I decided to sit down with the chief of ob/gyn at my training center and discuss hysterectomies and and the history of ob/gyn. Needless to say it was very enlightening and interesting. I had forwarded him my blog address so that he could read the comments prior to our meeting. He has been practicing ob/gyn since 1974 and has served in many leadership roles and faculty positions with in the community of women's health initiatives. He was able to shine some light on many aspects of ob/gyn and women's health.
One of his interesting and profound statements that he made was that as a doctor you can't focus on anything other than the patient you are treating at the moment. You have to put aside your views, your opinions, your ideals and really focus on what is best for that patient. Any time you make blanket statements or decisions you will run into trouble. For example you can't think "Every women with disease X should get procedure Y". You also can't say patient X had a bad outcome with treatment Y so this treatment should be thrown out and noone should ever get treatment Y again. Every patient is so different and unique that they have to be approached in an individual custom process.
I asked him about his opinion of hysterectomies and the controversy around the procedure. He said that it is his policy that surgical intervention should be the last option after all other options have been attempted. He said his biggest challenge is that he spends much of his time trying to talk patients out of getting a hysterectomy but that many patients have friends and relatives who loved their results and they want instant gratification and really push for the procedure. He said he has had several patients that he tried to sway from a surgical procedure ultimately go to a different doctor and twist their arm to do the procedure until they were able to get it done. He also said that there is definitely a need for hysterectomies in the right patient. He explained that there are certain patients with disease that would benefit from hysterectomy and if the physician failed to offer the procedure he would be negligent.
He explained that he has never lost a law suit and has been sued very few times compared to the normal ob/gyn doctor. He said he has been sued 4 times for not performing a hysterectomy and has never been sued for performing a hysterectomy. It has been his experience that this is a common phenomenon. An ob/gyn is more likely to be sued for not performing a hysterectomy than for performing a hysterectomy. He also explained that because reimbursement is dropping that ultimately a physician is better compensated for managing the patient medically than performing the surgery. Many of his patients will try medical management but ultimately give up with frustration and ask for the hysterectomy. We chatted for a long time on this issue and I do not have time to include all of the information. It is a complicated issue that involves many aspects.
He will allow me to call any of his patients and ask them about their experience with their hysterectomy for the purpose of my learning. I am developing a survey to use for this purpose.
Thanks to all for your comments.
Edit after some comments: There is no way I have time to list and write out everything that was discussed at my meeting with the chief or ob/gyne and the other doctors and patients I have talked with at length however I can tell you we discussed everything that your comments have mentioned. I also have the copy of our consent forms and I am not allowed to post them I can tell you they cover many of the issues mentioned like loss of orgasm in some woman and loss of libido in others and the health risks.
13 comments:
JJ,
The response of the chief of ob/gyn at your medical center was predictable, typical, and avoided the essential, basic issues.
He has a professional responsibility to inform women about the consequences of hysterectomy and removal of the female gonads, the ovaries. I interviewed the chief of ob/gyn at Hartford Hospital, Steven Curry, and with his permission, I called the 55 ob/gyn's in his department to ask what they tell women about the effects of hysterectomy. Not one of them tell women that the uterus is a hormone-responsive sex organ that supports the bladder and bowel. The vagina is shortened, sutured shut at the top and made into a closed pocket. Women who experience uterine orgasm do not experience it after their uterus is removed. When only the uterus is removed pre-menopausal women have a three times greater incidence of myocardial infarction. When the ovaries are removed the incidence is seven time greater than intact women.
These are but a few of the well-documented consequences of hysterectomy and female castration. In one of your earlier posts you said that some women on your blog referred to hysterectomy as castration, but it is oophorectomy, removal of the ovaries, that is castration. 73% of women are castrated at the time of hysterectomy.
The issue is not whether women are begging for hysterectomies and doctors are simply fulfilling their wishes, or whether the surgery was medically indicated, the issue of primary importance is informed consent.
If you watch the short video on HERS website, www.hersfoundation.org/anatomy, you will understand how vital the information is that truly empowers women to make an informed decision about what she will, and will not, allow to be done to her body. Without the information she has no idea what she is choosing. Women who watch HERS video, "Female Anatomy: the Functions of the Female Organs", do not consent to hysterectomy unless it is life saving. Only about 2% of hysterectomies are life saving. But if a woman chose to die with her female organs intact, she has the right to make that decision.
Women are not being given the information that is requisite to informed consent, which is the same as an unconsented surgery. Every woman has the right to be fully informed before being told to sign a form consenting to the removal of her female organs.
continued...
I will gladly contribute to your medical education by sending you the just released book "The H Word", co-authored by me (Nora Coffey) and Rick Schweikert. If you are interested you can email your address to hersfdn@earthlink.net and say that Nora Coffey offered to send you a courtesy copy of the book.
With regard to being given access to the chief of ob/gyn's patients to discuss their experiences, do you really believe that included will be the names and telephone numbers of the women who told him that their sex life, their family life, and their professional life was destroyed by the surgery? And do you think those women are still his patients? I also doubt that any standardized survey will ask the type of questions that reveal the truth about the effects of the surgery. Our survey asked the questions that doctors do not ask, and we reported their answers verbatim with the woman's comments, some of which were as much as ten additional pages. Hysterectomy and female castration are complicated issues, and how a survey is conducted and responses it elicits are equally complex.
When you speak with the chief of ob/gyn again, I would ask the following questions:
1. Do you tell women that the uterus is a sex organ and that if they experience uterine orgasm they will never experience it after their uterus is removed?
2. Do you tell women that their vagina will be shortened, made into a closed pocket, with a loss of depth, elasticity, and lubrication?
3. Do you tell women that when their uterus is removed they will have a 3X greater risk of cardiovascular disease, and if their ovaries are removed their risk is 7.2X greater?
4. Do you tell women that lower back pain, hip pain, loss of stamina, profound fatigue, change in personality and loss of maternal feeling are common consequences of the surgery?
5. Do you tell women that all of these effects are permanent. The surgery can only be done, it cannot be undone.
In response to the informed consent at the center I am training at there is a form and discussion on the 5 points you have mentioned plus more you did not mention. The patients are not allowed to just sign the form either. The patient advocate must read and discuss each risk listed and answer questions along with the other healthcare providers in attendance. I have attended these meetings and would have to say the risks you mentioned are discussed.
SO WELL SAID NORA from the HERS foundation. I agree that the chief of ob/gyn at JJ's medical center did not give him the names of the women whose lives has been destroyed by having a hysterectomy and castration. I don't understand when you want to find out what this surgery does to a woman's body and her life they don't read what women are saying on the Hers Foundation Web Site. WE ARE THE EXPERT, wouldn't you think? There is no way a doctor is going to tell a woman all the consequences you have stated. If they did, you wouldn't have the surgery, especially knowing removing the ovaries is castration!
I don’t doubt your sincerity, JJ, but it would be extraordinary for women to be told these few adverse effects and have them still consent to a surgery that will take destroy their ability to experience uterine orgasm, shorten their vagina, cause a loss of vaginal elasticity and lubrication, put them at significant increased risk for cardiovascular disease, cause lower back and hip pain, loss of stamina, profound fatigue, change in personality and loss of maternal feeling and that women said “sure, let me sign that form, I’d love never to have a uterine orgasm again, it would be terrific to have my vagina shortened and have vaginal dryness, and it would be great to have a myocardial infarction, lower back and hip pain, no more stamina or energy so I could just stay in bed all day and wont’ be able to work like I do now, I never did like my personality so I’d love to have my personality change, and losing the feeling for my children would be such an improvement in our family life.”
Or if this information is presented is it done in a way that immediately trivializes it: “You could experience some change in sex, but most women say sex is better, and there are hormones for women who have some sexual changes”, and so on.
If you read The H Word you’ll find that I interviewed the chair of Obstetrics and Gynecology at Hartford Hospital. He said he and all of the 55 ob/gyns in his department spend an hour fully informing women about the consequences of hysterectomy. I asked him what he tells women, and he said he tells them that they won’t be able to get pregnant and they won’t menstruate again. I asked him what he tells them in the remaining 59 minutes of his informed consent process. He responded by changing the subject. I then asked if he would mind if I interviewed the 55 ob/gyn’s in his department, and he said that was fine with him. I called all of them, and succeeded in speaking with more than half. Not one of them told women the consequences that I listed above.
Furthermore, the loss of uterine orgasm, shortened vagina and loss of elasticity is not a possible risk, it is an anatomical fact. As soon as you characterize it as a risk it makes me wonder in what way the presenter countered that risk to make it seem like it’s something that’s possible, but that it wouldn't happen to them.
I have two questions for you, JJ. Do you and others in the ob/gyn department tell women that removal of the ovaries is castration? And is it conceivable that when you take a knife, scalpel or laser and cut into a woman’s pelvis or vagina, sever the ligaments, blood supply and nerve supply, shorten her vagina when you suture it shut, that it doesn’t occur to you that you have seriously and permanently damaged a woman?
I respect your interest in learning more about the effects of removal of the female organs, and for not backing away from some very difficult dialogue.
Nora W. Coffey
President, HERS Foundation
If I can get permission to post at least parts of the consent form we use I will do it as you will see these items are discussed at this center. The chief of OB\Gyn at this non-profit center's goal is to avoid doing surgeries if possible.
As far as who I can contact as patients I have access to the center's entire database and full access to call whomever I want. So I can look under any procedure and choose and name or multiple names and call. No restrictions, good outcomes or bad outcomes. There is some talk about using my info for a study if I want to pursue it. I already have logged into the database and compare it with the hospital stats for procedures and it matches as far as the numbers go.
I also interviewed 3 female Ob/gyn surgeons who volunteer at this center that have had hysterectomies and there info is very interesting. The problem is that I do not have time given my schedule to create a blog dedicated to controversial aspects of hysterectomies to discuss both sides of the issues. The info I posted about the chief's comments are literally about 10% of what we discussed.
Today has been my first day off in many days so I thought I would post a little bit but I certainly can't spend a bunch of time writing about all of the conversations. I have an exam coming up and should really be studying for that :)
Continued: I forgot to mention I also was given the name of patients who had complications or who have made complaints. There names are in the complete database as well but a separate database houses all patients who have had reported complications. I have been cleared to contact any of these patients and ask about there procedures and opinions. I do have to tell them that this not an official survey of the hospital and explain that I am a medical student doing research and if any of their info is used for any official research or otherwise they will need to approve the use of it.
Sex After a Hysterectomy: Never Better
by Laura Chisholm, MPH
Despite the fact that more than half a million American women have their uteruses surgically removed each year, most women don't blithely sign up for the procedure. Besides having the usual worries about undergoing major abdominal surgery, they are concerned about how hysterectomy will affect their health and lives, especially their sex lives. In fact, studies have shown that concerns about sexual functioning are foremost in women's minds before surgery.
"While not all women contemplating hysterectomy ask about the effect of the procedure upon sexual functioning, they most certainly think about it," writes gynecologist Sarah Berga, MD, in OB/GYN Clinical Alert. But there's good news about sex after hysterectomy. A 1999 study revealed that hysterectomy can have very positive effects on a woman's sex life, especially if she was experiencing significant medically related sexual problems before surgery.
The Good News
Published in November 1999 in the Journal of the American Medical Association, the Maryland Women's Health Study followed the experiences of 1,101 women during the first two years after a hysterectomy. The results were surprisingly positive. Overall, the study group's frequency of sexual relations increased after surgery, and the number of women experiencing pain during sex dropped from 41% to 15%. Although improvements in vaginal dryness were not as marked, women in the study group did report strong orgasms almost 15% more frequently one year after surgery. Even more impressively, almost three-quarters of the women initially experiencing low libido reported an improvement after surgery, and two-thirds of the women who reported not having orgasms before hysterectomy were having them a year later.
"This study shows that women are incredibly adaptable sexually," says Jillian Romm, RN, LICSW, a medical social worker who specializes in counseling women on reproductive issues. "Even after a major pelvic surgery, women can actually improve on their past in many cases," she says.
A Change In Thinking?
Although hysterectomies are very common among major surgeries performed in the United States, the procedure hasn't had the best reputation among the general public. Common knowledge held that removal of the uterus was the cause of many problems, including increased vaginal dryness, painful intercourse, lack of interest in sex, and lower number and quality of orgasms.
However, according to Leon Speroff, MD, professor of obstetrics and gynecology at Oregon Health Sciences University in Portland, Oregon, the results of the Maryland study didn't surprise experts.
"It's not new news, and the results make good sense," he says. "Because women usually undergo hysterectomy as a result of major medical problems, it's not surprising that quality of life generally improves after surgery."
Continued from previous post
All Hysterectomies Are Not the Same
One cause of the confusion about hysterectomy's affect upon sexual functioning may have been the public's assumption that all hysterectomies are the same. They're not. Sometimes the ovaries are removed along with the uterus, and in other cases they're left intact. Although the uterus is thought to play a role in women's hormonal functioning, the ovaries are the master producers of estrogen and the regulators of the menstrual cycle.
" Oophorectomy [surgical removal of the ovaries] often has a far more devastating impact than removal of the uterus, particularly among premenopausal women," says Amanda Clark, MD, a gynecological surgeon at the Oregon Health Sciences University Center for Women's Health. "When a woman hasn't reached menopause and her ovaries are surgically removed, we get a situation of 'instant menopause' that can cause just the sort of sexual problems that people commonly blame on hysterectomy," she says.
Too Many Hysterectomies?
Another possible cause for hysterectomy's bad reputation may be recent arguments that the procedure is performed too frequently. "The uterus has hardly been studied separate from its role in childbearing," writes Christiane Northrup, MD, in Women's Bodies, Women's Wisdom. "After the uterus's childbearing function has been completed or when a woman chooses not to have a child, modern medicine considers the uterus to have no inherent value."
The high number of hysterectomies performed in the United States has also caused an outcry from feminists who refer to the procedure as "the ultimate rape" and argue that it represents a form of cultural and sexual discrimination. Although opposing views may confuse the issue, the continuing controversy over hysterectomy does remind women to keep themselves well-educated and informed.
An Informed Recovery
Romm believes that one of the best ways to increase the chances of having a positive sexual recovery after hysterectomy is to contemplate the decision to undergo the surgery as thoroughly as possible ahead of time.
Not only should women explore all available medical options, but they may also benefit from delving into related psychological issues, she says.
"I help each patient explore the nature of her attachment to her uterus. If having a womb is a big part of what makes a woman feel feminine, then having a hysterectomy will be a much bigger deal for her than, say, having her appendix out."
According to Romm, each woman's process of pre-surgery decision making, as well as her subsequent experiences during recovery, are entirely individual and must be treated as such.
"What makes our sexual self really alive is extremely individual. I urge women to talk about their feelings with loved ones, and think through every possible outcome. This takes a lot of the fear and unpredictability out of the process of adjusting."
Preparation: Key to a Positive Outcome
Along with the practical and emotional preparation, it's important for women and their partners to have realistic expectations about recovery.
"It's really common to go through a postoperative honeymoon period," says Romm. "It's kind of exciting, like having a whole new vagina. But then things usually settle down into the pre-surgery pattern."
Knowing what to expect, she says, makes changes easier to accept in a positive light. Because hysterectomy also releases many women from previous medical problems and fear of pregnancy, the odds seem to be stacking up in favor of great sex after hysterectomy.
The uterus produces hormones like the ovaries for the rest of a women’s life. With out the uterus you can not have a vaginal orgasm it is medically impossible. How can you keep women informed when the doctor doesn’t tell you all the consequences to a hysterectomy? Pre surgery decision depends on the doctor explaining everything, which they never do. How can’t a women talk about her feelings and work through them if they are not informed of the whole procedure or the consequences of the surgery. It is not a whole new vagina; it is now damaged and dislocated from the surgery. I believe this article is deceptive of what really happens from a hysterectomy. This article misinforms women of the consequences to the surgery.
vaginal orgasm is still possible after a hysterectomy and can even be better. Uterine orgasm is not possible after the uterus is removed. My orgasms are much better following my hysterectomy. I had a very similiar experience as mentioned in the article. Hysterectomy was a God send and saved my life. My quality of life is way better. I read the H Word prior to my surgery and it came across as having an underlying political agenda and it was hard to accept all the info which seemed like propaganda. Mant of my friends had good results with their hysterectomy. It is not fir everyone and your doctor can't predict exactly how you will be affected as everyone is different. Do your research, it saved My life!
On every blog about hysterectomy, there's always some "Anonymous" token post about how someone has great sex after their sex organs are removed. Are you kidding? If you were a man, and you were trying to tell other men that your sex life was better after your prostate was removed, your penis was shortened and you were castrated, you'd be a laughing stock. You cannot have better orgasms without your sex organs so stop lying to other women. Out of all the women I know who have been hysterectomized and/or castrated, not one of them out of about ten says that sex is better. Not one of them feels better. In a few cases where there was extreme bleeding, they found it a relief not to bleed so heavily, but they've also acquired many more problems. When a woman wants to get a sex change, guess what the first major surgery is? Hysterectomy/castration. It is anatomically impossible for a woman to have better sex without sex organs, not to mention all the extensive damage that is done to the body when that barbaric surgery is performed. These so called doctors have hysterectomized nearly half of the female population in the United States. Now, any reasonable person would be able to see that there is something very wrong with that. Women are not lining up saying, hey, please remove my sex organs. In most cases, they are being deceived by their trusted doctors. You can read it all over the internet how women are told they need a hysterectomy for minor benign conditions, but they are NOT told they are minor or benign. Many of them are told they probably have cancer, or that their condition is very bad. Women don't go into a hospital and surgery room because they have nothing better to do, they are led there by doctors who they are supposed to be able to trust. Most women have no idea that this is a very profitable business and these "doctors" have worked very hard at deceiving the public so they can continue making huge profits off the amputation of female sex organs.
Women who are castrated (removal of ovaries) do not go into surgical menopause. Instead, they suffer from loss of ovarian function. When a woman goes into menopause, her ovaries produce less sex hormones slowly over a period of time, but they always produce hormones, all her life. When the ovaries are amputated (female castration), there is no decline, and there is no more function. Women who are castrated are in a category of their own, and to call it menopause is completely inaccurate, and it also leads women to believe the propaganda that they'll just go into normal menopause after they are castrated when nothing is further from the truth.
Any study that finds that women have better sex after their sex organs are removed is laughable. Either the study is very flawed, or the women are too embarrassed to admit the truth.
And, to the person who said she read "The H Word" before her hysterectomy, well, that book has only been available for a couple months, so who do you think you're kidding? As I said at the beginning, a token "Anonymous" post. It was probably posted by an ob/gyn hunting for more business.
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