Winning the Sterilization Prize
If there is a sterilization lottery for women, hysterectomy has to be the grand prize. And just as winning a huge cash prize will change a winner’s life, having your uterus surgically removed is life altering as well.
To understand what you are getting when you win the sterilization lottery’s grand prize, you have to understand what a hysterectomy is. There are four types.
Total hysterectomy: With a total hysterectomy, the entire uterus and cervix are removed via an abdominal incision or through the vagina.
Sub-total hysterectomy: In a sub-total hysterectomy, only the upper portion (or fundus/body) of the uterus is removed. The cervix is left.
Hysterectomy and bilateral salpingo-oophorectomy: Along with the removal of the uterus and cervix, the fallopian tubes and ovaries are removed.
Radical hysterectomy: The entire uterus is removed along with the upper portion of the vagina and some surrounding lymph nodes.
Looking at the description of a radical hysterectomy makes hysterectomy seem like a lousy grand prize. But radical hysterectomies account for only 10% of the nearly 600,000 hysterectomies performed annuall in the U.S. Radical hysterectomies are only used for the treatment of gynecological cancers.
The majority of hysterectomies are performed to rid the patient of fibroids or chronic pelvic pain. Fibroids account for 30% – 40% percent of all hysterectomies. Fibroids are non-cancerous tumors that grow from the smooth muscle cells of the uterus. These tumors are solid and can vary greatly in size, causing symptoms such as long and heavy menstrual bleeding, pelvic pressure, pain, problems during pregnancy, and infertility. Since fibroids can recur after being removed, hysterectomy is the only way to get rid of them permanently.
Pelvic pain, usually diagnosed as endometriosis, accounts for about twenty percent of all hysterectomies. Endometriosis is a condition where endometrial tissue that normally lines the uterine cavity appears other places such as the lining of the pelvis, fallopian tubes, ovaries, bowel, or bladder.
The remaining 30% – 40% of hysterectomies are performed for reasons such as pelvic relaxation, heavy or abnormal bleeding, ovarian mass, or treatment for pre-cancerous conditions.
The more you look at it, the more hysterectomy does seem like a prize. Unlike, say, tubal ligations, a woman must be diagnosed with a medical condition before she can undergo a hysterectomy. So a hysterectomy brings relief from a host of medical symptoms along with guaranteeing freedom from unwanted pregnancy. But unlike a less invasive tubal ligation procedure (which is usually an out-patient procedure performed in the doctor’s office), hysterectomy involves abdominal surgery.
With any abdominal surgery there can be side effects such as changes to bowel and bladder habits (more or less frequent bowel movements, bladder spasms, etc). Usually after a few weeks of recovery, bowel and bladder habits will return to normal. Women are at a higher risk of developing stress incontinence (leakage of urine when exercising, sneezing, or other exertion of the abdomen) post hysterectomy. Regular practice of Kegel exercises can resolve this issue. Along with the side effects common to all abdominal surgeries, women receiving hysterectomies can experience other side effects.
If a woman is still having periods at the time of her hysterectomy, her periods will end with the removal of her uterus. If the ovaries are not removed, she’ll still have hormonal changes associated with menstruation, but without the bleeding. If the ovaries are removed, she’ll experience symptoms associated with menopause (hot flashes, night sweats, vaginal dryness, mood swings and other symptoms). Approximately 50% of all hysterectomies involve the removal of the ovaries. Ovary removal is often debated amongst doctors, since the role of hormones is not fully understood. Whether she should keep her ovaries or not should be approached on a case by case basis based on the individual needs of the woman.
Depending on the reason for a woman’s hysterectomy, depression can also be a side effect. Depression is more common if the hysterectomy was performed due to cancer or severe illness, rather than as an elective procedure. It’s also occurs more for women who see the removal of their uterus as an interference to childbearing. The availability of a good support group of family or friends, along with the individual’s general outlook on life, greatly affects the severity of depression.
Oh no. That list of side effects is making hysterectomy look less and less like a prize. But it’s not all doom and gloom.
As a hysterectomy winner (four and half years since receiving my award) I couldn’t be happier. But my voice is rarely the one you’ll hear. A quick web search brings a host of medical sites (explaining the procedure), support sites (like hystersisters where women share information), and even blatant anti-hysterectomy sites (like our friends at the Hers Foundation—who spread some of the most entertaining misinformation available) but finding stories of happily uterus-free women was difficult (I did manage to find two sites and a total of about a dozen stories).
For those who rejoice in the removal of a uterus, there are many small victories to celebrate afterward. For instance, no more periods! I took great delight in giving away my stockpile of tampons and pads and gloated that I no longer had to go down the feminine hygiene aisle at the grocery store. And just like a new millionaire, I went on a small spending spree, replacing all my ratty old “period underwear” with nice new items.
Along with the instant gratification of no more periods, I soon discovered I now have the ultimate comeback for one of my most hated breeder bingos. I found myself in one of those “do you have kids?” conversations where, after repeatedly telling the person “no” they counter with “oh, but you never know…” Playing the hysterectomy card shuts them up.
Now I can live the rest of my life with the sense of freedom in knowing that no matter what, now that I’m uterus-free, I’m guaranteed to always remain childfree.
Copyright . Published 1 August 2007 in Features.
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