- The Washington Times - Sunday, June 15, 2003

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 conclude that none of our body parts is dispensable, and I think most people would agree with me on that one. 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.

c Gynecologists withhold information: 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 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.

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 sexual dysfunction.

Lack of training in women’s sexual health: 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.

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), which 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 women should investigate.

Mary Anne Wyatt of Massachusetts, a researcher in molecular biology and electrochemistry, says there are various 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.”

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.

Reports have shown that the hysterectomy rate is highest in poor, rural regions where the level of education is low.

This 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, of women who have just recently undergone the procedure, or in the case of women who retained their ovaries. But as Winnifred Cutler, Ph.D., 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 Dr. Cutler’s research, it happens in a great many cases.

According to Mary Anne Wyatt and other experts I approached, there has not been any significant patient outcome studies done in the U.S. to date. Ms. Wyatt said no one knows how many divorces or suicides result from hysterectomy, for example. Such a study would be a good place to start.

Now that we have an understanding of 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 at 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.”

Lise Cloutier-Steele is author of “Misinformed Consent: Women’s Stories About Unnecessary Hysterectomy. “

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