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.
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
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
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.
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
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:
Hysterectomy: Trends, Analysis, and Sexual Function
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
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
Read an interview
Read Susun Weed's chapter excerpt, Mammograms?
Who Needs Them?