Prolapse after hysterectomy
For example, a common instance of prolapse occurs after hysterectomy for uterine fibroids. The uterus is enlarged and the size alone may support the uterus in the pelvis so that breaks in the ligaments are not appreciated before surgery.
Then within 3-12 months after surgery, the vaginal vault and the bladder drop down. This causes many women to conclude that hysterectomy "causes" prolapse when in fact a better term would be that potential prolapse was being prevented by the enlarged uterus.
This can happen to all surgeons such that even with appropriate surgical repair, the abdominal pressures shift from the repaired points to the weakest anatomical points in the lower pelvis. Thus different areas seem to "fall down" even after successfull surgical repair.
Are there a lot of unnecessary hysterectomies performed?
I'm sure there are many "unnecessary" hysterectomies performed. How many is unknown by anyone. Ever since the mid 1950's there has been criticism of doctors performing too many uterine removals.
The rate of hysterectomy in the U.S. varies from geographical region to region but on the whole is about twice that of other industrialized countries. Therefore you would think there would be quite a few unnecessary procedures.
The problem becomes the definition of "unnecessary". In whose eyes is a procedure deemed as "needed" versus "unnecessary". There seems to be disagreement about this. The only unnecessary hysterectomy is the one that I or you or someone else disagrees with!
For example in insurance programs requiring 2nd opinions, about 8% of hysterectomies are recommended as not needed at the time (6). In an interesting note, this study mentioned that in the Northeast region of the U.S., women whose second opinion thought the hysterectomy was unnecessary did not go on and have the procedure done.
Whereas in the South and North Central regions, women chose to have the hysterectomy even though it was not recommended. This means that they thought it was in their best interest even though the 2nd physician did not. Even 8% unnecessary hysterectomies by that study does not explain the higher rate in the U.S.
I am sure there are doctors who tend to overuse hysterectomy especially for pain and abnormal bleeding problems. They see the procedure as the solution to a problem that may be difficult to manage.
Many women look at these symptoms as a quality of life problem. In putting up with pain or bleeding, there can be a moderate amount of inconvenience in work, school or leisure activities.
Hysterectomy may be looked at as the quick, long term medication-free answer. We live in an impatient world. On the doctor's part, there may be the perception without thoroughly discussing with the patient, that the woman is unlikely to tolerate the medical therapy, frequent office visits and sometimes minor biopsy procedures that would be needed for the condition complained about.
The best protection a woman has from an unnecessary hysterectomy is an informed education and consideration of all of the treatment options
What can I expect after hysterectomy, aside from the effects of whether the ovaries are functioning?
As best I can tell from both experience and the medical scientific literature, hysterectomy alone, without ovarian removal in the premenopausal woman, or with ovarian removal in the menopausal woman will result in:
- a change in sexual response during orgasm, but not an adverse change
- increased tiredness for several months after the hysterectomy
- in general a recovery time of almost 6 months be complete return to preoperative function.
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