Alternatives to Vaginal Hystorectomy

This book is for you: 

  If you have been told you need a vaginal hysterectomy 
  If you have problems that may lead to hysterectomy in the future 
  If you want to be fully informed about a health decision that could affect the rest of   your life 
 

Why?  Because all women are at risk of losing their organs! This book is for you and me - for all women and their daughters.  It will empower you by
educating about female health care and the risk of vaginal hysterectomy.  It will help you in your discussion of options with your physicians.  It will show you
why hysterectomy should no longer be blindly condoned as the norm for all women. 

I'm frustrated and angry at what I see is the accepted standard of medical care for women. I'm angry at the needless suffering, illness, and emotional
trauma that are caused by my own colleagues - professionals who often mean well but whose practices, in actuality, cause irreparable harm for
millions of women and their families.  I'm angry because often I feel alone in my struggle to effect change within the "good old boy" medical system. 

I'm telling you this because, perhaps ironically, No More Hysterectomies is not an angry book, although from time to time, I'll get up on my soapbox
to vent my frustration.  Indeed, this book has been written out of concern that women have shown me over the years as I've helped them to maintain
the integrity of their bodies. 

The following letter is typical of the hundreds I've received from patients whose organs I've saved: 

Dear Vikki: 
What I thought was going to be a nightmare turned out to be one of the most positive experiences of my life.  As you know, being 46 years old and
healthy all my life, I was appalled to be told during a recent routine exam by my doctor that my "useless" uterus would have to be removed because
of a tumor mass (fibroid) and 
"at your age you really don't need it anymore."  I saw a succession of doctors but everywhere I turned, nobody seemed to offer any alternative
except hysterectomy.  I was continually admonished for 
wanting to retain my organs as being "silly and ridiculous" since I was "way past childbearing age and the risk of cancer was growing daily" as I got
older. 

Then I happened to be watching TV and there you were, telling the world exactly my sentiments: that gynecological procedures as practiced in this
country today are archaic and too many women are suffering needless butchery. 

You said that because of advances in technology, you have developed a procedure called Female Reconstructive Surgery which, with the exception of
cancer, can correct and restore many female problems - fibroids being a specialty.  Using the latest equipment, laser and microsurgery, there is
minimal blood loss and very minimal shock to the body.  You said hospital stays were usually three to four days with full resumption of daily activities
in ten to fourteen days.  This was for me! 

I saw you as soon as I could.  After using ultrasound, you reconfirmed the presence of fibroids and asked me what I wanted you to do.  I was
impressed that you weren't dictating orders to me but wanted my input. 

"Can't you fix it?"  I asked, and then you explained in great detail how you were going to do just that.  You indicated that you would videotape my
operation so I could review it later. 

During what turned out to be a four and a half hour operation, you skillfully removed eight large but benign tumors from inside my uterus, one of
which was the size of a watermelon and was twisted around my other organs.  Not only did you fix them, but you removed a cyst on one of my ovaries,
and some endometriosis and then resuspended all of my organs. 

Four days later, I was up and at 'em.  After ten days I was just about back to normal, including driving my stick shift car. None of my friends who had
had hysterectomies could believe it!  Now, six months later, it's as if I never had surgery.  My periods have returned to normal and I am completely
energized and feeling terrific. 

I am very, very grateful to you [...].  How wonderful to be instrumental in enhancing the quality of lives.  Continue the "good fight".  You have all of
my support. 

With letters like that it's hard for me to remain angry for long! But then I'm reminded of the facts behind hysterectomies - facts that few women are
privy to - and I begin to feel that same sense of injustice. 

NEARLY THREE QUARTERS OF A MILLION WOMEN CASTRATED IN THE U.S LAST YEAR 

Imagine reading that headline in your local newspaper.  You would be aghast that such barbarity were occurring in your civilized country, wouldn't
you?  Well, look again.  This headline is true. 

Hysterectomy is the surgical removal of the uterus, often accompanied by oophorectomy, or the removal of the ovaries.  Frequently, the ovaries are
removed by the surgeon simply because we "might as well take them since I'm 'in there' anyway."  These organs are portrayed as having no function
beyond your desire to bear children, but this is plainly not true.  Your ovaries continue to secrete hormones for a dozen or more years after
menopause.  Estrogen helps ward off osteoporosis and heart disease, whereas testosterone augments sexual desire. 

The words hysterectomy and oophorectomy can be a euphemism for castration. Of course we could not call a procedure performed on nearly three
quarters of a million American women a year castration, because that label would probably force a reexamination of the practice.  Incredible as it may
seem, in 1983, 13,000 women lost their reproductive organs because they complained of premenstrual tension (PMS), a condition that could have
been treated with hormone therapy, nutritional supplements and exercise.  Other reasons listed by surgeons are cancer (which often does require
hysterectomy), as well as endometriosis, fibroid tumors, and prolapse (which may not). 

One wonders whether castration of the male would be a prevalent if men grew fibroid tumors of the testicles or if men suffered from monthly
depressions.  I think not.  If as great a proportion of the male population were faced with castration as the female population is, I venture to say there
would be a branch of medicine dedicated solely to the saving of the male organs. 

The uterus is the only part of the human anatomy that lacks a constituency determined to preserve it.  Although the "solution" to the problems of
female disorders was found ninety years ago to be hysterectomy, generations of doctors have staunchly continued to remove those organs as if
hysterectomy were the perfect, immediate and only solution.  In fact, to my knowledge, they rarely inform the potential hysterectomy patient of the
serious negative consequences, both physical and emotional, that may affect many post hysterectomy patients. 

THE SHOCKING FACTS ABOUT HYSTERECTOMY 

Because of the prevalence of hysterectomy in the United States today, statistics now project that within a few years every woman will have a 50-50
chance of losing her reproductive organs by the time she reaches the age of 65.  If you have been told that you might need a hysterectomy, or if
hysterectomy looms in your immediate future, you may feel confused and vulnerable.  Knowledge about your body is essential to making any
choices.  Before you rush into any surgery, here are some facts that you ought to know: 

You may experience a loss of physical sexual sensation, desire or arousal as a result of hysterectomy. 

Your uterus holds many of your internal organs in place. After hysterectomy, they may cave inward or prolapse, causing pelvic 
pain, sexual difficulties, pressure on your bowels and bladder. 

Hysterectomy's long term consequences, in addition to operative dangers and complications, include: 

  osteoporosis 
  increased risk of heart disease 
  bone and joint pain, immobility 
  chronic fatigue 
  urinary tract infection 
  urinary tract infection, frequency, incontinence 
  emotional changes, depression 
 
 
 

This short but potent list explains, in part, why I'm angry.  It is clear that hysterectomy is a surgery that should be avoided if possible because of its
serious, long term consequences.  And yet hysterectomy is the most performed major gynecological surgery.  In my opinion, and I'll get into the
statistics in Chapter 5, a vast number of hysterectomies are done unnecessarily.  They can and should be avoided.  Studies have shown that surgeons
remove perfectly healthy organs. Only cancer, emergencies, and incurable, recurrent diseases should necessitate the removal of your uterus and/or
ovaries. 

In fact, with the exception of these life threatening situations, hysterectomy should be regarded as the last possible option - not the first line of
treatment.  Wouldn't you elect a conservative surgery using a regional anesthetic before choosing something more radical?  Of course. The risks are
lower, the side effects less severe. Similarly, you should do everything possible to save your organs.  If more conservative measures fail, then - and
only then - should you consider a hysterectomy.  But first consider the options. 

HOWEVER - and this is a big HOWEVER - if you choose to seek alternatives to hysterectomy, you must be responsible. That means regular Pap
smears, and, as you grow older, uterine biopsies and ultrasound exams of your ovaries. When you empower yourself and participate in your own
health care, you and your physician must create a preventative program and screening system to detect any problems early.  This approach can save
your life. 

SHOULD YOU CONSIDER A POSSIBLE HYSTERECTOMY? 

Gladys had fibroids.  Her gynecologist, Dr. M., promised exploratory surgery and implied that with his surgical skill, he could "preserve
everything".  Gladys checked into the local hospital, feeling prepared for what lay ahead.  Just prior to surgery, however, the nurse brought in the
consent form. On it was written "possible hysterectomy" Gladys had not been told that her exploratory surgery might result in the loss of her female
organs. 

The nurse was adamant; if Gladys didn't sign the consent, they would not proceed.  Imagine her confusion and dismay a being confronted with the
possibility of hysterectomy on such short notice. 

Did Gladys have the opportunity to discuss the procedure with her gynecologist?  Did they review together the possible operative and post-operative
complications?  Did they explore the long term hormonal, emotional, and sexual side effects?  Did she have a day, a mere 24 hours, to consider fully
what such an operation would mean to her in the long run? 

Of course not.  Gladys signed under duress without adequate education.  She awoke from the operation with "everything out." 

THE FUNCTION OF DENIAL 

When the truth becomes too frightening to bear, it is our natural inclination, at first, to deny the facts.  We can't and then won't believe them. 
Psychologists tell us that this happens frequently when a loved one dies.  How can we accept the idea that the person is gone? 

The same can be said for the shocking facts about hysterectomy.  No one wants to believe that such an enormous segment of the population has been
made to suffer for so many years.  "How could this be occurring today, on such a large scale?"  you might ask, and your skepticism is justified. 
"After all, we have laws.  Women are educated and liberated.  There are even women doctors.  Certainly we should have heard of this before now. 
Why are you the only gynecologist against hysterectomy?  You must be some kind of feminist kook." 

Mass hysterectomy is just too horrible to be true, so it isn't true.  Or, if it's happening, it has to be valid.  After all, if everyone approves of it, it must
be okay. 

Imagine the rage we would feel once we realized how we have been victimized; how our mothers and friends and even how we ourselves have been
made to suffer needlessly; how our rights have been abrogated.  Better to believe that all 670,000 hysterectomies performed yearly are absolutely
necessary.  Better to buy the line than to question.  Yet I have seen the pain of thousands of women.  It is essential, I feel, to put an end to the denial. 
HOW I STARTED QUESTIONING MY OWN MEDICAL TRAINING 

During my training as a resident physician, making the rounds with the technically swift surgeons, the gynecologists known for the fastest
hysterectomies, I learned the bedside sales pitch for hysterectomy.  It was repeated so often to vulnerable women in such a rote and essentially
insincere manner that it rendered me suspicious. 

"You won't have those messy, unpleasant periods anymore." 
"You'll finally be rid of those cramps." 
"No more worry about unwanted pregnancy, especially at your age!" 

"By taking everything out, you'll never get cancer." 
"If you want, I can do your hysterectomy through your vagina so you won't have an ugly abdominal scar.  No one will ever know." 

I had absorbed the party line for merchandising a vaginal hysterectomy, but I couldn't espouse it, perhaps because being female, I identify with women. 
Besides, it could happen to me. 

At that time, I only had contact with hospitalized patients, immediately before and during surgery.  When I began my private practice as a
gynecological surgeon, however, I became aware of the full picture and I learned the truth about hysterectomy.  I was startled to find a multitude of
hysterectomized women with various complaints filling my office.  In fact, 80 percent of my patients who had been hysterectomized by other surgeons
consulted with me for post hysterectomy problems. 

I began to question my medical training.  Hysterectomy had always been the first and the easiest answer.  Yet something had to be wrong with the
way I had been educated.  A few "crazy" women made sense.  But this onslaught of distraught, hysterectomized women bearing the same woeful tale
was completely out of proportion with what I had been led to 
expect. 

Had my medical training dehumanized and defeminized me to such an extent that I, like so many of my colleagues, had been deaf to the truth?  Finally
one day things became very clear:  There the truth sat, in the person of a patient named Joyce, opening her heart to me.  Would I finally be the one to
hear her?  Would I believe her?  And, could I  help her? 

IS IT ALL IN YOUR HEAD? 
 

When Joyce noticed sexual problems and pain after her hysterectomy, she returned to her surgeon, seeking advice.  What she received was denial: 
"Everyone knows that the removal of the uterus cannot cause any of  these problems," he said.  "The uterus and ovaries are needed for reproductive
purposes only." 

Admonished for acting out of line, Joyce was told to "Shape up!"  That was all the comfort she could expect. 

Joyce became desperate and changed physicians, abandoning years of trust and loyalty.  But soon she heard a more insidious line from her new
gynecologist.  Because the vaginal hysterectomy wasn't at fault,  the crisis of the surgery must have uncovered a latent emotional illness in Joyce, suddenly
triggering all her deep seated neuroses to make themselves evident.  The woman was advised to seek psychiatric counseling. 

Frantic, without answers, without alternatives, Joyce, like so many others in her predicament, traipsed from one M.D. to another, praying that
someone would listen, someone would care.  What did she gain from this?  Nothing.  In the end, she lost her credibility, her self respect, even,
ultimately, her marriage.  She was labeled "hysterical".  Since she couldn't even stay with one physician for any substantial amount of time, she must
be crazy.  With "unstable" medical records, Joyce became the classic example of a "difficult patient." 

I shuddered at the thought that I, too, had contributed to the senseless hysterectomies and unfounded accusations of mental illness.  If I were to be a
part of the "good old boy" system, I, too, should have 
turned a deaf ear to Joyce.  Doing what everyone else did would make me acceptable, one of the "guys".  All I had to do was prescribe tranquilizers,
sleeping pills, and refer her and women like her back to her original physicians and to a therapist to help her with her frigidity and assorted other
neuroses. 

The trouble was, I couldn't.  As I listened to Joyce's and my other patients' stories, as I paid attention to what they were really saying, I found the
whole situation intolerable.  In case after case, the pathology reports showed that the removed uteruses were normal or had minimal pathology.  The
truth had been kept from these patients who had never read or been taught to understand their own medical records. 

The majority of these women had other options, including no surgery. The majority of the complaints were justified.  These women had real physical
problems and now they suffered emotionally from feeling so powerless in their own lives and from being labeled "neurotic". 

No, the wholesale castration of these women was wrong - and painfully, in too many cases, there was no strong medical indication for the surgery.  I
could no longer be part of this conspiracy.  There had to be another way. 
MY OWN BREAKTHROUGH 

In my own years as a physician, I have realized that when you look at  problems with openness, creativity, and a willingness to learn, alternatives do
make themselves available and answers can be found.  In breaking the rules and actually listening to my "hysterical" patients, I found that I could
create solutions - or at least try.  Much of my inspiration came from my patients themselves. 

One woman, Nora, a well educated, active, trim blonde in her late forties, had been told by at least five gynecologists that she required a
hysterectomy for a prolapsed uterus.  Prolapse is a condition in which the uterus is no longer adequately suspended by its ligaments. 

Women with prolapse have legitimate complaints.  Most often, the descended uterus causes them to lose bladder control.  These women can't leave
the house without wearing pads.  Given the choice between a life of fear, embarrassment and surgery, hysterectomy seems a welcome relief. 

I was taught that prolapse was cured only by hysterectomy.  Every attending physician, every professor, every modern textbook confirmed that.  But
Nora didn't want the operation.  Although she had no intention of having more children, she wished to preserve her uterus.  And her case was severe. 
Her uterus had fallen so drastically that it took up all of the space in her vagina.  Sex was out of the question.  In fact, if she pushed or strained at all,
her cervix would emerge through the vaginal opening.  Yet she simply looked me in the eye and asked me to find a way to fix it. 

I had performed a D & C, and found that the lining of Nora's uterus was completely normal.  Physical exam and ultrasound also showed everything to
be the correct size and shape.  It appeared that her organs were perfect, but the ligaments that held the female organs had stretched out.  What was I
to do? 

Let's look at a simplistic analogy.  Imagine that you've bought an exquisite designer silk skirt - the kind you save for and purchase once in a lifetime. 
Now, suppose you send this skirt to the dry cleaner and, to your distress, the dry cleaning agents cause the elastic in the waistband to deteriorate. 
Suddenly, the garment is large enough for two.  Do you toss out your prized skirt or simply fix the elastic? 

Several of the surgeons whom I consulted told me that it was impossible to tighten the ligaments.  In reviewing the medical 
literature, however, I found that during the late nineteenth century, operations had been performed to correct prolapse.  Yet nowhere could I find
recent information on ways to repair the loss of elasticity in the ligaments that held the female organs on place.  Nora's request had forced me to
wonder why gynecologists had abandoned fixing the organs rather than just removing them. 

It made sense to me that it prolapse was a result of weakening ligaments, all one would have to do was to strengthen or shorten 
those "elastic bands" to resolve the problem.  What if I merely suspended Nora's female organs, restructuring the whole support system? 

I discussed my idea with the patient and she decided that she could always have a hysterectomy later - she wanted me to see if I could strengthen her
ligaments.  I performed a laparotomy (I opened her abdominal cavity) and found the stretched ligaments.  Using permanent  sutures - stitches that
would not dissolve but would stay in her body - I restructured the ligaments, resuspended the uterus in the proper position, and brought the uterus
(which had prolapsed) upward to its original position. 

Then we discovered that part of Nora's bowel had also prolapsed and had fallen into the vaginal cavity.  My dexterous assistant, a general surgeon,
helped to reposition the bowel.  After two hours of surgery, Nora's "insides" were back to the way they had been some twenty years earlier.  Before I
closed her up, I looked at it all and was amazed.  We had re-established Nora's anatomy. 

WOULD IT HOLD? 

The true test was gravity.  Everything looked wonderful on the operating table and in the hospital bed.  But would the correction hold once Nora got
up and resumed her active normal life?  I am delighted to say that indeed it did!  Basic anatomy and surgical procedures have eliminated the need for
hysterectomy in many cases like Nora's. 

In fact, not only had I corrected the problem, but I had improved Nora's condition markedly.  With her vaginal walls pulled up higher and into their
normal position than what would have resulted with a hysterectomy,  Nora could resume her life without the dire consequences of organ loss.  She is
now a functioning, sexual, active woman whose intact ovaries continue to produce the hormones her body needs. And should she require a
hysterectomy in the future, that option is still open to her. 

Since Nora's surgery, I have performed many prolapse repairs.  Most have withstood the stress of the earth's gravitational pull.  And, more
significantly, all of these women have retained their precious organs. 

THE PSYCHOLOGY OF VICTIMIZATION 

Some women have been so socialized or so terrorized that they cannot take action or control their lives.  They seem to make 
choices that eventually will be hurtful.  They become accomplices in their own victimization. 

I have encountered women with abnormal Pap smears or bleeding who refuse to return to their doctors for diagnosis and treatment. These women
risk the development of cervical and endometrial cancer in the future - diseases that would necessitate hysterectomies. Yet, they are too uneducated
or frightened to take action necessary to alter the course of the disease. 

Others opt for the hysterectomy and other surgeries to remove their reproductive organs.  It's hard for me to believe that women could want to be
victimized, but they defer to "authority" figures without doing their own evaluation.  As women, we have been well trained in self sacrifice.  The needs
of others must come before our own. 

HOW WE SACRIFICE OURSELVES 

Dana came to see me after learning about my work from a friend who had done beautifully after Female Reconstructive Surgery (FRS).  Dana had
already been scheduled for a hysterectomy with her gynecologist  and was seeing me for a second opinion about her multiple fibroids. 

In my office, she expressed fear about her impending surgery.  She didn't want it.  She knew that she could encounter problems as a  result of the
hysterectomy.  I assured her that FRS could probably resolve her medical condition without the loss of her organs. 

Dana went home in confusion.  She informed her husband that now she had options - either hysterectomy or FRS.  She wasn't sure what to do, so he
made the decision for her, insisting that she have the hysterectomy because it had already been scheduled.  If the surgery was rescheduled, his
business plans would be disturbed.  They had planned their vacation around the surgery. 

Dana had the hysterectomy.  She couldn't bear to confront her doctor of seven years.  And, worse yet, she couldn't disappoint her husband who had fit
the hysterectomy into his schedule.  His business plans were more important than her health and well being. According to him, postponement of
surgery would put more stress on the family. 

But what about Dana and her needs?  What about the stress that hysterectomy would put on her body? 

Why in the world do some women allow and even encourage this kind of treatment?  Perhaps it's a pattern of abuse, stemming 
from childhood.  If you have been victimized as a child, it is easy to fall back into an old mode of behavior.  You are used to the situation.  As painful
and destructive as it may be, victimization is still a known quality, and reassuringly familiar.  Unfortunately, 
women who are continually victimized cannot understand that perhaps there is another way to deal with the world. 

THE COMING REVOLUTION 

A majority of women who enter my practice do so as if they are prisoners on death row, hoping for a reprieve.  These women have received two, four,
even twenty four opinions prior to seeing me.  Each opinion rendered by a gynecologist is similar - you need a hysterectomy, but not to worry
because: 

Your uterus and "aging" ovaries are useless after childbearing years and may become cancerous in the future. 

Replacement hormones will correct all of the aftereffects of your hysterectomy. 

PMS and dirty, nasty, interfering menstrual periods are inconvenient and better off eliminated surgically. 

This "consequence free" form of birth control enhances your sexuality. 

Most women benefit from undergoing a "spring cleaning". 

My patients are lucky, for their persistence has led them to my office and the education and reprieve they sought.  Sadly, most 
women succumb to the pressure, eager to please their trusted doctor, uneducated about the true nature of their female problems, and frightened by
the ugly specter of cancer.  I am shocked that so many are not informed of the severe and irreversible consequences of this serious surgery.  Once
the organs are amputated, there is no way to put them back! 

So I have gone public with my message.  After being interviewed on the "Phil Donahue Show", other television programs, radio, and newspapers, I've
received thousands of letters from women, describing their private  ordeals, asking for help and education, and wanting to help others avoid their own
fate. 

WHY NOT GIVE WOMEN A CHOICE? 
 

I openly advocate giving women a choice.  I claim that the uterus has many functions other than childbearing, and that whenever possible it should be
repaired and not removed.  Because this stance is contrary to preconceived 
notions, I have been challenged to "prove" that the uterus should be repaired whenever possible. 

Therefore, among other things, I have researched the relevant medical journals, I have interviewed hundreds of women; I have worked for two years
on a study of the National Hospital Discharge Survey for the years 
1965 - 1984.  I have consulted leading professionals who are working in women's health. 

I believe the research substantiates my claim that the uterus is a vital organ and should be removed only if there is no alternative.  This book is an
expression of the conclusions I've reached both in my practice and 
my research.  It is not presented as a final report, but rather as a basic introduction, and is written for the average woman, not for my peers in the
profession - though I hope they will read it too. 

I believe there needs to be a revolution in women's health care.  The battle cry?  No More Hysterectomies!  What must be changed is very simple:
how we in the medical profession and how women themselves perceive the 
female body and psyche.  Having done this, we can use new and scientific technology to improve women's lives, and perhaps most important, women
themselves can be empowered to make responsible decisions about their own 
bodies in concert with their physicians. 

In a way, I hope you become angry too.  This is a call to action.  The aim of this book is to inform you of the many options open to you, including new
surgical techniques and medications that would help avoid the unnecessary loss 
of your organs.  Armed with the facts and knowledge of the risk factors involved, you, too, will be clamoring for a change in the way things are done. 

WHAT IS MY BACKGROUND? 

You may be asking what my credentials are for making these strong statements. I have been operating on women since 1980, and to date I have
performed nearly 400 Female Reconstructive Surgeries.  Many of my patients come from around the country for Female Reconstructive Surgery and
then return to 
their local gynecologist for continuing care. 

Most of my formal medical training occurred at the University of California, San Francisco's School of Medicine.  Later, I continued as Chief Ob/Gyn
Resident at the Albert Einstein School of Medicine in the Bronx, New York. 
During my schooling and early training, I learned how to perform the surgery that was a required part of my medical schooling and, in my early years
as a doctor, I admit that I did perform hysterectomies where now other options exist. 

Combining my experience with my patients' needs, however, I was able to improve upon traditional surgical techniques and originate new ones. As
one of the pioneers in the use of real time ultrasound, for example, 
my work led to the practice of using ultrasonography during surgery. This procedure gives the surgeon "eyes" and direct moment-to-moment
visualization of the uterus, its contents, and the adjacent pelvic organs. It limits and reduces potential complications such as the perforation of the
uterine wall. 

Today, of course, I do perform hysterectomies on women suffering from cancer. In such cases, hysterectomy is a necessity.  Better to lose the uterus
than to allow the disease to spread to other vital organs.  Indeed, when it comes to cancer, hysterectomy saves and improves the quality of women's
lives. I have developed new techniques to be used during hysterectomy, including pelvic suspension.  And I perform surgical corrections for post
hysterectomy patients. 

Over the years, I have coupled my training and experience with the latest technology advances to create alternatives to elective hysterectomy -
Female Reconstructive Surgery (FRS) - which I will explain in detail 
throughout the book.  I have simply reinstated the concept of saving women's organs, using various existing and new techniques to reach this goal. 

It's time to break free of the myths.  It's time to empower yourself 
with knowledge. 

More Info: Vaginal Hysterectomy