Tuesday, May 15, 2018

The Herstory of Hysterectomy: A Horror Story

For those of you in Ukraine and Russia who drive up my blog stats but don't follow me on FB because you're robots, let me catch you up.

Here are links to articles I've shared on FB about the appalling rate at which women in this country have unnecessary hysterectomies, and to which I refer in this post:




What started me on this hysterectomy jag was the video about the Essure device (see link from Chicago Tribune) in which Dr. Brett Cassidy talks about 100 women coming to him complaining about the onset of Lupus-like symptoms after receiving their Essure implants.

After he surgically removed their Essure implants, all of their symptoms went away--except when some tiny part of the implants (two coil-shaped medical devices with delicate inflammatory filaments attached) was left behind; in those cases, he had to go back in and surgically remove any remnants of the coils and associated filaments. Once he had successfully removed all traces of the Essure coils, symptoms of Lupus (fever, fatigue, pain, headaches, tingling, numbness, and anemia) just stopped.

I had read articles about the side-effects of the Essure device recently, but Dr. Cassidy's testimony in particular described my situation exactly, leaving little room for doubt that the Essure implants in my body are the likely cause of what my rheumatologist broadly refers to as Lupus.

For a host of reasons, it would be nice not to have Lupus.

So, I'm looking into having the Essure coils removed from my body. I have an appointment on May 22, with an OBGYN in Platteville--one hour's drive away.

She was recommended by other Essure "sisters" on the "Essure Problems Facebook" as a doctor who understands about the complications this device can present--unlike my rheumatologist and GP, who claim to know absolutely nothing about Essure at all.  (Apparently, they do not read.)

In the case of my rheumatologist PA, I found this gap particularly disappointing. She should be asking her patients if they have had Essure implants, and, if so, what was the timing of the implant relative to the onset of auto-immune disease.

If, as we are discovering, some women find complete relief from auto-immune disease with the removal of Essure coils, shouldn't that be discussed at some point in the rheumatological relationship?

Apparently not. (Clears phlegm from throat.)

I have to drive an hour east to Platteville to see a doctor who is willing to have that conversation.

I suspect I will have the Essure implants removed.

You might think I would be excited about this: a cure for all my ills.

You would be wrong.

I am not at all jazzed about the prospect of a hysterectomy. Surprisingly, I do not take a casual view to losing my reproductive organs--or any organs, for that matter.

Yes, I know that one in three women have a hysterectomy by the time they reach sixty.

One in three.  

At a glance, that seems like too many women having hysterectomies.

By comparison, what ratio of men have vasectomies?  One in ten.

My friend refers to vasectomy as the bag-of-peas procedure.  It's an outpatient procedure followed by a frozen bag of peas applied to the sutured area.

Maybe it would be more appropriate to compare vasectomies to tubal ligations.  One in four women, according to the link below, have tubal ligations. One in four.  Nowhere near one in ten. Not even close.


But what is a hysterectomy?  It is the removal of the uterus.  It may or may not include, as indicated, removal of fallopian tubes, ovaries, and cervix, too.

Since the late 1990s, there have been several alternatives to the wholesale removal of a woman's reproductive organs.

For example, a woman who has problems due to fibroids in her uterus may opt to have the fibroids removed, and keep her uterus.  Or, she may opt to have the fibroids and her uterine lining removed--but not the uterus.

Fact is, this kind of creative thinking is frequently discouraged.  Instead, a more casual attitude toward the inevitability of the total hysterectomy is encouraged.

However, in order for a woman to exercise free choice, which may include opting to keep her bodily parts, she needs to know that she has options.

The 1997 New York Times article (in one of the links above) noted that too many women (1 in 3!) are having hysterectomies simply because they are not being advised of their options and because...Well, it's easier just to take the damn uterus out.

Removing the uterine lining requires a level of surgical skill beyond the middling average.

And why bother become a more skilled surgeon if you can just take the whole thing out and be done with it?  (Just don't mention the other options and she won't know the difference.)

But there are alternatives.  You can go under the knife and have your reproductive organs removed in the manner of a c-section.  Or you can have laparoscopy.

Now, with the laparoscopic approach, you have a menu of options:

You can have a robot do it, but some people think that a skilled human surgeon is better than a robot, on average, by one or two sutures.

You could have a robot-assisted procedure, and that might be ideal.  You're in a pretty swank operating arena if that is on the menu.

You also have the choice of whether to have your reproductive organs removed through your abdomen or through...You want to sit down for this...through your vagina.  Yes, that's what I said.

Your uterus, cervix, maybe fallopian tubes, maybe ovaries, all passing ironically through the birth canal and out of the maternal body.

If you ask me, it's grotesque.  I don't appreciate that kind of irony on my body.  Even in books and movies, that turning of a woman's maternity inside out, the morcellation of her womb, the birthing of...God!  It's distasteful and revolting.

How do one in three women sign up for that?  How is this just a problem for me?

We haven't touched upon the possible side effects yet.

You really don't want to know.  But I will tell you anyway.

The worst possible side effect is having your intestines fall out of your body through your vagina.

This happens not immediately, but later, because the internal structures of support that once held everything in place are no longer there.

For that reason alone, if you can remove the uterine lining but not the uterus, all the better. Not only will save the uterus, which has a role in hormone regulation, but you will avoid (with any luck) experiencing vaginal prolapse.

(Vaginal prolapse can also result from giving birth to children, which can make everything kind of loose up there, and which used to be a shockingly common malady among middle-aged women before birth control was widely available, requiring many fruitful women to spend the remainder of their lives cooped up and sitting down.)

The ovaries, but also, science tells us, the uterus and fallopian tubes--the whole reproductive kit, as it were--are useful beyond their child bearing function.  They in fact belong in a woman's body and play a role throughout her life, if allowed to remain in situ.

There are sound medical reasons why some women's uterus (uteruses? uteri?)  cannot be saved.  In those case, let's hope that she may keep her ovaries--which play a key role in regulating hormonal balance.

Hey. Without hormones, there is no sex drive.  Without hormones, we are miserable.  If you can keep your ovaries, you won't need to prescribe to hormone replacement therapies for most of the rest of your life.

If we can keep our cervix, for God's sake, let us keep our cervix.  It is part of the structural integrity of the vagina and may allow a woman to avoid the misery of vaginal prolapse.

If we can keep our fallopian tubes, and the muscles surrounding our uterus, and our ovaries, then we will, in every sense, be structurally and in every respect more intact.

It may be easier for a mediocre surgeon to take everything out, wholesale.  If he is a surgeon who has, through hundreds of hours spent dissecting cadavers and cutting into living breathing bodies, lost his empathetic feeling for women's maternal organs, let him try to imagine the contents of his own testes run through a morcellator and dragged through the diminutive canal of his own prolapsed vagina (also known as a penis).

I'm not even going to get into the whole highly political matter of vaginal reconstruction or... (eyeballs rolling, gag reflex, deeply violent emotional response) hymen restoration.  Suffice it to say, both have been, to my everlasting outrage, medically normalized.

As the 1997 New York Times noted, there are too many unnecessary hysterectomies occurring in this country.  One in three women.  In the years to come, the article optimistically projected, that figure should be reduced, because there are now so many more options for dealing with different types of issues that a woman may have--options are that are less intrusive and much less radical.

There is rarely a reason to have a total hysterectomy, and compelling reasons why you shouldn't.

And yet...

And yet, twenty-one years later, with all of the alternatives to hysterectomy available from 1997 added to all of the progress of science introduced over the last twenty years, isn't it shameful and appalling to discover that the statistic for women having total hysterectomies in this country has not changed one iota.

If anything, the numbers have increased.

One in three women have a total hysterectomy by the age of 60.  We treat it like it's nothing.  We treat women like their maternal organs mean nothing.  We treat women this way.

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