Removing a woman’s uterus used to be the first response to heavy bleeding or other “female issues” – thankfully, those days are long gone. We now have a variety of less invasive treatments, but occasionally these newer treatments fail and hysterectomy becomes the best option.
Some women, even after exhausting all other treatment, are still hesitant about the idea of having their uterus removed. In many instances, their fears are unfounded, and when they finally decide to have the surgery, many feel so much better, they wish they had the procedure years before. Hysterectomy is a major surgery, and there are risks that should be discussed with your gynecologist, but there are also a lot of myths and false perceptions that often prevent women from from having a procedure they really need. Here are the three I hear most often:
Myth #1: Hysterectomy will bring on menopause.
When I start discussing the option of hysterectomy with patients, often they will cut me off before I can finish my first sentence: They tell me that their Aunt Suzie had a hysterectomy years ago and “she went crazy afterward.” I practice in Tennessee, so this is often said in a deep southern twang followed by an apologetic “bless her heart.” Some people automatically and incorrectly assume that hysterectomy includes removal of the ovaries with the uterus and therefore instant menopause. (Menopause does not “make you go crazy” either, but that’s a myth to be tackled in another post.) Previously, ovaries were routinely removed with hysterectomy to prevent the possibility of future ovarian cancer. We now realize the many benefits of preserving ovaries for heart and bone health; not to mention that most women simply feel better with their own hormones, rather than trying to replace them with a patch or cream. Newer data suggests that removing the fallopian tubes but leaving ovaries at the time of hysterectomy can reduce the risk of ovarian cancer without the sweaty side effects of menopause. No one wants to lose an organ, but getting rid of the uterus that causes the offending pain and bleeding while still keeping the ovaries that provide normal hormones is really a win/win.
Myth #2: Hysterectomy will affect sex.
Women often worry that sex will be different or less pleasurable after a hysterectomy, but studies have shown improved sexual function after hysterectomy for the great majority of women. Most women have spent years hurting, bleeding, and cramping all the time, so when they finally feel better, their libido feels better too. Removing the uterus does not affect sexual sensation. The vagina is the same length after a hysterectomy, but instead of a cervix and uterus sitting at the top, the vaginal tissue at the top is sewed together. The majority of women’s sensation with intercourse comes externally from their clitoris and from nerves in the front portion of the vagina. So, removing the uterus usually does not have a negative effect on sex. I say “usually” because, as with any surgery, there is always a risk of complications, and scar tissue in the vagina can result in painful intercourse.
Myth #3: Hysterectomy equals a big scar.
A lot of women picture a large scar from stem to stern when they think of a hysterectomy. The size of the scar is related to the size of the uterus removed. For extremely large uteruses we do still have to make big incisions, but for the great majority of cases we use smaller, less invasive incisions. Normal sized uteruses can often be removed through the vagina, leaving no incision at all on the stomach. For slightly larger uteruses, laparoscopic or robotic techniques can be used, which require 2-4 fingertip-sized incisions on the abdomen. Recovery for most vaginal and laparoscopic hysterectomies consists of one night in the hospital and a few weeks downtime.
Hysterectomy is a major surgery that does have rare, but serious, risks associated with it. But it doesn’t mean menopause, big incisions, or loss of libido. Surgery is rarely the first treatment choice for obnoxiously heavy periods or pelvic pain, but when conservative options have failed, hysterectomy is often a good option.