– 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 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
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.
Here's the transcript:
Hysterectomies Can Hurt Sex Lives
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 The Ontario Womens Health
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
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
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)
More on Sex after Hysterectomy
(type “hysterectomy” into the site’s search
function to get to this article.)
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 purchase a copy of
Misinformed Consent - Women's Stories about Unnecessary Hysterectomy
please go to Next Decade Books www.nextdecade.com