The Endangered Uterus

If your doctor has recommended a hysterectomy, don’t make a decision until you read this startling report on the real risks of surgery and the less-invasive alternatives your ob-gyn may not be mentioning.

Many of these treatments have existed since the 1980s, which is why it’s appalling that the annual rate of nearly 600,000 hysterectomies in the U.S. hasn’t declined significantly in 10 years, according to the Centers for Disease Control’s statistics. What’s more, almost 70 percent of these hysterectomies are still being performed via open abdominal surgery, which was pioneered in 1843, despite the fact that laparoscopic hysterectomy, available since the mid- to late-1990s, is a less-invasive removal method. The surgery is guided by a tiny camera inserted into the body via a small incision, in a procedure that causes less pain, less scarring, and less risk of infection. And women who have laparoscopic surgery are back at work in about one-third the time as those who undergo an open abdominal hysterectomy.

With such effective alternatives now available, why do physicians continue to treat non-life-threatening problems by removing our reproductive organs? Why, even when a hysterectomy is appropriate for noncancerous conditions, is it being done in the most scarring and disabling way possible? And why are we — a generation of women who research and challenge personal trainers, investment advisers, and other professionals in our lives — allowing this?

Our Mistaken Acceptance

The idea that hysterectomy is okay is deeply ingrained in our culture, Dionne says. "The 20 million American women who have had hysterectomies indoctrinate their daughters, sisters, and friends: Just do it. You’ll feel so much better once the pain is over." Granted, if you are a woman who is seriously worried because she is bleeding heavily, any relief will seem like an improvement. "What many women don’t realize is that they might have resolved their problem without such a drastic measure or without the physical complications that may result — the complications that many of their friends and relatives don’t connect with the removal of their uterus," Dionne says. One eye-opening statistic: Compared with women who haven’t undergone the surgery, those who’ve had a hysterectomy have a 60 percent greater risk of being incontinent after age 60, according to a study from the University of California, San Francisco.

"Women also may not realize that the uterus supports everything above it. Removing it is like pulling out the cork from an upside-down wine bottle. Unless the woman has strong muscles, her bladder or her bowels can descend into her vagina," says Beth Battaglino Cahill, RN, of The National Women’s Health Resource Center (NWHRC), in Red Bank, New Jersey. Finally, the surgery itself can shorten the vagina and damage nerves, making sex less enjoyable or downright painful.

Some research has nonetheless suggested that hysterectomy improves women’s sexual lives, but that claim is controversial. "I’m wary of such studies," says biologist Winnifred Cutler, PhD, author of the upcoming Hormones and Your Health. As an example, she cites the 1995 Maryland Women’s Health study, in which women two years beyond hysterectomy reported they were more sexually active, more orgasmic, and had sex more frequently than before the surgery. "But the researchers asked the women about their sex lives in the 30 days prior to the surgery [to establish a baseline]. What woman, experiencing and fearing pain, is going to be having a lot of sex in the month before her operation?" With such a low baseline, Cutler notes, any increase may be misconstrued as improvement due to the hysterectomy. Her own findings with coauthors on sexual response postsurgery, presented in 2000 to the American College of Obstetricians and Gynecologists (ACOG), showed just the opposite: Hysterectomy can have a negative impact on sexuality. That is why she urges women considering the procedure to look closely at the facts.

What Most Doctors Will Tell You

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