The uterus is a definitive organ. It represents the comforting, empowering spirit of femininity—seemingly fragile yet unexpectedly powerful. It possesses elegance and prestige, while yielding the formidable potential to create and nurture life. It is utterly inspiring.
But while this beautiful organ possesses such a vital role in conceiving life, it is passively surrendered far too often and unnecessarily.
The fact is, by the age of 60, more than one-third of cisgender women will have their uterus removed through a procedure called a hysterectomy. And, in the United States, a hysterectomy is the second most commonly performed procedure for cisgender women of reproductive age. With over 600,000 hysterectomies occurring annually, this rate beats those of Australia, New Zealand, and most European countries.
Naturally, this poses a question: Why are hysterectomies performed at such high rates in our country? And, in our male-dominated medical industry, what does this mean for our folks with uteri?
To preface, this is not to say that hysterectomies should be viewed as evil. In fact, hysterectomies can be life-saving procedures. For instance, they can remove gynecological cancer; 1 in 10 hysterectomies performed are for oncological treatment. Additionally, hysterectomies can subside the effects of certain conditions such as endometriosis, pelvic inflammatory disease, leiomyomas, and chronic pelvic pain. Thus, even though a hysterectomy may not be performed for a life threatening or “medically necessary” reason, the procedure may still offer a lot of utility in an individual’s life.
Nonetheless, there are heavy physical and psychological tolls of this procedure which are under addressed. Those who undergo hysterectomies can experience heavy bleeding, infection, early menopause, breathing/heart difficulties, and death, among a slew of other potential complications. Additionally, the removal of a uterus—especially at an earlier age (premenopausal)—can increase the chances of a stroke, and heart attack. During the operation, there is a 30% complication rate for hysterectomies, although physicians are rarely sued for not properly disclosing the potential dangers of the procedure. Additionally, in a total hysterectomy where the ovaries are also removed, there may be additional consequences. For instance, the procedure causes a sharp decline in hormone levels. This decreases sexual sensation and may contribute to depression. According to D.H. Richards in “Depression after Hysterectomy”, approximately 36% of individuals who have their uterus removed will experience post-operative depression. In individuals under 40, this percentage was remarkably higher at 55%. Most notably, individuals who have their uterus removed are no longer able to become pregnant and bare children.
In conjunction with these physical impacts of the procedure, a hysterectomy comes with many emotional repercussions. Patients may have difficulty fathoming who they are after surrendering the organ that gave them the prestige to bear life. Importantly, the procedure poses immense battles with gender identity. This is because an individual’s identity is based on their self-perception of their body. Although gender is not biologically determined, the removal of the uterus and ovaries can heavily influence the way an individual recognizes themselves or feels recognized by others. Especially because the natural dichotomy between males and females heavily manifests our sense of self, the removal of a uterus may cause a lot of hidden emotional turmoil. Gender is a rather salient marker of identity and hence; a hysterectomy can cause a surgical disruption of someone’s concept of self. This may cause one to feel lost, guilty, or even ashamed after the procedure. In fact, a lot of patients hide that they even had the procedure done. The vilification of this supposedly “defeminizing” surgery heavily contributes to its emotional consequences.
As such, hysterectomies constitute a major procedure because they have major repercussions— both physical and emotional. And, according to recent research, the epidemic of unnecessary hysterectomies is not due to elevated rates of medical disease: there is not an increased rate of uterine disease in individuals today when compared to the 1940’s. Only 15% of hysterectomies are performed in order to remove gynecological cancer. Rather, the decision constituting the need for a hysterectomy has become increasingly elective and driven by non-medical factors. While we can hope that medical practitioners have their patients’ best interests in mind, there are often subconscious factors such as finances or gender prejudice that overly contribute to what is decided in the pre-surgical setting.
While many physicians may not openly admit that they are financially motivated to operate (although some gynecologists do openly acknowledge this extrinsic factor, as Quintilian mentions), hysterectomies are especially profitable procedures when physicians are paid for each surgery individually. In fact, hysterectomy rates are lower for physicians who are not paid for each operation. Thus, it appears that this financial gain may incline physicians to push for the surgery, despite the true necessity for it.
Apart from this financial motive, other implicit biases may also influence a physician’s advice. Today, sex role stereotyping impacts every aspect of our world. Unfortunately, our health care industry is no exception. The “value” of a uterus may be determined by age and whether an individual has borne children before. After the child-bearing phase, the uterus may seem to be an unnecessary or medically dispensable organ. As a result, a physician may disqualify the repercussions of the procedure when discussing its utility. This blind-sided, ignorant approach may leave the patient feeling guilty when they start to realize the momentum of the procedure. This potential regret can be extremely debilitating and upsetting.
At the end of the day, it is our health care industry’s responsibility to ensure the integrity of this decision-making process. Understanding the complex issue surrounding hysterectomies is the first step towards initiating change. Looking ahead, practitioners can ensure the proper discussion and evaluation of all the possible alternatives to this procedure before it is performed. For instance, common alternative procedures to a hysterectomy could involve a myomectomy (the removal of uterine fibroids) or an ablation (surgical destruction of endometrium). Additionally, the after effects of the procedure should be disclosed transparently. The decision to have the surgery should be completely consensual, educated, and accessible. The patient needs to be completely aware of what they are signing up for.
While there is no politically correct stance on whether a hysterectomy should be performed, individuals should feel empowered and confident in their decision—whatever it may be.
Edited by Tyler Schutt and Blair Hoeting