A closer look at why millions of women
opt for unnecessary surgery instead of
less invasive alternatives
By Lise Cloutier-Steele
Our bodies are marvelous creations with
each organ or part playing a significant
role in our physical, emotional and
sexual well-being. It makes perfect
medical and scientific sense to think
that our body parts are indispensable,
and I believe that most people would
agree with me on that one. Most people
would also agree that there are serious
risks linked to any kind of surgery. For
the record, an elective procedure
doesn't make it any less dangerous. Yet,
every day in North America, thousands of
women surrender their non-cancerous
reproductive organs to gynecological
surgeons. In many cases, without having
given it much thought.
Consider this: Why are Westerners
shocked by reports about female
castration and mutilation in other
countries when the same thing is
happening in our midst? The only
difference is that it isn't done as part
of any ritual or belief, but as a quick
fix for a variety of women's problems.
Why is this happening? That's the
burning question, and the first place to
look for an explanation is the medical
specialty of gynecology.
Doctors Withhold Information
According to a recent study published in
the December 2002 issue of the American
Journal of Obstetrics and Gynecology,
the rate of hysterectomies performed
each year is on the rise. In his
comments for a print interview made
public at the time of the release of
this study, Dr. Ernst Bartsich, a New
York gynecologist, attributed the
increase to his colleagues who continue
to withhold information about the
aftereffects of hysterectomy and ovary
removal. He added something to the
effect that if women knew the truth,
they wouldn't agree to these surgeries
as readily. And I would like to add that
if women aren't given all the
information they need to decide, how can
it be informed consent?
Risks are Downplayed
Gynecologists have traditionally
downplayed the risks involved with the
operation itself and its many lasting
consequences. Side effects include hot
flashes, depression, anxiety,
osteoporosis, generalized fatigue,
stress and urge incontinence,
masculinization, insomnia, bowel
dysfunction, mood swings, just to
mention a few. More importantly, the
removal of the uterus and the ovaries
can lead to loss of sexual desire,
diminished orgasmic response and pain
with intercourse.
One would think that when a surgical
procedure involves the alteration of a
woman's sexual anatomy, it would be
discussed at great length. It's not. But
sexual functioning is an important part
of the discussion with men undergoing
surgery for prostate cancer. As is the
case with men, "a woman's sexuality is
as important as her blood pressure" said
Dr. Judith Reichman of California, in
one of her 1998 interviews on The Oprah
Winfrey Show.
Lack of Training in Women's Sexual
Health
Though hardly an excuse, part of the
reason why post hysterectomy sexual
dysfunction is rarely discussed prior to
surgery is because gynecologists are not
taught much about women's sexual health
in medical school. Dr. Yvonne Thornton,
representative for the American College
of Obstetricians and Gynecologists (ACOG),
raised this point in her interview on
Good Morning America in November of
1999, after admitting that she couldn't
define the term "orgasm". A sad
statement coming from a female
gynecologist whose profession involves
the excision of organs affecting
sexuality. Perhaps this would explain
why some women claim to have great sex
following a hysterectomy. If they never
experienced a deep uterine orgasm, the
big O in layman's terms, how can they
miss it?
Since post hysterectomy sexual
dysfunction is almost always left out of
the discussion, I think it warrants some
special attention here. This outcome is
often the result of nerve damage caused
by the cutting with surgical instruments
around the organs being removed (uterus,
cervix, fallopian tubes and ovaries),
which in turn, results in diminished
orgasmic response. If a woman's vagina
is made too short at the time of the
removal of the cervix, it can make
intercourse either painful or
impossible.
The ACOG admits to vaginal shortening at
hysterectomy in its 1999 pamphlet
Understanding Hysterectomy. It states
clearly that if the hysterectomy
procedure requires vaginal shortening,
deep thrusting with intercourse may
become painful. I was thrilled to see
this information finally made public
until I read the recommendations. There
were two: 1) Being on top during sex or
2) bringing your legs closer together
may help. Any woman will tell you that
intercourse wouldn't be pleasurable, if
at all possible, if she had to keep her
legs closer together, and women living
with the condition of a shortened vagina
will tell you that attempting the "on
top" position would be excruciatingly
painful.
Last, but not least, loss of libido is
another form of sexual dysfunction,
which is the direct result of
oophorectomy (removal of the ovaries).
This is a problem that is getting lots
of attention lately and some medical
experts are now specializing in the
treatment of female sexual dysfunction (FSD).
The problem is that their services are
aimed only at women who still have their
reproductive organs, excluding
oophorectomized women who probably need
their help the most. Sadly, when a
woman's sexual anatomy has been altered
by hysterectomy, without prior consent,
it is very hard to find help anywhere.
Due to the "fraternity" that continues
to exist among doctors, it's equally
difficult to be successful with a
complaint to a Medical Board or a
College, or with a lawsuit. That's why
it's so very important for women to be
aware of the risks and aftereffects of
hysterectomy and ovary removal prior to
surgery.
Women's Vulnerability
Mary Anne Wyatt of Massachusetts, a
researcher in molecular biology and
electrochemistry, says that there are a
variety of reasons why intelligent women
wind up with an unnecessary
hysterectomy. "They are vulnerable,
scared, uninformed of options or
ignorant of the actual consequences.
Their gynecologist may not be skilled in
a technique for preserving the uterus.
From a surgeon's point of view, the
hysterectomy is an easier and cheaper
operation than the current alternatives.
Re-imbursement from insurance companies
encourages the faster, less skillful
approach, likely the reason why teaching
hospitals train hundreds of residents a
year in hysterectomies instead of the
less invasive procedures requiring
greater surgical expertise."
Surgeons' Comfort Level
In addition to surgical skill, we must
consider a surgeon's comfort in
performing a particular technique, and
in some cases, the unwillingness to
learn a newer, less harmful procedure
that could minimize the impact of the
surgery on patients. A perfect example
of this was reported by Medscape in its
April 2003 news release about a study
suggesting that a new ligament-sparing
hysterectomy procedure proved to be
better, with less morbidity than with
the traditional abdominal surgery. The
new procedure is the brainchild of Dr.
Daryoosh Samimi, medical director of the
U.S. Women's Institute of Fountain
Valley, California. Having performed it
successfully on 43 women, Dr. Samimi
believes that his technique preserves
the integrity of the ligaments
surrounding the uterus. But Dr. Bryan
Cowan, professor and chairman of
obstetrics and gynecology at the
University of Mississippi in Jackson,
said he wasn't buying into this new
approach. Of greater concern were his
remarks about surgeons' preference to
cut the ligaments to give them a more
open field of surgery. A review of
operative gynecology textbooks indicated
that the uterosacral ligaments can
affect bowel, bladder and sexual
function, which makes one wonder why a
surgeon's preference for the wider field
of surgery would take precedence over a
woman's chances at a better outcome.
Education and Social Class
Education and social class, are two
additional important factors. These were
addressed in the Ontario Women's Health
Council's 2001 report titled, Achieving
Best Practices in the Use of
Hysterectomy. The report shows that the
hysterectomy rate is highest in poor,
rural regions where the level of
education is low. Similarly in the U.S.,
the hysterectomy rate is highest in the
southern states. Those who are
interested in a complete copy of this
report can get one HERE.
Women Misleading Other Women
Finally, women misleading other women is
an equally significant factor
contributing to the overuse of
hysterectomy. Some recommend the
procedure to others as a permanent
solution for birth control, while others
may paint a rosy picture of post
hysterectomy life because they
themselves do not associate their
symptoms with the surgery. This is
particularly true of senior women who
remain uncomfortable talking about their
surgery and the difficulties they faced
because of it over the years, women who
have just recently undergone the
procedure, or in the case of those who
were able to retain their ovaries. But
as Winnifred Cutler, PhD, explains in
her book, Hysterectomy Before and After,
the aftereffects of hysterectomy tend to
surface over time, sometimes years after
the operation, and if the blood supply
going to the ovaries was damaged at
hysterectomy, these organs will cease to
function. According to Cutler's
research, it happens in a great many
cases, and when it does, surgical
menopause follows with its nasty and
unpleasant symptoms.
Living life as a boiling kettle is not
something I would wish on my worst
enemy, and unlike Lauren Hutton's and
Patti Labelle's personal claims in their
commercials for the makers of hormone
replacement therapy (hrt), it's not a
problem that can be easily corrected by
the conventional forms of hrt on today's
market, not if you've been castrated.
Besides, conventional hrt can lead to
breast cancer, blood clots and heart
disease, as confirmed in last year's
reports on the National Women's Health
Institutes' halted study. And another
study released just last week showed
that conventional hrt is linked to
dementia. Most women don't want to
invite these risks into their bodies,
however minimal some doctors may claim
that they are. Evidence to the contrary
is in the results of these studies.
We must not discount women with claims
of a positive experience because their
hysterectomy rid them of the problem
they had. In many of the women I
interviewed, it doesn't matter that the
trade-offs have greatly affected their
quality of life, or that they can't find
a hormone therapy to keep the symptoms
under control, they want others to know
that their story is a "positive" one.
Lack of Outcome Studies
In May 2001, Charles J. Wright, M.D.,
released his study on the outcomes of
six surgical procedures in Western
Canada. His study included hysterectomy
and revealed that very little
information is available about the
outcome of surgery from the patient's
perspective. Without more and better
research into the long-term effects of
hysterectomy and female castration,
women cannot truly give their informed
consent for these operations. Yet in a
feature article by health reporter, Paul
McKeague, published on May 5, 2003, in
The Ottawa Citizen, Dr. Andre Lalonde,
executive vice-president of the Society
of Obstetricians and Gynecologists of
Canada, said that a large survey
(commissioned by none other than the
society itself), indicates "that the
satisfaction rate for hysterectomy is
very, very high." Dr. Lalonde didn't
offer any numbers or specifics about the
women interviewed for the internal
study, and boasted that "the majority of
people answering us are saying, 'Why
didn't I get it done years before?'"
Gail McFall of Kingston, Ontario, wrote
to say that Dr. Lalonde is a prime
example of why unnecessary
hysterectomies are continuing to occur.
According to Mary Anne Wyatt, and other
experts I approached, there have not
been any significant patient outcome
studies done in the U.S. either. Ms.
Wyatt said that no one knows how many
divorces or suicides result from
hysterectomy, for example. Such a study
would be a good place to start.
Awareness, our Best Defense and Key
to Change
Now that we have an understanding as to
why women continue to subject themselves
to unnecessary hysterectomy when
alternatives do exist, what can we do to
put a stop to it? Charles B. Inlander,
President of the Pennsylvania based
People's Medical Society, says "there is
too much good information available for
women to be bullied or misinformed by
doctors who make a living off of
performing hysterectomies. Women must
take charge of their own health, seek
out information, discuss it with their
physician, but ultimately make their own
informed decision. In this day and age,
the old medical demand of 'Trust me, I'm
a doctor' should only be heeded based on
solid evidence, not blind faith."
Here are a few helpful internet
resources:
Abdominal Hysterectomy: Trends,
Analysis, and Sexual Function
The Hidden Power of Body Odors: Studies
find that male pheromones are good for
women's health, John Lea (Time, December
1, 1986)
Hysterectomy and Sexual Orgasm
Alternative Therapy: The Uterus
Lise Cloutier-Steele is a communications
specialist and a professional writer and
editor, who has survived a traumatic
experience with hysterectomy. She is
also the author of Living and Learning
with a Child Who Stutters. And she is
the recipient of a Canada 125 Award in
recognition of a significant
contribution to the community and to
Canada for her volunteer efforts to help
the parents of children who stutter. She
has appeared on Canada AM, the Women's
Television Network (now W), The Phil
Donahue Show, The Body and Health Show,
and several other media to talk about
the important topic of unnecessary
hysterectomy in North America.
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