Deciding on Gyn Surgery

Medical breakthroughs provide many options for treatment
Millions of American women suffer needlessly from pelvic pain, bleeding problems and other gynecologic problems. Medical breakthroughs provide many options for treatment depending on the cause and extent of the problem and the individual situation of the patient.
Unfortunately there is a continuous stream of misinformation that creates controversy and confusion. The internet provides a fantastic resource of excellent reference information, but users have to weed through an obstacle course of self-serving, inaccurate or purposely one-sided “expert” opinion on any particular issue.
There is no better example of this than in the topic of women’s health. A recent segment on ABC’s 20-20 program about hysterectomy accomplished its purpose in getting a reaction from viewers, but couldn’t have been more slanted. Still, it’s an important subject that needs thoughtful discussion, especially if it is a serious medical treatment option and you are the one considering it.
Hysterectomy is the surgical removal of the uterus. This is the organ with the primary function of receiving the fertilized egg from an ovary and carrying the developing fetus to birth. If it’s not doing that, the uterus is preparing monthly to do the same task. In some women, significant problems such as pain, excessive bleeding, or cancer risks bring up the option of hysterectomy. In most cases there are many options or variations to consider. These might include removal of one or both ovaries, vaginal repair work, bladder repair, or other procedures accomplished at the same time for specific purposes.
Almost all hysterectomies can now be done through small incisions or a vaginal technique, avoiding large incisions, higher risks and extended recovery. In many cases, there are better and less invasive surgical options where hysterectomy can be avoided or postponed. These include laparoscopic surgery, laser, endometrial ablation, myomectomy, hysteroscopy and even removal of a part of the uterus…the supracervical alternative to hysterectomy.
Of course, for most conditions, there are many considerations that are non-surgical. Non-traditional medical techniques may also be advised. One of the biggest breakthroughs in recent years is the refinement of the LASH (laparoscopic supracervical hysterectomy), which involves removing only a portion of the uterus with no vaginal incision and only small incisions in the navel and lower abdomen. The biggest benefit of this minimally-invasive approach is the fast recovery and less “down time”. The additional suggested advantages, although not yet proven, are the possibility of even less chance for any negative sexual effects or future bladder/ pelvic support problems. If Gyn surgery is recommended, and future child-bearing is not desired, this technique should at least be considered. Most patients undergoing a LASH procedure are 80% back to normal after just one week. These patients don’t have periods anymore, but have an undisturbed vagina and cervix. If the ovaries are left in place, then hormonal function should be the same as well.
There continues to be controversy regarding sexual function and gyn surgery. Most research, practical experience and common sense suggest that with current techniques and well-informed patients, the potential for negative effects is very unlikely. Actually many procedures are done with the goal of improving pelvic pain and/or sexual function. If pain, extreme menstrual periods, fear of unwanted pregnancy or pelvic support problems contribute to sexual problems, then an improved sex life is anticipated. Exceptional situations, such as major cancer surgery, radical life-saving procedures and sudden surgical menopause from the removal of both ovaries in younger, premenopausal women might be expected to impact sexuality in a negative way. Unfortunately, these much less common scenarios are the ones that receive most of the attention when the “negatives” of gyn surgery are debated. In some of these cases, or any individual situation where sexual issues result or develop, a full effort at correcting problems is warranted.
What is known about female sexuality suggests that contributing factors are complex, and much of the human sexual response is perception. The brain is the most important sex organ as evidenced by the “non-pelvic” causes of the majority of sexual problems, the existence of “wet dreams” and surprisingly satisfactory function seen in many people with spinal cord injuries, major pelvic trauma or sensory-motor loss from disease.
The bottom line is this…when significant gynecologic problems warrant corrective action, find a reputable specialist that is trained, certified, highly-experienced and fosters a sense of trust. Review all available options, including surgical and non-surgical methods. Allow for a thorough workup and evaluation. Consider a second or even third opinion. If possible, try the simplest and least invasive approach first. In the care of a qualified, board-certified gynecologist, one can anticipate successful outcomes in the vast majority of cases. As with any important decision, your own knowledge and confidence helps tremendously in making the right choice.?