Myths, Lies and Hysterectomy

doctor with patientHysterectomy. The very word brings up emotions unlike any other surgical procedure. For some women, hysterectomy brings out sadness and signals an end to fertility. For others, the removal of their uterus signals the beginning of being pain-free, not feeling tired from anemia, not having to worry about contraception and not having to dread their monthly menses.

And, in fact, in my hysterectomy survey last spring, a whopping 86% of you told me that you were glad you had your hysterectomy and that your life was better as a result. I decided to compile a list of the 5 most common myths I still hear, every day, regarding this operation, which over 500,000 women undergo each year.

Myth 1: A hysterectomy will put me into instant menopause.

Hysterectomy actually refers only to the removal of the uterus, and has nothing to do with the ovaries. And it’s your ovaries, not your uterus, which provides estrogen. Since removal of the ovaries is sometimes done at the time of hysterectomy, many people understandably, but mistakenly, think that is always part of the procedure. Women under the age of 50 usually keep their ovaries unless they have a situation in which there is a problem with an ovary, or their ovaries are contributing to their problem, as in the case of severe endometriosis. If you keep your ovaries (a choice you can make!), nothing will change hormonally.

Myth 2: If I have a hysterectomy, I will need to take at least 6 weeks off work to recover.

Today, most women are candidates for an outpatient laparoscopic or robotic procedure. My patients generally go home within hours of surgery with 3 or 4 tiny bandages on their belly. Many women express concern that such a quick discharge is not only inhumane, but also potentially dangerous. Be assured that hospitals that routinely discharge women hours after hysterectomy have strict protocols in place to make sure that it is safe to do so. Far from being cruel, most women who are eligible prefer going home hours after surgery knowing they will be far more comfortable in their own beds, eating their own food, and peeing in the privacy of their own bathrooms.

The majority of my patients report that they feel “like nothing happened” within two weeks or less after the day of surgery. One woman told me she was out for a stroll the day after her laparoscopic hysterectomy when she got a frantic call from her husband: “Quick, you have to get home and look sick! Your church group is here with casseroles and flowers!” She snuck in the back door and quickly got into bed so the ladies could visit her during her “recuperation”!

Myth 3: Sex will never be the same again.

Virtually every woman expresses concerns, if not to her doctor, to her partner, or even herself about how hysterectomy will affect her sexual function, desire, and desirability. Unfortunately, studies have shown that only half of gynecologists initiate a discussion of sex and few patients are brave enough to bring it up themselves. That means a lot of women who worry about their postoperative sexuality do just that – worry.

But, there is good news. Studies (and my survey!) consistently show that the most important thing that determines what sex after hysterectomy is like, is what sex before hysterectomy was like.

The decline in libido, and/or vaginal lubrication, that some women experience after hysterectomy occurs from the loss of ovaries, not the loss of the uterus. In other words, if you don’t go into menopause as a result of your hysterectomy, nothing should change. In the spirit of full disclosure, the occasional woman, even if she keeps their ovaries, say that things seem different, their orgasms less intense. Most women have orgasms that are clitoral and vaginal in nature, but some women are aware of uterine contractions when they climax. If the uterus is gone, that aspect of their orgasm will also disappear.

Myth 4: There will be a big empty space where my uterus was.

This is a really common concern. Picture this. If you have a bowl of spaghetti with a large meatball in the middle and then someone removes the large meatball, the space the meatball formerly occupied is replaced by the spaghetti. No one would know that the meatball was ever there. A woman’s pelvis is like a bowl filled with bowel (the spaghetti!). If the uterus (the meatball) is removed, the bowel falls into the space formerly occupied by the uterus. There is no “empty space.” Phew.

Myth 5: My vagina will feel different to my husband.

This was a question I was also really curious about. There have not been any good scientific studies on this topic, so I did the next best thing. I did my own study and polled the guys. Reassuringly, almost every single man who returned the questionnaire said that their wife’s vagina felt exactly the same as it had before her hysterectomy.

The majority of the men felt that their sexual relationship had not suffered as a result of surgery, and many felt it had improved. In the cases that the men did report that their wives’ vagina felt different, or that their sex life had deteriorated, almost every one was in the case of a woman who went through menopause as a result of the surgery and elected not to use estrogen therapy. So, bottom line, once again, it is menopause that seems to sabotage sex, not hysterectomy.

Obviously, I could go on and on. There are hundreds of myths, questions and concerns about this procedure, which is still the most common major surgery performed in non-pregnant women. Not to mention, their are many new alternatives your doctor may not have told you about for those women who want to avoid a hysterectomy. But, all that information wouldn’t be a blog, it would be a book. Oh, it is a book – my book, The Essential Guide to Hysterectomy which was released this week!

Read an excerpt from The Essential Guide to Hysterectomy in Dr. Oz’s Book Corner.