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- Totale Hysterektomie
- Subtotale Hysterektomie (mit Erhalt der Cervix- Gebärmutterhals)
*The Unkindest Cut of All - removal of the cervix
Some are sad. Some are horrific. And some are just plain inept. These stories started with a signature on the bottom of a consent form that gave licence to remove organs and tissue believed to be contributing to the problem. The woman had her chance to ask questions but what questions can you ask if you know nothing about the operation or its effects.Of the 40,000 hysterectomies performed every year in the UK, the vast majority are ‘total’. This means that the uterus, ovaries, fallopian tubes and cervix are removed. There may also be some shortening/scarring of the vagina and occasionally accidental damage to the bowel (due to its physical proximity to the cervix). In France fewer hysterectomies are performed per head of population since many gynaecological problems are dealt with through less radical operations. Unlike the UK, most hysterectomies that are performed are sub-total i.e. they leave a perfectly healthy cervix in place where there are no medical reasons for its removal. As a consequence the issues of vaginal shortening or scarring don’t arise and accidental damage to the bowel is rare. But perhaps there is a more profound reason for leaving a perfectly health cervix in place. The Hysterectomy Association receives hundreds of letters about another form of damage - damage to the couple’s physical relationship. Some medical research is only now being undertaken into the effects of hysterectomy, particularly the removal of the cervix, on the intensity and even the capability of achieving orgasm. Generally, an orgasm will depend on three things, how you feel emotionally about yourself and your partner at the time, the amount and quality of foreplay and once above the ‘orgasmic threshold’ the amount and quality of clitoral stimulation. As orgasm approaches, the padded third of the vaginal barrel grips the penis and the musculature of the pelvic muscles, within which the cervix resides, go into mild spasm. This is followed by a series of rhythmic convulsive contractions occurring at one second intervals. The clenching and unclenching of the pelvic muscles is accompanied by subjective feelings of intense pleasure known as orgasm. Where the cervix is removed and the vagina shortened or scarred, there can be a considerable reduction in the orgasmic intensity for both the woman and her partner.
It has been suggested that the rationale behind total hysterectomies as opposed to sub-total is upon grounds of training, cost and/or ignorance. Can it be possible that predominately male gynecologists are ignorant of the effect that unnecessary removal of healthy organs has upon a woman’s sexuality? In a recent ‘Woman’s Hour’ programme, one consultant gynecologist was amazed that a 59 year old woman should be concerned about the effect of hysterectomy on her sex life, as if she should be bothered at that age!
It has been very difficult to write this article. I am aware that reading it should perhaps carry a health warning since a major indicator of the success of any major surgery is the psychological preparedness of the patient. The psychology of sexuality is even more fragile. However, I feel that the need justifies the means and risks involved so that the thousands of women considering hysterectomy can insist upon full information provision before signing the consent form.
HYSTEREKTOMIEARTEN
In der Hälfte der Fälle (50,2%) betraf es Patientinnen zwischen 15 und 44 Jahren. In 38,3% lag das Alter der Frauen zwischen 45 und 65 Jahren [1].
In Frankreich werden jährlich ca.40.000 Hysterektomien durchgeführt, bei einer Population von ca. 58.978.000.
In Belgien wurden 1993 ca.21.000 Hysterektomien durchgeführt (21/10.000 Einwohner).
Die Verteilung der Hysterektomiefrequenzen unterscheidet sich sehr.
In der Literatur werden die Unterschiede durch die bei den Gynäkologen bestehende Unklarheit der korrekten Indikationstellungen zur Hysterektomie erklärt. Die angegebenen Ursachen hierfür sind neben den Schwierigkeiten auf der diagnostische Ebene die fehlende Datenlage über die Effektivität der Hysterektomie und alternative Therapieformen. Dazu
kommt noch, dass manchmal deutliche Differenzen auftreten können zwischen der von der ärztlichen Seite vorgeschlagenen
und der von der Patientin gewünschten Therapie [2].
http://www.springerlink.com/content/30p3dwamf14qa1c3/fulltext.pdf?page=1