Most of the symptoms women suffer following hysterectomy have long been thought to be psychological, to the exclusion of any physiological basis. It has been suggested by some psychoanalysts that these problems are based in an infantile overattachment to the uterus, "a sign that a woman's sexuality is inappropriately confused with her ability to reproduce," wrote Dorothy Reider in the 1994 edition of The New Ourselves, Growing Older. "Most gynecologists and some psychiatrists still believe this," she stated.

Stanley West, M.D. wrote in The Hysterectomy Hoax: "It is interesting to note that except when dealing with women's problems, doctors are trained never to attribute symptoms to psychological factors unless we have ruled out all possible physical causes." He reminded us of the time in the not-too-distant past when doctors thought menstrual cramps were a psychological manifestation found only among neurotic women and that the symptoms of premenstrual syndrome (PMS) were a manifestation of female emotionalism.

Very little is known about why certain symptoms consistently occur following hysterectomy. Wrote West:

. . . because we have no medical answers--and no useful help--to offer patients, these complaints often are dismissed as psychological. Indeed, medical students are taught that women who attribute symptoms to hysterectomy must be neurotic, hysterical, or obsessed with their uterus. But . . . these problems are very real and have absolutely nothing to do with a woman's mental stability.

The list of aftereffects of hysterectomy is long: fatigue, memory loss, insomnia, vaginal dryness and thinning, loss of firm body tone, hair loss, premature graying, weight gain (despite dieting and exercise), unpleasant vaginal odor, protruding abdomen, constipation, bloating, recurrent vaginal yeast infections, dry eye syndrome, lower resistance to colds and infections, less intense emotions, loss of maternal instinct, hot flashes, headaches, and dizziness.

In her book, Hysterectomy: Before & After, Winnifred Cutler, Ph.D. summarized the most frequent aftereffects of hysterectomy:

1. An alteration in the hormonal environment. Hysterectomy alters circulating levels of estrogen, progesterone, testosterone, androstenedione, luteinizing hormone, follicle-stimulating hormone, and the beta endorphins.
2. Earlier aging. Hysterectomy causes 5 years earlier menopause when ovaries are kept; with oophorectomy, postmenopausal women age even more rapidly.
3. A high likelihood of serious postoperative depression. Hysterectomy significantly increases risk for depression, which often emerges as much as two years after surgery.
4. A deterioration of bone health. Hysterectomy accelerates loss of bone mass and increases osteoporosis likelihood.
5. Decreased cardiovascular health. Heart attack rate among women is 0% premenopausal, 33% of mature women with surgical menopause, 12% of mature women with natural menopause; increased risk of atherosclerosis and coronary heart disease among hysterectomized women is three to seven times that of age-matched women who have not had the surgery.
6. Reductions in sexual functioning. Hysterectomy reduces libido, arousal, vaginal lubrication, and orgasmic capacity.
7. Increased incidence of urinary incontinence. Frequently, hysterectomized women experience both stress incontinence (inability to hold urine when jumping, dancing, or running) and urge incontinence (the need to urinate frequently).

Depression and loss of libido (sex drive) are the two most psychologically devastating effects of hysterectomy. Nora Coffey, founder of HERS, an organization devoted to hysterectomy education, remains embittered by her personal experience with hysterectomy, particularly the destruction of the rich and fulfilling sexual relationship that she and her husband enjoyed prior to her surgery. Even with testosterone therapy, which restored her desire, the ability for sexual satisfaction never returned.

A few months ago, a young friend in her early 30s told me of a problem she had been suffering since her hysterectomy for cervical cancer. The great sex that she and her husband had enjoyed prior to her surgery had become a thing of the past. "I just have no sex drive!" she exclaimed.

Her doctor assured her that there was no physical reason and that the problem was unrelated to her surgery. She eventually consulted a clinical psychologist who confirmed the gynecologist's opinion. She continues with her therapy, and despite accomplishing valuable insight into her childhood and her marital relationship, she still suffers from total lack of libido.

Though some women report an increase in libido after hysterectomy and others report no change, a 1981 article in the American Journal of Obstetrics and Gynecology reported that 33% to 46% of hysterectomized women have partial or total loss of sexual function after amputation of the uterus. My young friend, then, is in the company of no less than 200,000 other women who, in 1994 alone, lost all hope of a rewarding sex life--not to mention their partners who forevermore can expect no more than submission to an act of sex.

With so many women suffering such life-altering, devastating effects from loss of the uterus, why do half a million women continue to go under the knife each year to yield organs that, according to West, "define you as a woman and are essential to your physical, emotional, and sexual well-being"?

Many women believe that their surgery is essential to their continued health, indeed to their continued life. West disagreed: ". . . more than 90 percent of hysterectomies are unnecessary. Worse, the surgery can have long-lasting physical, emotional, and sexual consequences that may undermine your health and well-being. . . . Most of the 'female problems' that lead to hysterectomy are medically trivial."

Though hardly a "reason," geography appears to have considerable bearing on a woman's chances for hysterectomy. Women in the southern and central regions of the United States have a two to three times greater chance of having a hysterectomy than women living in the northeast or on the west coast. West pointed out that the U.S. rate for hysterectomy is twice as high as Great Britain and four times as high as France; yet the death rate from conditions treated with hysterectomy are no greater in these countries than in the United States.

The largest number of hysterectomies (30%) are performed as a treatment for fibroids, followed by endometriosis (24%), prolapsed uterus (20%), endometrial hyperplasia (6%), and menstrual disorders & other (20%).

There are a number of other "hidden," nonmedical reasons for hysterectomy, claim writers on the subject.

Profit

It has been suggested that physicians, hospitals, and insurance companies stand to profit from a high hysterectomy rate. "Gynecologists are surgeons," stated West. "We make our living by performing operations. If hysterectomy is the operation a surgeon knows best, it is the one he or she will recommend and perform most often."

Reider proposed that hospitals and physicians are trying to compensate for the declining birth rate, with an accompanying loss of hospital and obstetrical fees. She further suggested that our problem may be one of surplus surgeons: "The tendency to recommend unnecessary surgery is greater where there is an overabundance of surgeons and hospital beds."

West saw insurance companies as having a financial interest. "As long as a woman has her uterus, she can develop problems that her insurance must cover," he wrote.

Training

In order to maintain status as a good teaching hospital, an institution must be able to offer a rich experience to young interns and residents preparing themselves for a future in the practice of medicine. As the profession is practiced today, a successful gynecologist must be proficient at hysterectomy. If the number of hysterectomies were dropped by 90%, as West has suggested they should be, there would not be a sufficient number of hysterectomies to guarantee that each resident would have a hands-on opportunity to learn her or his craft. But then, with a 90% drop in number of hysterectomies, there may be no new residents in gynecology, only gynecologists lining up for job training for new careers.

West's story of Sarah, the young woman who had been given a hysterectomy and oophorectomy when the doctor told her she was having a cyst removed from her ovary (see Part 1 in the Jan.-Feb. issue of Uptown Express), is an example of surgery for the sake of medical training. When West received Sarah's medical records from the prestigious teaching hospital where her surgery had been performed, the pathology report indicated her uterus and fallopian tubes were normal and that a corpus luteum cyst of the ovary had been found. These cysts, West stated, are "a common and normal occurrence among young women," and "usually disappear on their own after one or two menstrual cycles." He finally concluded that Sarah's health had been sacrificed to give a resident in gynecology a chance to perform a hysterectomy.

Population control and birth control

Population control on poor and minority women, who were not informed, was openly practiced as recently as 15 years ago. Though it is generally thought that such practice no longer exists, there are some who believe that it continues clandestinely under the guise of medical necessity.

In the mid 1970s, the heyday of hysterectomy, hysterectomy was a popular alternative to tubal ligation as a means of permanent birth control. Surgery and Its Alternatives, a publication of Rodale Press, reported in 1980 that 10% of hysterectomies were done for sterilization. "It's like cracking a nut with a sledgehammer," Dr. Stanley Birnbaum told the book's editors. "[S]ubjecting a woman to this relatively dangerous operation for sterilization alone is an outrage," said Dr. Sidney Wolfe (currently taking on the establishment again with his 1994 Best Pills, Worst Pills). Under assault by such criticism, the federal Department of Health, Education and Welfare withdrew its pamphlet, "Your Sterilization Operation: Hysterectomy."

With so many physicians continuing to advise their patients that hysterectomy is routine, safe, and of no damage to their health, it is likely that sterilization hysterectomies still occur.

Abysmal Ignorance

In a discussion of the hidden reasons for hysterectomy, it would be remiss to omit ignorance, even though it does not appear in the writings of the authors quoted here. Reluctance to accept new information and new treatments in the face of such overwhelming evidence can only be classified as abysmal ignorance. This contention is supported by the fact that the hysterectomy rate within physicians' own families is much higher than in the general population.

Because hysterectomy is so common, most of us tend to view it as a routine surgery. It is not; the risks are significant. Postsurgical complications after hysterectomy are relatively common; one of the more common complications is bladder damage and/or the accidental severing of a ureter. Approximately 800 women die in the United States each year from hysterectomy, a rate of about one to two per thousand. Half of these deaths are from anesthesia. One woman with whom I spoke was told by her surgeon that her radical hysterectomy due to endometrial cancer was far more life-threatening than open-heart surgery.

Prior to her surgery, Nora Coffey described herself to Lee Rothberg, writer for New Jersey's Woman's Newspaper, as "a strong, healthy, vigorous woman, working as a researcher in biochemistry." After a year of experiencing irregular vaginal bleeding, Coffey's doctor advised a hysterectomy. As was the common practice at the time (1978), Coffey's physician also removed her ovaries to prevent the possibility of developing ovarian cancer at some later point in time (without advising Coffey that he would be doing this additional surgery). Within a year, she manifested a host of symptoms: skin "like parchment," extreme fatigue, insomnia, bone and joint pain, eye changes, short-term memory loss, loss of intense maternal feelings, loss of sexual desire, a deadening from waist to mid-thigh.

Describing herself as "fairly wealthy," Coffey told Rothberg that she was able to "go anywhere in the world to find a solution to these problems." For Coffey, there has been no happy ending. Estrogen helped her skin, but did nothing to alleviate her other symptoms. For seven years she used testosterone implants that relieved her joint pain and improved sexual desire (but not sexual satisfaction). When she began to experience undesirable side effects, the testosterone was discontinued. Eventually, she found that weekly trips to an acupuncturist improved her energy level and general feeling of well-being. Coffey attributed this to stimulation of the adrenal glands by the acupuncture.

A woman who had a hysterectomy for endometrial cancer has suffered terrible side effects from the surgery, but she is happy to be alive. A friend who wants a hysterectomy to end her menopausal grief claims her mother and sister are very happy with their hysterectomies.

In 1972, I was very happy with my own hysterectomy. The disabling bleeding that had kept me too weak to function normally for the four months prior to my surgery was finally over. I would never again have to soak stained underwear in bleach. I would never again have to take The Pill that had created symptoms of B vitamin deficiencies in my body, or use the IUD that had wreaked the havoc that resulted in my hysterectomy, or jump out of bed in the heat of passion saying, "Excuse me dear while I insert the jelly and let's cool it for about 15 minutes." My sex life was better than ever, and my too-thin frame had transformed to a more voluptuous shape. I had a lot of reasons for being happy with my hysterectomy. Until nine years later when things began to go wrong, and I spent the next ten years being patronized and disparaged by doctors as I sought the answers to the changes in my body.

What I am most unhappy with is doctors denying my symptoms. I diagnosed and treated myself for osteomalacia after a physician insisted I had a pulled muscle, despite my description of deep bone pain that had persisted for months. I faced a deep sigh, rolling eyes, and a firm, "It is not caused by your estrogen," when I asked about a sudden growth of hair on my upper lip. It had never occurred to me that it could have been caused by the estrogen; I was just responding to his questions about my state of health. But ten years later when I read "hirsutism" as a possible side effect from Premarin, I realized that the doctor had been reacting to a repeated experience with many other women who had linked their hairy upper lips with their estrogen therapy. There is more--15 years more of having my experience denied before I gave up and began to do my own research.

I am aware now that many times the doctors had the answers, and they would not trust me with the information. Sound far fetched? In 1976 when the FDA ruled that estrogen drugs must include a sheet explaining possible side effects, a physician testifying against the regulation stated that he could not think of a patient population less able to handle the truth than a bunch of menopausal women.

Menopause and necessary hysterectomy can be very difficult times in a woman's life, and indeed nervous symptoms and periods of crabby behavior can result. Telling someone a symptom doesn't exist when they know it does, does not cure the anxiety of having the symptom. It makes people crazy or it makes them angry--or both. To paraphrase the unenlightened physician who testified before the FDA, I can't think of any patient population less able to withstand the mind fuck of being lied to than a bunch of menopausal women.