But studies show that up to 75 percent of those surgeries may be medically unnecessary, failing to meet the guidelines established by the American College of Obstetricians and Gynecologists (ACOG), according to NUFF.

We asked gynecologist and fertility specialist Stanley West, M.D, author of The Hysterectomy Hoax: The Truth About Why Many Hysterectomies Are Unnecessary and How to Avoid Them (Next Decade; $20), about his belief that most women who are not facing cancer should decline the procedure, as well as his claim that doctors are not telling women about all of the potential consequences, including a ruined sex life.

Say whaaat!?

Read on . . .

Q: You say that there is never a reason for a woman to have a hysterectomy unless her life is in danger. Does "never" really mean never?

A: There may be some exceptions, but in general, cancer of the uterus equals hysterectomy; noncancerous problems mean pursuing some alternative. [Go here for information about uterine fibroids, the most common cause of hysterectomy, and hysterectomy alternatives.]

Q: Then why, in your opinion, are so many hysterectomies performed?

A: Gynecologists are taught that hysterectomy is good for women--that it gives you a new lease on life and ends your problems with no downside whatsoever.

Q: And why do women agree to have them?

A: Because they don't know any better. If no one ever tells you that you have options, you believe what the doctor tells you.

Q: Speaking of options, are all gynecologists trained to perform myomectomies and other less invasive procedures?

A: Theoretically, during their [training], all gynecologists are exposed to all the variations of how to manage gynecological problems. The reality is, many have never seen a myomectomy in their life. I went through my [training] and never saw one in all those years. Gynecologists do what they know, and they know how to do a hysterectomy, so this is the operation they offer. Since they have been taught that it's a wonderful operation for women, without any side effects, they feel extremely comfortable doing it.

Q: What is posthysterectomy syndrome?

A: The aftereffects of hysterectomy can include depression, mood swings, and fatigue, and the fact that the sex life may go to hell in a handbasket. But a lot of women never hear that from their doctor. [Go here to view a summary of reports by more than 600 hysterectomized women about the adverse effects they experienced.]

Q: What do you mean, the sex life may "go to hell in a handbasket"?

A: When doctors perform a hysterectomy and remove the cervix, they end up shortening the vagina. Your partner may not fit any more. Doctors also sew up the hole that now exists at the top of the vagina. It will scar and may shrink the vagina even more. It can become painful.

If you are having sexual intercourse, every time your partner thrusts, you may not enjoy it. It's very common. Plus, if you don't have a uterus, you may not have an orgasm, or it may not be as strong. Or your orgasm could not be affected at all. I've certainly seen a number of women who never have an orgasm again because they no longer have uterine contractions. So if you're going to allow a doctor to remove your uterus, tell him or her to leave your cervix. It is a much better option.

Q: And what if the doctor also removes the ovaries, as happens with about 60 percent of women?

A: That will certainly affect you. For example, you lose testosterone, which gives you your sex drive and sense of general well-being. You lose estrogen, which is what makes you a female. You end up with vaginal dryness. You lose your desire, your libido. Doctors will tell patients, "We've got this pill [hormone replacement]," but believe me, it doesn't quite cut it. It can't replace what you're losing.

Q: Why, in your opinion, don't doctors tell women all of this?

A: It may simply be that they don't know. They don't teach posthysterectomy syndrome in med school. [Go here to learn more about sexual dysfunction after hysterectomy.]

Q: Then how can women give informed consent to the surgery?

A: They can't. They don't know the consequences or the alternatives. What usually happens is misinformed consent. [To learn more about informed consent, go here.]

Q: Some charge that gynecologists have a financial incentive to perform hysterectomies instead of referring women to doctors who know how to perform a myomectomy or other procedure.

A: If the doctor doesn't know how to do a myomectomy, he or she may try to convince you that hysterectomy is your only option. Because if you decide that you want something other than a hysterectomy, the doctor just lost, let's say $5,000. So it's financially in the doctor's interest to talk you into doing what he or she is suggesting.

Q: What should women do if their doctor suggests surgery?

A: First ask why. Second, ask if there is any alternative. Then ask what are the consequences of doing this. And a second opinion is always warranted when you're contemplating major surgery.

Q: And after those questions are answered?

A: Ask your doctor, "How many myomectomies have you ever done, and how many are you doing currently?" Don't accept vague answers. If a doc does one or two a month, he or she is certainly qualified. Find out how many times the doctor has converted a myomectomy to a hysterectomy. The answer should be never.

And if your doctor wants you to sign a consent form giving him or her authorization to perform a hysterectomy if there's a lot of bleeding, there are too many fibroids, or they're too big or are located poorly--none of which should be a reason for doing it if you know what you're doing--look for another doctor.

If the doctor tells you, "I've been in practice 20 years and have done a total of 10 myomectomies," run! If the doctor says, "I've been in practice 10 years and I've done 100, and of those I haven't converted any to hysterectomy," that physician might know what he or she is doing. Otherwise, keep going until you find somebody.

If you're looking for a support group, a database of physicians who perform myomectomies or other hysterectomy alternatives, or firsthand stories from women who have undergone the various procedures, Dr. West suggests you join the Yahoo Groups support group at NUFF.

And, as always, let us know what you think in the comments section below.

Hilary Beard is a Philadelphia-based writer

Published on: 07/19/2004

Hysterectomy Educational Resources and Services (HERS) Foundation  






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