Weed Wanderings Herbal eZine with Susun Weed : Feature Article
December 2003
Volume 3 Number 12

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Feature Articles...

Hysterectomy – The Alleged Quick Fix with Lasting Consequences
by Lise Cloutier-Steele
Prevention and Treatment of Fibrocystic Breast Disease
by Ralph L. Reed, Ph.D.

Hysterectomy – The Alleged Quick Fix with Lasting Consequences
A closer look at why millions of women still 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 conclude that none of our body parts is dispensable, and I think 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 and, 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.

Crucible by Kathi AndersonConsider 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.

Note: On Friday, August 22, the 20/20 show did an excellent segment on hysterectomy and its impact on a woman's sexuality. Dr. Stanley West of NY, the author of the prologue to Misinformed Consent, was interviewed for that program.

Visit Jennifer Zimmerman's art gallery onlineWomen’s Vulnerability
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. 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 at http://www.cihr.ca/e/33786.html.

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 traditional forms of hrt on today’s market. Not if you’ve been castrated. Besides, hrt can lead to breast cancer, blood clots and heart disease, as confirmed last year’s reports on the National Women’s Health Institutes’ halted study. And another study released just last week showed that 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 mustn’t 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 (SOGC), 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 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."

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)

About the author:
Lise Cloutier-Steele is a communications specialist and a professional writer and editor. She is 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 is also the author of
Misinformed Consent – Women’s Stories about Unnecessary Hysterectomy
and 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. To order Misinformed Consent - Women's Stories about Unnecessary Hysterectomy go to Next Decade Books.
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