Hysterectomy

• Hysterectomy associated with urge incontinence- WHW Sept 2002
• Urinary incontinence higher after hysterectomy- WHW Sept 2002
• Sterilisation and hysterectomy- WHW April 1998
• Update on hysterectomy- WHW Dec 1994
• Advantages of a subtotal hysterectomy WHW 1994
• An old method of hysterectomy revived- WHW Sept 1994
• Two Women's Stories- WHW Sept 1994

Resources

• Hysterectomy Factsheet
• Hysterectomy Info Pack

Hysterectomy associated with urge incontinence

September 2002 Women's Health Watch

Women contemplating hysterectomy should be warned that the operation is associated with an increased risk of urinary incontinence, according to a Dutch study.
In 1999, 1,626 women aged 35 to 75 completed self-report questionnaires. The odds ratio for urge incontinence was 1.93 for the 209 women who had had a hysterectomy although the operation did not significantly increase the likelihood of stress incontinence.
The Utrecht University Medical Centre researchers attributed the effect to the surgery's impact on the detrusor muscle.
Ref: Br J Obstet Gynaecol 2002;109:149-54

Urinary incontinence higher after hysterectomy

September 2000 Women's Health Watch

Women having hysterectomies should be warned about the risks of developing urinary incontinence. A study in the Lancet reports that women who have hyster-ectomies are at least 40 percent more likely to develop urinary incontinence compared to women who do not have the procedure. Women over the age of sixty were 60 percent more likely to become incontinent. The researchers say hysterectomy may damage the pelvic nerves or pelvic support structures and increase the risk of incontinence, although this may not develop for some years after the hysterectomy is carried out. Reasons for the delayed onset of incontinence are unclear but the pattern is similar to that of childbirth where incontinence often occurs five to ten years later.
Ref: Lancet 2000; 356: 535-39

Sterilisation and hysterectomy

April 1998 Women's Health Watch

Women who have undergone sterilisation are 4 to 5 times more likely to have a hysterectomy than women who have not been sterilised, says a new report from the Centres for Disease control and prevention in Atlanta... Read More

Update on hysterectomy

Decmber 1994 Women's Health Watch

Routinely removing a woman's cervix along with the uterus during hysterectomy is being re-evaluated in various centres around the world. In the l9SOs, sub-total hysterectomy - conserving the cervix - was far more common than total hysterectomy which removes the cervix as well as the body of the uterus. The shift to total hysterectomy was based on the dubious premise that this prevented the possible subsequent development of cervical cancer.

The illogic of this argument is that women who have a hysterectomy are no more likely to develop cervical cancer than women who never have a hysterectomy (assuming the hysterectomy is not because of malignant cells in the cervix or uterus). If hysterectomised women continue to have smears tests, they can protect themselves against cervical cancer like any other women.

The other change in practice which led to the rejection of sub-total hysterectomy was the fashion for vaginal hysterectomies. These were preferred to the abdominal operation, as the recovery time was usually slightly less. But the vaginal operation often resulted in a shortened vagina, and sometimes there are problems at the top of the vagina, such as slow healing of the wound and prolapse.

The worst aspect of these shifts in treatment practice was that women were not given an option. Total hysterectomy, increasingly by the vaginal route, became standard practice.

Patient information about hysterectomy usually baldly stated that the operation had no effect on women's sex lives. In the 1970s, a commonly heard medical view was that stated by Professor Dennis Bonham, head of National Women's Hospital, that 'we're just taking away the carry-cot and leaving the play-pen.'

In vain did women protest about such demeaning meta-phors. Women's reports of less intense orgasms and other effects on sexual enjoyment after total hysterectomy were discounted. Rather, they would be told they needed 'more foreplay' or prescribed tranquillisers.

Now medical science is admitting that in some women the cervix may play an important role in sexual response. Some studies have shown that total hysterectomy is asso-ciated with a significant reduction in orgasms compared to the sub-total operation. And there are illogical varia-tions in practice. Sweden, for example, has a 21% sub-total rate. In the USA it is 1%. In the UK it is even less.

Although a total hysterectomy is usually necessary when a woman has a prolapse, a malignancy, chronic cervicitis, or endometriosis, women with the commonest indications for a hysterectomy - heavy bleeding and fibroids - do not have diseased cervices.

Advantages of sub-total hysterectomy

December 1994 Women's Health Watch

In a recent issue of the British Journal of Obstetrics and Gynaecology, Professor James Drife of Leeds summarised the advantages of sub-total hysterectomy. These were:

Interest in sub-total hysterectomy is also being fuelled by the fashion for laparoscopically performed hysterectomy. In this method, the surgeon operates through small inci-sions in the abdomen. The uterus is morcellated (cut into little pieces) for removal. Until recently, the cervix has then been removed vaginally, but some gynaecologists are now questioning whether this step is necessary at all.

Laparoscopically performed hysterectomy does have risks, and the jury is still out as to whether it provides any ad-vantages over older methods.

Ref: Drife, James 1994; Conserving the cervix at hyster-ectomy BrJO&G 101: 563-64; Letters to the editor, BrJ O&G 1994; 102: 77-78; Grimes, David A, Shifting indications for hysterectomy: nature, nurture, or neither? Lancet 1994; 344: 1652-53

An old method of hysterectomy revived

September 1994 Women's Health Watch

In recent months we have heard from a number of women who have had sub-total hysterectomies. In this technique, the cervix is retained while the body of the uterus is removed.

Sub-total hysterectomies were commonly performed up to the 1950s, but from the 1960s, total hysterectomy involving the removal of both uterus and cervix became the most commonly performed type of hysterectomy. Later, vaginal hysterectomy became common, which of course always involved the removal of the cervix.

Women's current interest in sub-total hysterectomy relates to the wish not to alter the structure of the vagina and pelvic floor - the group of muscles in the pelvis supporting the uterus, bladder and rectum. There has been some research to show that while many women report more enjoyment of sex after hysterectomy - often because they feel healthier and more energetic and are not constantly bleeding - some women have less enjoyable sex after hysterectomy. This is thought to be due to the interference with and alteration of the muscles of the pelvic region.... Read More

Two Women's Stories

September 1994 Women's Health Watch

I tackled fibroids and accompanying very heavy bleeding for some years, using conventional and alternative methods, hoping to hang in there until menopause. My reading of women's health movement literature had prejudiced me against hysterectomy as a solution... Read More

Resources

WHIS: Hysterectomy Factsheet- Find Here

WHIS: Hysterectomy Info Pack- Find Here