Understanding the Value of the Uterus: A Nationwide Cross-sectional Survey on Women's Preferences With Benign Gynecological Conditions

OBJECTIVE: To identify clinical and demographic predictors associated with placing high value on the uterus among women with gynecological conditions in the United States.

DESIGN: Multicenter cross-sectional survey study utilizing the validated Value of the Uterus (VALUS) instrument and visual analog scale (VAS) to assess uterine value perceptions.

SETTING: Eleven medical centers across four U.S. regions (South, Southwest, West, and Northeast) from December 2023 to June 2024.

PATIENTS: Participants included adult patients with a uterus, assigned female sex at birth, and not considering future pregnancies. Of 906 surveys distributed, 714 completed surveys (79% response rate) were analyzed. Most participants identified as White (74.9%), were 45 to 60 years old (36%), and postmenopausal (55.3%). Regional distribution included South (35.6%), West (34.7%), Northeast (22%), and Southwest (4.3%).

INTERVENTIONS: Participants completed surveys assessing demographics, clinical history, the VALUS instrument (range 6-30), and a VAS question rating importance of uterine preservation (0-100 scale). Participants were stratified using median VALUS score of 16 as the cut-off: 336 (47%) had low uterine value (VALUS <16) and 378 (53%) had high uterine value (VALUS ≥16).

MEASUREMENTS AND MAIN RESULTS: The mean VAS score was 40.8 (SD: 32.4). Multivariable logistic regression, controlling for income, age, and urinary incontinence (UI), revealed significant predictors of high uterine value. Asian American/Pacific Islander (AAPI) individuals had higher odds compared to White individuals (adjusted OR = 2.34; 95% CI, 1.24-4.60; p = .01). Annual income of $20 000 to $49 000 was associated with higher odds vs the highest income bracket (adjusted OR = 2.53; 95% CI, 1.49-4.36; p <.01). Self-reported UI was associated with lower odds of high uterine value (adjusted OR = 0.71; 95% CI, 0.51-0.97; p = .03).

CONCLUSION: AAPI racial identity, lower income, and absence of UI predict placing high value on the uterus. Clinicians should incorporate these factors into shared decision-making when counseling patients regarding hysterectomy vs uterine-preserving procedures.