation and owing to the specificity of PFD symptoms and location, the women stated that they suffered from negative feelings, such as shame and guilt, which seriously affected their quality of life. The present study indicated that, among the participants, losing their uterus meant losing their femininity, an observation also reported by a previous study [23]. A qualitative study of the psychological consequences of pelvic floor trauma after vaginal birth also reported that the women plunged in negative emotions, such as anxiety, stigma, and failure [24]. Another study showed that feelings of shame about the disease is the main factor why women do not see a doctor [25]. However, the women in the present study affirmed that they were eager to receive professional help. Therefore, health care professionals should focus on the psychological and mental health of affected women, strengthen their confidence that they would recover, and enhance their sense of self-worth sense while conducting health education/pelvic floor function rehabilitation care. In addition, an excellent intervention might be to organize a group of women who suffers from PFD with the assistance of health care professionals. Doing so might alleviate their suffering, and they could receive understanding and support from each other.
The interviews revealed that most of the participants adopted a positive coping mechanism in the face of PFD after radical hysterectomy. However, some of them adopted a negative coping mechanism, such as seeing a doctor only when the symptoms had affected their lives, gave up seeking help, and accepted their condition as their fate. Several reasons may explain these observations. First, some of them believed that PFD is an inevitable suffering brought by aging, and disease management is unnecessary in their old age. This belief was similar to that described by Vethanayagam et al. [26]. Second, the public’s misconceptions on PFD stigmatized the women with this disease because of poor social awareness. The stigma reduces the possibility of women disclosing their illness and seeking help [27]. Third, owing to the overarching influence of traditional Chinese concepts, some women in rural areas have a low degree of self-identity and largely rely on their husbands when it comes to making decisions about major family affairs [28]. As wives and mothers, women in traditional Chinese culture assume the responsibility as caregivers in the family, prioritizing family obligations over their own health and hiding their own needs to decrease the burden and not impose on the family [29]. These reasons not only highlighted the importance of popularizing PFD knowledge in the society but also emphasized the importance of improving women's self-identity.
An effective support system for individuals can reduce psychological burden, improve the level of disease response, and ultimately promote disease recovery [30]. With regard to family support, the participants hoped to receive understanding and support from their families, especially from their husbands. A study reported that cooperation between husbands and wives is necessary in the prevention and treatment of chronic diseases, such as PFD [31]. The closer the family relationship is, the stronger the couple’s coping ability will be, and the better they can deal with the problems caused by the disease [32]. Given that PFD is related to privacy and sex, understanding and support from husbands are especially important. Therefore, family-centered care is an important way to support women with PFD. Health care professionals should focus on husbands, help women receive understanding and support from family members, and encourage family members to actively participate in women’s rehabilitation care.
Moreover, the participants hoped to receive social support. Social support can not only promote patients’ healthy behaviors but also promote their compliance with medical regimens [33, 34]. A low income usually negatively affects people's awareness of diseases and willingness to seek medical treatment [35]. Owing to the increasing number of patients with PFD, basic medical insurance for pelvic floor function rehabilitation care is also necessary to reduce the financial burden on women and increase their willingness to seek medical help. The medical insurance system in China covers all Chinese citizens living in the country. Thus, people can enjoy preferential medical treatment at a relatively low price [36]. However, some women from rural areas revealed during the interviews that they did not have medical insurance, suggesting that the public, especially in rural areas, not only lacks knowledge of PFD but also of medical insurance.
This study has several limitations. First, the data may not be sufficient. The results might have been affected by some nuances in the translation of the texts from Chinese to English. Nevertheless, a qualitative study through detailed interviews and observations can provide insights into individuals’ thoughts, behavior, and understanding in life [37]. This study offered evidence on the low cognition of PFD and rehabilitation care after radical hysterectomy among women and the society. This study explored the underlying reasons and specified various ways to improve the quality of care for women with PFD.
In conclusion, this study explored the low cognition of pelvic floor dysfunction and rehabilitation care among women living in southeast China after radical hysterectomy. The poor awareness of PFD in the society is one of the reasons women did not seek support from the society and even from family members. Therefore, knowledge of PFD must be popularized to raise public awareness of this condition. In rural areas in southeast of China, knowledge of medical insurance must also be popularized. Family-centered care is an important way to support women with PFD.