Unnecessary Hysterectomy

Our bodies are marvellous 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 conclude that none of our body parts is dispensable. Yet women willingly surrender their noncancerous reproductive organs to surgeons.

In a single year, 71,000 women in Canada will have a hysterectomy, the majority as a first-line treatment for conditions that are not life threatening. I wonder why Westerners are 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 a tribal or religious custom, but as a quick fix for a variety of women’s health problems. The burning question is, why?

Under the Knife and in the Dark

According to a 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 from women about the after-effects of hysterectomy and ovary removal.

Hot Flash! A Roster of Side-Effects

Gynecologists have traditionally downplayed the risks involved with the operation itself and its many lasting consequences. Hot flashes, depression, anxiety, osteoporosis, generalized fatigue, stress, urge incontinence, masculinization, insomnia, bowel dysfunction, and mood swings are just a few of the side-effects. Most medical textbooks and other books on the subject do not differentiate the symptoms linked to uterine-only compared to uterine-and- ovarian removal. But the loss of the hormones once produced by the ovaries is commonly linked to some of the same effects, with the addition of severe PMS and thyroid dysfunction. More importantly, the removal of the uterus and/or the ovaries can lead to sexual dysfunction.

Post-hysterectomy sexual dysfunction is the result of nerve damage caused by the cutting with surgical instruments around the organs being removed (uterus, cervix, Fallopian tubes and ovaries). This, in turn, results in diminished orgasmic response or pain with intercourse. Loss of libido is another form of sexual dysfunction and the direct result of the removal of the ovaries. All are outcomes that women should investigate.

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. Gynecological students need to know that most women over 40 want to hang on to their sexuality. They also need to be taught about the nerves surrounding the female reproductive organs and the role that these nerves play in sexual arousal. These gaps in knowledge lead to an obvious question: what else is lacking in doctors’ education?

Alternative Procedures

Mary Anne Wyatt of Massachusetts, my collaborator on Misinformed Consent and 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, and their gynecologist may not be skilled in a technique to preserve the uterus.”

A third of all hysterectomies performed in the US are to remove uterine fibroids (benign tumours). Excessive or “dysfunctional” uterine bleeding (DUB) accounts for another 20 percent of hysterectomies. See the box for information on alternatives to hysterectomy to resolve these problems.

Divided We Fall

An equally significant factor contributing to the overuse of hysterectomy is that women mislead other women. 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 side-effects with the surgery. But as Winnifred Cutler, PhD, explains in her book Hysterectomy Before and After (HarperCollins Publishers, 1990), the after-effects of hysterectomy tend to surface over time - sometimes years after the operation, and if the ovaries were retained, and their blood supply damaged at hysterectomy, these organs will cease to function.

Denial, Not Just a River in Egypt

In May 2001, Charles J. Wright, MD, 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 this surgery from the patient’s perspective. Without more and better research into the long-term effects of hysterectomy, 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. Andr?alonde, executive vice-president of the Society of Obstetricians and Gynecologists of Canada, said that a large survey, commissioned by 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, “The majority of people answering us are saying, ’Why didn’t I get it done years before?

The Evidence, Please

Charles B. Inlander, President of the Pennsylvania based People’s Medical Society, says “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.”