Hysterectomy is the surgical removal of the uterus, and it may also involve the removal of the cervix (total hysterectomy), fallopian tubes (salpingectomy), and/or the ovaries (oophorectomy). Until recently hysterectomies were performed through an incision in the abdomen, but nowadays they are often done through the vagina. Vaginal hysterecomies are preferable because they have a lower risk of post-surgery complications and a faster recovery time. In some cases hysterectomies are absolutely necessary - say, to remove malignant tumors or to relieve extremely painful and debilitating endometriosis; however, in many cases they are done to relieve temporary conditions like fibroids, which will abate with menopause, or they can even be performed preventatively, to guard against future possible cancers.

Hysterectomy, whether abdominal or vaginal, is an invasive procedure which requires a long healing time. It eliminates the possibility of childbearing and causes menopause in premenopausal women. If an oophorectomy is also performed, the production of estrogen and progesterone ceases; these hormones have beneficial health effects for women and help guard against heart disease and osteoporosis. The removal of the uterus may lessen women's sexual pleasure through loss of deep uterine contractions, and the shortening of the vagina may make deep penetration painful.

There are alternatives to hysterectomy which do not have these side effects. Less invasive procedures include laparoscopic surgery, hormone therapy, or removal of only the fibroids rather than the whole reproductive system. Nevertheless, hysterectomy is the second most common surgical procedure performed in the United States, perhaps because some doctors feel that if a woman has already had all the children she wants, and is approaching menopause, her womb is nearing the end of its "useful life", and can be removed. Some studies have shown that up to one-quarter - some would say many more - of the hysterectomies performed in that country are unnecessary.

Any woman who is faced with a potential hysterectomy should seek out as much information as possible about the particular condition she has and what her alternatives are for treatment. Only she can decide what is best for her, and for some women, hysterectomy is the answer. However, every woman needs to be well-informed before she can make this decision, and while your doctor may be a fount of information about hysterectomies, s/he may be rather less helpful when telling you about alternatives. There are some good websites to visit, however. An excellent resource, maintained by Dr. Michael E. Toaff, which describes conditions for which hysterectomies are commonly prescribed and how they can be treated successfully without this major surgery, can be found at
http://www.althysterectomy.org/index.html#TABLE OF CONTENTS

Also useful is the HERS Foundation (Hysterectomy Educational Resources and Services) website at
http://www.ccon.com/hers/

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