**3. Hybrid model validation**

To verify the accuracy and reliability of the proposed model to simulate the battery-pack behavior, hardware-in-the-loop simulations are used. HIL is a widely used experimental technique to reproduce the real conditions of physical applications [27, 28], using lab devices such as electronic loads, power sources, sensors, and


From literature, other culture as presented in Indian, the author found the term "normalization of hysterectomy" was mentioned in many studies. The women are preferred to do hysterectomy as treatment for any menstrual or uterine problem instead of receiving medical or pharmacological treatment. This term underscores "the complex negotiations between women's agency and medically un indicated procedures, as well as the ethical obligations of providers—both of which require further consideration in the Indian context" [20]. However, this term is not presented in Arabic context; in contrast the family likes to have more children as highlighted above from religious and cultural side. Arabic families like to have more male children because they considered that in Arabic term "Ozwa" as a positive point and they will help them in future when parents become old. The more male children the women have delivered the more respect will receive from their culture, husband family and mother in law. So, we can imagine the scope of problem, how the effect of remove part of her women body "uterus" on her self-image.

**143**

tant in this case [37].

ity, and the type of hysterectomy [28].

*Perspective of Women about Her Body after Hysterectomy*

It is recognized that effects of hysterectomy on women's sexuality are debated and controversial from literature [17]. A Socio-cultural construction is main factor that influenced the sexuality that involves many factors such as gender, identity, sexual orientation, pleasure, intimacy, and reproduction [22]. Many previous studies reported that the majority of women and their partners reported zero negative impact on sexual satisfaction after abdominal hysterectomy, regardless of the surgery was subtotal or total to [23], for example the majority of Norwegian women and their partners reported no negative impact on sexual satisfaction after abdominal hysterectomy, regardless of whether the hysterectomy was subtotal or total [23]. While From the literature, some of the studies are inconsistent with these findings [15, 21–26, 35]. Other study reported that only one fourth of the women reported decreased sexual arousal, while the majority had experienced higher sexual arousal after abdominal and vaginal hysterectomy [27]. Various measures are used in these studies so comparing the degree of improvement in sexual is difficult. Guliz et al. mentioned in his study that advanced age, women's attitude towards sexuality, and type of hysterectomy are the main elements that determine sexual functioning after hysterectomy.  A negative sexual experience before hysterectomy will be a strong predictor of having a negative sexual experience of partners after operation [23]. A survey conducted in Jordan, which is one of Arab countries found that sexual performance after hysterectomy was their most significant concern, and there was a significant improve-

ment in sexual function for women undergoing this procedure [26].

 The main reason for sexual annoyances were included the modified self-image perception after surgery and decrease in vaginal lubrication a [34].  The counseling and discussion prior hysterectomy for potential sexual changes after surgery is crucial and may enhance the situation [36]. Another problem that might occur is the urinary problems after the operation or hysterectomy for sexually active and healthy women, they resulted in sexual dysfunction and increase in depression. The age, educational status, working condition and family structure is also impor-

In the other study, that is titled by" Women's attitudes about sexuality".  It was also found that level of depression was less in the postoperative period compared to the preoperative period. Three months after hysterectomy, sexual functioning had significantly decreased. A clear resolution in symptoms of depression was seen after hysterectomy. It was determined that sexual functioning after hysterectomy was affected by advanced age, a women's attitude about sexual-

It is indicated in this review that sexual function is a major cause of women's concern for scheduled hysterectomy; therefore, it is important to spread awareness among women and let them know that most probably they will neither lose their sexual desire after hysterectomy, nor they will lose their feminine shape or style [26]. It is important to figure if ethnicity, socioeconomic status and sexual function are taken into account; it is easily to manage the physical and psychological changes [17].

 [19].

pelled.} [Quran 6:119].

would cause permanent sterilization.

accept any change to her body and soul.

Another issue that should be highlighted in this review is the role and effect of environment as cultural and religious on the perception of women who undergo hysterectomy. The woman is not presented on isolation; she interacted with surrounding that affect her status and view to her body and problem. It is important to

The woman is not totally responsible for her body from legal and cultural aspect, it is partially. In Arabic countries as in Saudi Arabia and Palestine the health care system ask the husband's consent for any medical procedure that affects the reproductive ability of his wife. In recent study that disuses this practice in Saudi Arabia, author recommended that "arguments advocating for discontinuing the requirement are offered along with measures to implement in order to overcome this social artifact" [18].

However, Islamic law closely regulates and governs the life of every Muslim. The basic principle is that it is impermissible for a woman to have her uterus removed because this entails permanent sterilization, and this conflicts with one of the most important higher objectives of the Sharee'ah – fruitfulness in procreation. Anas ibn Maalik narrated that the Prophet, sallallaahu 'alayhi wa sallam, said: "Marry fertile affectionate women, for I will be proud of your numbers in front of the Prophets on

However, if there is concern of real or prevalent harm to the woman's health if the uterus is not removed, or it is feared that it could cause her death or bring about considerable hardship beyond her ability to endure, and it is necessary, according to the advice of reliable and experienced doctors, for the uterus to be removed to ward off such harm, then it is permissible for the woman to have her uterus removed. This is based on the well-established principles that "elimination of harm takes precedence to realization of benefit" and "necessity makes something prohibited permissible". Allaah The Exalted says (what means): {…while He has explained in detail to you what He has forbidden you, excepting that to which you are com-

Moreover, the Prophet, sallallaahu 'alayhi wa sallam, said: "There shall be no harm or reciprocal harm." [Musnad Ahmad and Al-Muwatta'] [19]. According to catholic a hysterectomy by choice over medical necessity would be a sin because it

It is obviously clear here the gap between the cultural practice and religions aspect, what presented in religion in not translate totally to reality and practice.  The powering women and taking her responsibilities will help her to cope well and

From literature, other culture as presented in Indian, the author found the term "normalization of hysterectomy" was mentioned in many studies. The women are preferred to do hysterectomy as treatment for any menstrual or uterine problem instead of receiving medical or pharmacological treatment. This term underscores "the complex negotiations between women's agency and medically un indicated procedures, as well as the ethical obligations of providers—both of which require further consideration in the Indian context" [20]. However, this term is not presented in Arabic context; in contrast the family likes to have more children as highlighted above from religious and cultural side. Arabic families like to have more male children because they considered that in Arabic term "Ozwa" as a positive point and they will help them in future when parents become old. The more male children the women have delivered the more respect will receive from their culture, husband family and mother in law. So, we can imagine the scope of problem, how

the effect of remove part of her women body "uterus" on her self-image.

figure that uterus is representing woman's femininity and fertility.

**142**

It is recognized that effects of hysterectomy on women's sexuality are debated and controversial from literature [17]. A Socio-cultural construction is main factor that influenced the sexuality that involves many factors such as gender, identity, sexual orientation, pleasure, intimacy, and reproduction [22]. Many previous studies reported that the majority of women and their partners reported zero negative impact on sexual satisfaction after abdominal hysterectomy, regardless of the surgery was subtotal or total to [23], for example the majority of Norwegian women and their partners reported no negative impact on sexual satisfaction after abdominal hysterectomy, regardless of whether the hysterectomy was subtotal or total [23]. While From the literature, some of the studies are inconsistent with these findings [15, 21–26, 35].

Other study reported that only one fourth of the women reported decreased sexual arousal, while the majority had experienced higher sexual arousal after abdominal and vaginal hysterectomy [27]. Various measures are used in these studies so comparing the degree of improvement in sexual is difficult. Guliz et al. mentioned in his study that advanced age, women's attitude towards sexuality, and type of hysterectomy are the main elements that determine sexual functioning after hysterectomy.  A negative sexual experience before hysterectomy will be a strong predictor of having a negative sexual experience of partners after operation [23]. A survey conducted in Jordan, which is one of Arab countries found that sexual performance after hysterectomy was their most significant concern, and there was a significant improvement in sexual function for women undergoing this procedure [26].

 The main reason for sexual annoyances were included the modified self-image perception after surgery and decrease in vaginal lubrication a [34].

 The counseling and discussion prior hysterectomy for potential sexual changes after surgery is crucial and may enhance the situation [36]. Another problem that might occur is the urinary problems after the operation or hysterectomy for sexually active and healthy women, they resulted in sexual dysfunction and increase in depression. The age, educational status, working condition and family structure is also important in this case [37].

In the other study, that is titled by" Women's attitudes about sexuality".  It was also found that level of depression was less in the postoperative period compared to the preoperative period. Three months after hysterectomy, sexual functioning had significantly decreased. A clear resolution in symptoms of depression was seen after hysterectomy. It was determined that sexual functioning after hysterectomy was affected by advanced age, a women's attitude about sexuality, and the type of hysterectomy [28].

It is indicated in this review that sexual function is a major cause of women's concern for scheduled hysterectomy; therefore, it is important to spread awareness among women and let them know that most probably they will neither lose their sexual desire after hysterectomy, nor they will lose their feminine shape or style [26]. It is important to figure if ethnicity, socioeconomic status and sexual function are taken into account; it is easily to manage the physical and psychological changes [17].

#### **3. Conclusion and recommendation**

The health care profession should have insight regards the perception of women of her body after hystrectomy. In order to provide a competent health care for women based of her needs. Women's sexuality fractioning is essence and concern of women after hysterectomy, this topic is debated and controversial from literature. It is important here to highlight that uterus has symbolic values related to femininity as mentioned previously and evidence by many studies [38]. This problem among Arabian women is apparent and clear, where the womb of a woman is considered everything for her it represent it femininity and fertility, it means a lot for her. The woman inside herself felt of "deficient being" in the eyes of herself and her extended family, taking into consideration the presented of conservative culture that women's have and early marriage practice that aimed to protect women and produce more children from cultural lenses view. This leads us the significant to power women by increase her awareness pre-operative, follow up post-operative and having a good support system.

Educational programs for women undergoing hysterectomy will promote better self-care behavior, reduce postoperative anxiety and pain, and mitigate some of the negative influences of hysterectomy. So, interventions may not affect the actual incidence of the side-effects; they may help patients cope with adverse outcomes better, thus emphasizing the importance of the adaptation process to accept this condition with a positive thought.

The results of this review reveal that hysterectomy had significant argumentative effects on women's' quality of life, physically, psychological and sexually. For effective handling of this problem, healthcare profession must be aware of these potentially problematic issues and use effective intervention pre-post operation. Multidisciplinary teams have to work together, nurses have to lead the work to ensure of using the holistic approach that cover women's needs that included physical, psychological, spiritually, culturally and be individually. One size not fit all.

The important point here, that we could not change the culture or the mistake in the interpretation of religion. So, the practical solution is to involve the family into the therapeutic plan, identifying and addressing the psychosocial problems of the particularly high-risk groups is another critical point and referred them.

Based on the findings from this review, recommendations can be made to nurses working at gynecological departments. Nurses could also help the patients explore current coping mechanisms and support systems after hysterectomy. Another recommendation is to conduct a future study that examine the current education that provides to women pre-post operatively and it suitability based on her ethnicity and needs where ever the women is presented in her home country or diaspora.

**145**

**Author details**

Eman Alshawish

An-Najah National University, Nablus, Palestine

provided the original work is properly cited.

\*Address all correspondence to<EMAIL_ADDRESS>
Head of Midwifery and MCH Department, Faculty of Medicine and Health Science,

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Perspective of Women about Her Body after Hysterectomy*

*DOI: http://dx.doi.org/10.5772/intechopen.94260*

*Perspective of Women about Her Body after Hysterectomy DOI: http://dx.doi.org/10.5772/intechopen.94260*

*Fibroids*

**3. Conclusion and recommendation**

and having a good support system.

condition with a positive thought.

The health care profession should have insight regards the perception of women

Educational programs for women undergoing hysterectomy will promote better self-care behavior, reduce postoperative anxiety and pain, and mitigate some of the negative influences of hysterectomy. So, interventions may not affect the actual incidence of the side-effects; they may help patients cope with adverse outcomes better, thus emphasizing the importance of the adaptation process to accept this

The results of this review reveal that hysterectomy had significant argumentative effects on women's' quality of life, physically, psychological and sexually. For effective handling of this problem, healthcare profession must be aware of these potentially problematic issues and use effective intervention pre-post operation. Multidisciplinary teams have to work together, nurses have to lead the work to ensure of using the holistic approach that cover women's needs that included physical, psychological, spiritually, culturally and be individually. One size not fit all. The important point here, that we could not change the culture or the mistake in the interpretation of religion. So, the practical solution is to involve the family into the therapeutic plan, identifying and addressing the psychosocial problems of the particularly high-risk groups is another critical point and referred them.

Based on the findings from this review, recommendations can be made to nurses working at gynecological departments. Nurses could also help the patients explore current coping mechanisms and support systems after hysterectomy. Another recommendation is to conduct a future study that examine the current education that provides to women pre-post operatively and it suitability based on her ethnicity and needs where ever the women is presented in her home country or diaspora.

of her body after hystrectomy. In order to provide a competent health care for women based of her needs. Women's sexuality fractioning is essence and concern of women after hysterectomy, this topic is debated and controversial from literature. It is important here to highlight that uterus has symbolic values related to femininity as mentioned previously and evidence by many studies [38]. This problem among Arabian women is apparent and clear, where the womb of a woman is considered everything for her it represent it femininity and fertility, it means a lot for her. The woman inside herself felt of "deficient being" in the eyes of herself and her extended family, taking into consideration the presented of conservative culture that women's have and early marriage practice that aimed to protect women and produce more children from cultural lenses view. This leads us the significant to power women by increase her awareness pre-operative, follow up post-operative

**144**

### **Author details**

Eman Alshawish

Head of Midwifery and MCH Department, Faculty of Medicine and Health Science, An-Najah National University, Nablus, Palestine

\*Address all correspondence to<EMAIL_ADDRESS>
© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

### **References**

[1] Kovac SR. Hysterectomy outcomes in patients with similar indications. Obstet Gynecol 2000; 95(6 Pt 1): 787-93. [PMID: 10831967]

[2] Spilsbury K Semmens JB Hammond I Bolck A. Persistent high rates of hysterectomy in Western Australia: a population-based study of 83 000 procedures over 23 years. BJOG: An International Journal of Obstetrics and Gynaecology 2006; 113: 804-9.

[3] Whiteman MK Hillis SD Jamieson DJ , et al. Inpatient hysterectomy surveillance in the United States, 2000- 2004. American Journal of Obstetrics and Gynecology 2008; 198: 34 e1-7.

[4] Stankiewicz A Pogany L Popadiuk C. Prevalence of self-reported hysterectomy among Canadian women, 2000/2001- 2008. Chronic Diseases and Injuries in Canada 2014; 34: 30-5.

[5] Carlson KJ Nichols DH Schiff I. Indications for hysterectomy. New England Journal of Medicine 1993; 328: 856-60.

[6] Dorsey JH, Steinberg EP, Holtz PM. Clinical indications for hysterectomy route: patient characteristics or physician preference? Am J Obstet Gynecol 1995; 173(5): 1452-60. [http://dx.doi.org/10.1016/0002- 9378(95)90632-0] [PMID: 7503184]

[7] Matteson KA, Raker CA, Clark MA, Frick KD. Abnormal uterine bleeding, health status, and usual source of medical care: Analyses using the medical expenditures panel survey. J Womens Health (Larchmt) 2013;22:959- 65. [PMC free article]

[8] Lis,Wagner.,Anne.,MetteCarls lund,Mette.,Sorensen,Bent.,Otte sen. Women's experience with short admission in abdominal hysterectomy and their patterns of behavior 2005; (19) :330-336.

[9] Valerie,Fleming. Hyserectomy a case study of one woman's experience 2003; 44(6): 575-582.

[10] Williams, R. and A. Clark. "A qualitative study of women's hysterectomy experience." Journal of women's health & gender-based medicine 9 Suppl 2 (2000): S15-25 .

[11] Gul Pinar, SeydaOkdem., NevinDogan, LaleBuyukgonec., Ali Ayhan. The effect of hysterectomy on body image self-esteem and marital adjustment in Turkish women with Gynecologic cancer 2011.

[12] Cara, Z.,delacruz , Martha,L.,Coul ter,Kathleen.,O'rourke,Aminaalio,Elle n,M Daley.,Charles ,S Mahan. Women's Experiences emotional responses and perceptions of care after emergency peripartum hysterectomy a Qualitative survery of women form 6 months to 3 years postpartum 2013.

[13] Uskulasye,K.,ahamd,farah.,Leyland, Nicholas.,A,sterwart,donna. Women's hysterectomy Experience and decision making 2003; 38 (1): 53-67

[14] DaugbjergSignem, B., cearoniGiulia, Ottesen bent, Diderichesn Finn, Osler Merete. Effect of socioeconomic position on patient outcome after hysterectomy 2014; 93(9): 926-934.

[15] Alshawish, E., Qadous, Sh., & Yamani, A. (2020). Experience of Palestinian women after hysterectomy using a descriptive phenomenological Study. *The Open Nursing Journal*, *14*(1),74-79. doi: 10.2174/1874434602014010074.

[16] GulizOnat,Bayram.,NevinSahin. Hystrectomy's psychosexual effects in Turkish Women, 2008; 26:149-158.

[17] Li ping wong., Kulenthran Arumugam. physical psychological and sexual effects in multi-ethnic

**147**

*Perspective of Women about Her Body after Hysterectomy*

[25] Danesh M, Hamzehgardeshi Z, Moosazadeh M, Shabani-Asrami F. The Effect of Hysterectomy on Women's Sexual Function: a Narrative Review. Med Arh 2015; 69(6): 387-92.[http://dx.doi. org/10.5455/medarh.2015.69.387-392]

[26] Fram KM, Saleh SS, Sumrein IA. Sexuality after hysterectomy at

[27] Goetsch MF. The effect of total hysterectomy on specific sexual sensations. Am J Obstet Gynecol 2005; 192(6): 1922-7. [http://dx.doi. org/10.1016/j.ajog.2005.02.065] [PMID:

[28] Bayram., NevinSahin. Hystrectomy's Psychosexual Effects in Turkish Women

[29] Lonnée-Hoffmann R, Pinas I. Effects of Hysterectomy on Sexual Function. Curr Sex Health Rep 2014; 6(4): 244-51. [http://dx.doi.org/10.1007/ s11930-014-0029-3] [PMID: 25999801]

[30] Farquhar CM, Steiner CA.

229-34. [PMID: 11814502]

[PMID: 17964350]

20072131]

Hysterectomy rates in the United States 1990-1997. Obstet Gynecol 2002; 99(2):

[31] Altman D, Granath F, Cnattingius S, Falconer C. Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study. Lancet 2007; 370(9597): 1494-9.[http://dx.doi. org/10.1016/S0140-6736(07)61635-3]

[32] Pauls RN. Impact of gynecological surgery on female sexual function. Int J Impot Res 2010; 22(2): 105-14.[http:// dx.doi.org/10.1038/ijir.2009.63] [PMID:

[33] Adorna E, Morari-Cassol E, Ferraz N. A Mastectomia e suas

University of Jordan Hospital: a teaching hospital experience. Arch Gynecol Obstet 2013; 287(4): 703-8. [http:// dx.doi.org/10.1007/s00404-012-2601-2]

[PMID: 26843731]

[PMID: 23132049]

15970852]

2008; 26: 149-58.

*DOI: http://dx.doi.org/10.5772/intechopen.94260*

Malaysian women how have undergone hysterectomy 2012; 38:1095-1105.

[18] Muaygil, R. U. A. I. M. "Her Uterus, Her Medical Decision? Dismantling Spousal Consent for Medically Indicated Hysterectomies in Saudi Arabia," Cambridge Quarterly of Healthcare Ethics. Cambridge University Press 2018; 27(3):397-407. doi: 10.1017/

S0963180117000780.

[PMID: 28913121]

[PMID: 17091422]

[22] Farquhar CM, Steiner CA.

229-34. [PMID: 11814502]

Hysterectomy rates in the United States 1990-1997. Obstet Gynecol 2002; 99(2):

[23] Lonnée-Hoffmann RA, Schei B, Eriksson NH. Sexual experience of partners after hysterectomy, comparing subtotal with total abdominal hysterectomy. Acta Obstet Gynecol Scand 2006; 85(11): 1389-94. [http://dx.doi. org/10.1080/00016340600917316]

[24] Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int 2015; 112(29-30): 489-95. [http://dx.doi.org/10.3238/ arztebl.2015.0489] [PMID: 26249251]

[19] islamweb.net . Ruling on the surgical removal of the uterus. 2020; Fatwa No: 296863. https://www. islamweb.org/en/fatwa/296863/rulingon-the-surgical-removal-of-the-uterus

[20] Desai, S., Campbell, O. M., Sinha, T., Mahal, A., & Cousens, S. Incidence and determinants of hysterectomy in a lowincome setting in Gujarat, India. Health Policy and Planning 2016; 32(1), 68-78.

[21] Kürek Eken M, İlhan G, Temizkan O, Çelik EE, Herkiloğlu D, Karateke A. The impact of abdominal and laparoscopic hysterectomies on women's sexuality and psychological condition. Turk J Obstet Gynecol 2016; 13(4): 196-202. [http://dx.doi.org/10.4274/tjod.71245]

*Perspective of Women about Her Body after Hysterectomy DOI: http://dx.doi.org/10.5772/intechopen.94260*

Malaysian women how have undergone hysterectomy 2012; 38:1095-1105.

[18] Muaygil, R. U. A. I. M. "Her Uterus, Her Medical Decision? Dismantling Spousal Consent for Medically Indicated Hysterectomies in Saudi Arabia," Cambridge Quarterly of Healthcare Ethics. Cambridge University Press 2018; 27(3):397-407. doi: 10.1017/ S0963180117000780.

[19] islamweb.net . Ruling on the surgical removal of the uterus. 2020; Fatwa No: 296863. https://www. islamweb.org/en/fatwa/296863/rulingon-the-surgical-removal-of-the-uterus

[20] Desai, S., Campbell, O. M., Sinha, T., Mahal, A., & Cousens, S. Incidence and determinants of hysterectomy in a lowincome setting in Gujarat, India. Health Policy and Planning 2016; 32(1), 68-78.

[21] Kürek Eken M, İlhan G, Temizkan O, Çelik EE, Herkiloğlu D, Karateke A. The impact of abdominal and laparoscopic hysterectomies on women's sexuality and psychological condition. Turk J Obstet Gynecol 2016; 13(4): 196-202. [http://dx.doi.org/10.4274/tjod.71245] [PMID: 28913121]

[22] Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990-1997. Obstet Gynecol 2002; 99(2): 229-34. [PMID: 11814502]

[23] Lonnée-Hoffmann RA, Schei B, Eriksson NH. Sexual experience of partners after hysterectomy, comparing subtotal with total abdominal hysterectomy. Acta Obstet Gynecol Scand 2006; 85(11): 1389-94. [http://dx.doi. org/10.1080/00016340600917316] [PMID: 17091422]

[24] Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section. Dtsch Arztebl Int 2015; 112(29-30): 489-95. [http://dx.doi.org/10.3238/ arztebl.2015.0489] [PMID: 26249251]

[25] Danesh M, Hamzehgardeshi Z, Moosazadeh M, Shabani-Asrami F. The Effect of Hysterectomy on Women's Sexual Function: a Narrative Review. Med Arh 2015; 69(6): 387-92.[http://dx.doi. org/10.5455/medarh.2015.69.387-392] [PMID: 26843731]

[26] Fram KM, Saleh SS, Sumrein IA. Sexuality after hysterectomy at University of Jordan Hospital: a teaching hospital experience. Arch Gynecol Obstet 2013; 287(4): 703-8. [http:// dx.doi.org/10.1007/s00404-012-2601-2] [PMID: 23132049]

[27] Goetsch MF. The effect of total hysterectomy on specific sexual sensations. Am J Obstet Gynecol 2005; 192(6): 1922-7. [http://dx.doi. org/10.1016/j.ajog.2005.02.065] [PMID: 15970852]

[28] Bayram., NevinSahin. Hystrectomy's Psychosexual Effects in Turkish Women 2008; 26: 149-58.

[29] Lonnée-Hoffmann R, Pinas I. Effects of Hysterectomy on Sexual Function. Curr Sex Health Rep 2014; 6(4): 244-51. [http://dx.doi.org/10.1007/ s11930-014-0029-3] [PMID: 25999801]

[30] Farquhar CM, Steiner CA. Hysterectomy rates in the United States 1990-1997. Obstet Gynecol 2002; 99(2): 229-34. [PMID: 11814502]

[31] Altman D, Granath F, Cnattingius S, Falconer C. Hysterectomy and risk of stress-urinary-incontinence surgery: nationwide cohort study. Lancet 2007; 370(9597): 1494-9.[http://dx.doi. org/10.1016/S0140-6736(07)61635-3] [PMID: 17964350]

[32] Pauls RN. Impact of gynecological surgery on female sexual function. Int J Impot Res 2010; 22(2): 105-14.[http:// dx.doi.org/10.1038/ijir.2009.63] [PMID: 20072131]

[33] Adorna E, Morari-Cassol E, Ferraz N. A Mastectomia e suas

**146**

(19) :330-336.

*Fibroids*

**References**

[PMID: 10831967]

[1] Kovac SR. Hysterectomy outcomes in patients with similar indications. Obstet Gynecol 2000; 95(6 Pt 1): 787-93. [9] Valerie,Fleming. Hyserectomy a case study of one woman's experience 2003;

[10] Williams, R. and A. Clark. "A qualitative study of women's hysterectomy experience." Journal of women's health & gender-based medicine 9 Suppl 2 (2000): S15-25 .

[11] Gul Pinar, SeydaOkdem., NevinDogan, LaleBuyukgonec., Ali Ayhan. The effect of hysterectomy on body image self-esteem and marital adjustment in Turkish women with

Gynecologic cancer 2011.

years postpartum 2013.

making 2003; 38 (1): 53-67

2014; 93(9): 926-934.

[15] Alshawish, E., Qadous, Sh., & Yamani, A. (2020). Experience of Palestinian women after hysterectomy using a descriptive phenomenological Study. *The Open Nursing Journal*, *14*(1),74-79. doi: 10.2174/1874434602014010074.

[16] GulizOnat,Bayram.,NevinSahin. Hystrectomy's psychosexual effects in Turkish Women, 2008; 26:149-158.

[17] Li ping wong., Kulenthran Arumugam. physical psychological and sexual effects in multi-ethnic

[12] Cara, Z.,delacruz , Martha,L.,Coul ter,Kathleen.,O'rourke,Aminaalio,Elle n,M Daley.,Charles ,S Mahan. Women's Experiences emotional responses and perceptions of care after emergency peripartum hysterectomy a Qualitative survery of women form 6 months to 3

[13] Uskulasye,K.,ahamd,farah.,Leyland, Nicholas.,A,sterwart,donna. Women's hysterectomy Experience and decision

[14] DaugbjergSignem, B., cearoniGiulia, Ottesen bent, Diderichesn Finn, Osler Merete. Effect of socioeconomic position on patient outcome after hysterectomy

44(6): 575-582.

[2] Spilsbury K Semmens JB Hammond I Bolck A. Persistent high rates of hysterectomy in Western Australia: a population-based study of 83 000 procedures over 23 years. BJOG: An International Journal of Obstetrics and

Gynaecology 2006; 113: 804-9.

Canada 2014; 34: 30-5.

65. [PMC free article]

[8] Lis,Wagner.,Anne.,MetteCarls lund,Mette.,Sorensen,Bent.,Otte sen. Women's experience with short admission in abdominal hysterectomy and their patterns of behavior 2005;

856-60.

[3] Whiteman MK Hillis SD Jamieson DJ , et al. Inpatient hysterectomy surveillance in the United States, 2000- 2004. American Journal of Obstetrics and Gynecology 2008; 198: 34 e1-7.

[4] Stankiewicz A Pogany L Popadiuk C. Prevalence of self-reported hysterectomy among Canadian women, 2000/2001- 2008. Chronic Diseases and Injuries in

[5] Carlson KJ Nichols DH Schiff I. Indications for hysterectomy. New England Journal of Medicine 1993; 328:

[6] Dorsey JH, Steinberg EP, Holtz PM. Clinical indications for hysterectomy route: patient characteristics or physician preference? Am J Obstet Gynecol 1995; 173(5): 1452-60. [http://dx.doi.org/10.1016/0002- 9378(95)90632-0] [PMID: 7503184]

[7] Matteson KA, Raker CA, Clark MA, Frick KD. Abnormal uterine bleeding, health status, and usual source of medical care: Analyses using the medical expenditures panel survey. J Womens Health (Larchmt) 2013;22:959Repercussões na Vida Afetiva, Familiar e Social da Mulher. Rev Saúde (Santa Maria) 2017; 43(1): 163-8.

[34] Schmidt, Alessandra, Sehnem, Graciela Dutra, Cardoso, Leticia Silveira, Quadros, Jacqueline Silveira de, Ribeiro, Aline Cammarano, & Neves, Eliane Tatsch. Sexuality experiences of hysterectomized women. Ginekol Pol Esc Anna Nery 2019; 23(4)

[35] G So, sozeri-varma., N kalkan – Oguzbanolgu ,F., Karadag , gand O.Ozdel. The effect of hysterectomy and oophorectomy on sexual satisfaction 2011;14: 275-281.

[36] Meston CM, Bradford A. Sexual dysfunctions in women. Annu Rev Clin Psychol. 2007;3:233-56. doi: 10.1146/ annurev.clinpsy.3.022806.091507. PMID: 17716055.

[37] Goktas SB, Gun I, Yildiz T, Sakar MN, Caglayan S.  Pak J Med Sci. 2015;31(3):700-5. doi: 10.12669/ pjms.313.7368. PMID: 26150871; PMCID: PMC4485298.

[38] Silva CMC, Vargens OMC. A mulher que vivencia as cirurgias ginecológicas: enfrentando as mudanças impostas pelas cirurgias. Rev Latino-Am Enferm 2016; 24(e2780): 1-8.

*Fibroids*

Repercussões na Vida Afetiva, Familiar e Social da Mulher. Rev Saúde (Santa

[34] Schmidt, Alessandra, Sehnem, Graciela Dutra, Cardoso, Leticia

[35] G So, sozeri-varma., N kalkan – Oguzbanolgu ,F., Karadag , gand O.Ozdel.  Annu Rev Clin Psychol. 2007;3:233-56. doi: 10.1146/ annurev.clinpsy.3.022806.091507. PMID:

[37] Goktas SB, Gun I, Yildiz T, Sakar MN, Caglayan S.  Pak J Med Sci. 2015;31(3):700-5. doi: 10.12669/ pjms.313.7368. PMID: 26150871;

[38] Silva CMC, Vargens OMC. A mulher que vivencia as cirurgias ginecológicas: enfrentando as mudanças impostas pelas cirurgias. Rev Latino-Am Enferm

PMCID: PMC4485298.

2016; 24(e2780): 1-8.

Silveira, Quadros, Jacqueline Silveira de, Ribeiro, Aline Cammarano, & Neves, Eliane Tatsch. Sexuality experiences of hysterectomized women. Ginekol Pol

Maria) 2017; 43(1): 163-8.

Esc Anna Nery 2019; 23(4)

2011;14: 275-281.

17716055.

**148**

### *Edited by Hassan Abduljabbar*

Uterine fibroids are benign tumors of the smooth muscle of the uterus. They are the most common pathologic abnormalities of the female genital tract, occurring in 20%–50% of women older than 30 years. Some fibroids present with symptoms, whereas others are asymptomatic. The etiology of uterine fibroids is unclear. As such, this book presents comprehensive information on clinical presentation, diagnosis, and management of myoma. Chapters discuss symptoms such as bleeding, pain, and sexual dysfunction, as well as imaging modalities for diagnosis and options for treatment, including medications and surgery.

Published in London, UK © 2021 IntechOpen © magicmine / iStock

Fibroids

Fibroids

*Edited by Hassan Abduljabbar*


**3. Results**

#### *3.1. Experiments in 2016*

The best storage temperature, based on weight loss, decay incidence and color quality parameters after 2.5 months storage, was found to be 15 ◦C (Table 1). At 10 ◦C, although fruits lost less weight and were much greener, decay incidence was significantly higher than in the other treatments. At 20 ◦C, fruits lost significantly more weight and their color was greenish/orange, but decay incidence was similar to that at 15 ◦C (Table 1).

**Table 1.** The influence of storage temperature on Acorn squash quality parameters after 2.5 months in cold storage plus 3 days at 20 ◦C.

z Values in the same column followed by the same letter are not significantly different at *P* = 0.05 according to Fisher's least significant difference test.

#### *3.2. Experiments in 2017*

Storing the fruits at 15 ◦C for 3.5 months significantly maintained fruit quality, based on firmness, decay development and color (Table 2, Figure 1). At this storage temperature, fruits were significantly firmer, showed less decay incidence, and were significantly greener than those in other treatments. TSS was not affected by storage temperature (Table 2; mean value at each temperature). Use of HWRB maintained significantly better fruit quality than that of untreated controls and TWRB-treated fruits (Table 2; mean value in each treatment; Figure 1). HWRB-treated fruits were very firm, had significantly less decay, and were significantly greener than untreated controls and TWRB-treated fruits. No significant differences were observed in TSS content although it was higher in HWRB-treated fruits (Table 2). No interaction between storage temperature and wash treatment was observed (Table 2).

**Table 2.** The influence of tap water rinsing and brushing (TWRB) and hot water rinsing and brushing (HWRB = 54 ± 1 ◦C for 15 s) on Acorn squash quality parameters after 3.5 months at 15 or 20 ◦C plus 3 days at 20 ◦C.

z Untreated control; y Tap water rinsing and brushing for 15 s; x Hot water rinsing and brushing for 15 s; w LSD, Least significance difference at α = 0.05; v Means within columns followed by the same letter are not significantly different at *P* ≤ 0.05, based on the least significant difference test; \*\*\*, \*\*, \*, NS indicate statistical significance at *P* ≤ 0.001, 0.01, and 0.05, and not significant, respectively.

**Figure 1.** The influence of storage temperature and water treatment on Acorn squash quality after 3.5 month at 15 or 20 ◦C plus 3 days at 20 ◦C (TWRB = tap water rinsing and brushing; HWRB = hot water rinsing and brushing at 54 ± 1 ◦C for 15 s).


**Abstract**

In today's world, the energy requirement has full attention in the development of any country for which it requires an effective and sustainable potential to meet the country's needs. Thermal energy storage has a complete advantage to satisfy the future requirement of energy. Heat exchangers exchange heat in the thermal storage which is stored and retrieved later or can be used as a pre-heating or post-heating devices to save energy. Criteria of design of heat exchangers for various thermal energy storage applications along with their various components are being elaborated. The latent heat thermal energy storage in a mass application has got many advantages over the sensible heat storage. The existing approaches in the design, integration and application of phase change materials (PCMs) are explored by experimenting on a prototype of a single heat exchanger module and analysing all the design aspects to get a significant idea and the analysis needed while charging and discharging the heat exchanger.

**Keywords:** thermal energy storage, heat exchanger, design, latent heat, PCM


*Edited by Plamen Kinov*

New technologies, developments in implant design and advances in surgical technique have improved outcomes after joint replacement and decreased rate of complications. It is not a surprise that the number of arthroplasties increases steadily every year and nowadays more than one million patients undergo the procedure annually worldwide. This book is a sequel of a successful series dedicated to one of the fastest growing fields in orthopedics - arthroplasty. Aiming at dissemination of scientific research this book provides a profound overview of the recent evolution of technology and surgical techniques. New developments of implant design and current treatment strategies have been critically discussed by the contributing authors. The process of improving care for patients and standards of treatment requires straightforward access to upto-date research and knowledge. The format of the publication allows easy and quick reference to shared ideas and concepts. We hope, that the current book will add significant contribution to the success of this endeavor.

ISBN 978-953-51-0995-2

Arthroplasty - Update

Photo by Goettingen / iStock


*5.4.7 The conceptual model*

The typical conceptual model is used to explain full spray combustion during mixing-controlled phase towards the end of fuel injection, **Figure 8**. The model is a modification of the last stage in jet development captured about 10.0° ASI and to

**Figure 8.** *Zones of Dec's conceptual model [29].*

highlight the peripheral turbulent combustion. For the developed jet, the entrainment of turbulent air vaporize all liquid fuel after some distance from the nozzle tip leading to the formation of uniform fuel-air mixture. This is made up of fuel rich mixture and PAHs which afterwards, burn to generate small soot particles that fills and extends the jet length. The soot concentration and sizes increase downstream in a length referred to as 'plume stem' towards the leading edge and larger particles recirculate within the vortex. In the course of vortex recirculation, some soot particles reach peripheral flame front where they are further oxidized by OH radicals. Descriptively (using the same color codes as in **Figure 5**), the conceptual model could therefore be visualized as having four main zones: the lift-off length, the premixed zone, the plume stem and the vortex head [29]. The emissions and other contributions associated with combustion processes are still the subject of many further investigations.


**Preface to "Polymers Synthesis and Characterization"**

Polymer science represents a domain of great interest due to the possible applications of polymers in areas that range from the most common to those that are high-tech. To achieve this, synthesis and characterization techniques, as well as the correlation of the chemical structure and morphology with their properties, is critical. From the perspective of synthesis, there are two strategies for obtaining polymers: step-growth (polyaddition, polycondensation, and reversible-deactivation radical polymerization) and chain polymerization (radical polymerization, coordinative polymerization, and cationic and anionic polymerization). Polymer analogous reactions aimed at the control of the hydrophilic/hydrophobic characteristics of the surface or the introduction of responsive moieties onto a polymer backbone are also interesting related topics. Surface modification can also be performed using surface-initiated controlled radical polymerization reactions such as atom transfer radical polymerization (ATRP), reversible addition-fragmentation chain transfer (RAFT), nitroxide-mediated living free-radical polymerization (NMP), and iodine transfer polymerization (ITP). Through these methods, polymer grafts and block copolymers are obtained, displaying different properties than random or alternate polymers obtained by radical copolymerization, which follows the well-known Mayo–Lewis equation. Thus, the physical properties of the polymers can be tailored depending on the structures that are synthesized and their morphology. The right design that encompasses structure, composition, and morphology is the key to the final applications of polymeric structures.

The advancement of polymer applications continues to lead to the expansion of the synthesis and characterization techniques that can be facilitated by novel, smart, multifunctional polymers. There is a correlation between structure, composition, morphology, and properties of applications that leads to substantial benefits for specific applications.

This Special Issue established a collection of articles and reviews that follow the latest developments in polymer synthesis, their characterization techniques, and the correlation between structure and properties.

> **Edina Rusen** *Editor*