If a woman in our society has her reproductive organs removed, no one takes much notice. It's an everyday surgical event. But if a man has his testicles removed, we gasp in shared pain. Are a man's organs more important?
Until the 1990s, when managed health care started taking a closer look at surgeries, approximately 665,000 hysterectomies were performed each year on women at an average age of 42.5 years. A university professor who was a second-opinion expert for Blue Cross reported, "The patients who had the recommendations for the hysterectomies either had no pathology whatsoever or had pathology that was so minimal it was inexplicable to me how anybody could have recommended surgery."
There are times when hysterectomy is necessary to save a woman's life, as in cases where cervical or ovarian cancer is found. Hopefully, if your physician recommends a hysterectomy, you will seek a second opinion. It is your body and your right.
There is nowhere near the kind of solid research on hysterectomy and sex that you would think, given the large number of hysterectomies that are done each year. To help with any decisions you might need to make, Annie Bradford, a researcher from the University of Texas at Austin, has been kind enough to off the following perspective to readers of The Guide:
"If I were a woman who is preparing to have a hysterectomy, there are a few things I would want to be asked. First, I would like my physician to discuss the possibility of less aggressive/less invasive treatment alternatives—hysterectomy isn't the only option for an increasing number of diseases.
I would want my MD to check in with me about my general well-being in life at that moment, because the literature shows that depression and anxiety going in tend to predict poorer outcomes. I'd also want to know that my MD cared that I had the support of friends, family, and/or significant others; this is another thing that seems to influence outcomes. If my MD suggested that I should have my ovaries removed, I would want a very good reason for it. The idea that I should remove organs that I supposedly 'won't need anymore' on that basis alone is preposterous!
"After hearing from many women about their hysterectomies, the main thing I have learned is that most of them just want information. Even if the MD can't guarantee a particular outcome, they really want to know the pros and cons of all of the treatment options. Contrary to what some paternalistic doctors might tell you, they really can handle that information! Several studies have demonstrated that patients tend to want more information, sometimes a lot more, than their doctors think they want or need. The bottom line is that women want to CONSENT to every aspect of their treatment, and that means they understand why they're taking one approach over the other, etc. Informed consent is not just 'this is what you need, now sign the dotted line.' It's an agreement to a collaborative treatment decision (thus the word 'informed').
"The jury is still out on to what extent hysterectomy affects basic sexual physiology. I would guess that any given outcome is a combination of the surgical technique and the individual woman's composition. I've heard some women say that they have lost some sensation after hysterectomy, or their orgasms aren't as intense as they used to be, but there is no 'typical' hysterectomy experience as far as I can tell. Whether any woman would do it all over again given the chance depends on a lot of different factors. Women whose sex lives are disrupted because of huge, basically inoperable fibroids are likely to still be mostly satisfied when penetration no longer causes sharp pain, and I suspect that for many this would be true even if the cost were a slight change in sexual sensation or the intensity of orgasm. The thing is, though, we can't KNOW what that potential trade-off would mean to any individual woman unless we actually ask her! So, if I were a doctor, I would say, "Look, these are side effects that some women have reported," and summarize the latest research to give her an idea of how common the side effects actually are. It would be up to her to decide if the risk, however small, was worth the potential gains associated with hysterectomy, which themselves are not 100% guaranteed either, of course! It's a cost-benefit analysis, and even though there are a lot of women who want their physicians to make the final decision, I've never heard anyone claim that they got too much information about what might happen to them.
"I have heard from a few women who said that they put off their hysterectomies needlessly because of scare tactics, and this is the other side of the story. There are activist groups putting out some pretty wild claims. According to them, hysterectomy can cause asthma! They don't do women any
favors with their misinformation and pseudoscience. Ultimately it's a hard decision to make, and women simply need the facts. I am fairly convinced at this point that, for an otherwise healthy, well-adjusted, well-supported woman who lives in a community or in a relationship that won't see her as losing her femininity, hysterectomy is not necessarily a bad thing for sexual function and in some cases might be exactly what she needs. If less invasive treatment options have been ruled out and the main issue is painful intercourse caused by the disease. Otherwise, the picture can be more complex.
One of the most consistent findings from past research, though, is that the worse off you are to begin with, both sexually and emotionally, the less likely it is that your outcome will be a complete success. When women ask me about their treatment decisions, I ask them right out: are you emotionally, mentally, physically, and spiritually ready for this? You'd be surprised how seldom women get asked this question.
"No matter how healthy you are to begin with, losing the ovaries IS a big deal, especially for premenopausal women, as it changes the hormonal profile and forces further decision-making about hormone-replacement therapy and so forth. The choice to remove the ovaries should be carefully justified. The medical opinion on this issue has shifted back and forth over the years, but there are many experts who would tell you that, for healthy women with no significant risk factors for ovarian cancer, the cost of losing ovaries is greater than the potential benefits. Sometimes removal of the ovaries is an easy decision to make because of cancer or other factors, but more often than not it should be deliberated very carefully. This is a time to get second opinions."
A friend of The Guide from way back when is one of the top sex researchers in the country. She is also a physician. Recently, she became so angry with her own private gynecologist that it appeared she was going to rip him a new—uh—vagina. She was diagnosed with cancer of the cervix, and his handling of it was neither sensitive nor professional.
The reason for reporting this is not to dump on gynecologists. There are many excellent ones. It is simply to remind you that even an MD can become an angry and frustrated patient. So if you are feeling overwhelmed by your dealings with modern medicine, you are not alone. Don't hesitate to get a second opinion. If it appears that you will need to have surgery and you don't feel comfortable with your physician, find a university health center to get another opinion. That is what Marca recommends after her personal experience with hysterectomy.
A SPECIAL THANKS: To Annie Bradford of the University of Texas at Austin for providing readers of The Guide with some of the best advice available for women who are considering a hysterectomy.