M. F. D. Streicher - The Essential Guide to Hysterectomy: Complete Advice from a Gynecologist on Your Choices Before, During, and After Surgery—Including the Latest Treatment Options and Alternatives

A Gynecologists Advice on Your Choices
Before, During, and After Surgery
Including Alternatives to Hysterectomy

Lauren F. Streicher, M.D.

Copyright 2004 by Lauren F. Streicher, M.D.

Illustrations prepared by Janet Abercrombie. Figure 4-3 on page 55 is reprinted with permission of the American College of Obstetricians and Gynecologists, from Laparoscopy. ACOG Patient Education Pamphlet AP061. Washington, D.C. ACOG, 1998.

All rights reserved. No portion of this book may be reproduced or transmitted in any form or by any means without the written permission of the publisher.

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Library of Congress Cataloging-in-Publication Data

Streicher, Lauren F.

The essential guide to hysterectomy : a gynecologists advice on your choices before, during, and after surgery, including alternatives to hysterectomy / Lauren F. Streicher ; illustrations, Janet Ambercrombie

p. cm.

ISBN: 978-1-59077-057-3

1. HysterectomyPopular works. 2. Patient education. I. Title.

Book design by Rik Lain Schell

Printed in the United States of America

9 8 7 6 5 4 3 2

This book is dedicated to the memory of

My dad, Dr. Daniel Streicher, who never would have predicted that his daughter, the doctor, would read the gynecologic textbook he used as a medical student as a reference to write her own book. I miss him every day.

Mary Donnellon, who said she wanted to dance at my publishing party. You are dancing in my heart and in my memories.

The following colleagues reviewed chapters and were instrumental in assuring accuracy of information on the following topics:

I would also like to thank:

My partners, Jane Blumenthal, Shari Goldman, Bonnie Wise, and Kim McMahon. Not only the best doctors I know (and awesome surgeons) but my dearest friends.

My brother, Paul, who saved me from computer emergencies too numerous to count. If not for Paul, I would have written the whole book longhand with carbon paper for backup.

Ann Hawkins, my agent, for agreeing to look at a manuscript from a gynecologist with no writing experience.

Enrica Gadler, my editor, for putting up with a gynecologist with no writing experience.

My mom, Lyle Streicher, for everything.

My daughters, Rachel and Danielle, who make it all worthwhile.

Performing hysterectomies for twenty years has given me a unique perspective regarding its impact on womens lives. What has really influenced my views, however, is twenty years of talking to women before and after their surgery. One thing is consistent. The more information a woman has prior to surgery, the better the choices she will make, and the better her long-term outcome will be.

I decided to write this book when I realized that there is just too much information to cover during the course of a typical pre-operative consultation. I often meet with patients who are scheduled to have a hysterectomy and try to discuss possible removal of the ovaries, removal of the cervix, anesthesia options, post-operative hormone replacement, and potential complications, all in thirty minutes. It is frustrating to me and my patient to cover such huge amounts of complicated information in such a short period of time. Many things are only superficially discussed, or the thirty-minute consultation turns into a ninety-minute marathon, with my patient furiously scribbling notes and me talking in fast-forward.

My decision to write this book also stemmed from the fact that there were no books on the subject that I could comfortably recommend. My patients often find the books directed to the general public overly simplistic and frequently turn to technical, hard-to-understand medical books for more in-depth information. With The Essential Guide to Hysterectomy, I have sought to bridge that gap by presenting thorough, up-to-date medical knowledge in an accessible, conversational way.

Any discussion of hysterectomy must also acknowledge that the procedure has become politicized. The backlash against past over-utilization of hysterectomy has unfortunately resulted in women being led to believe that avoiding hysterectomy is always in their best interest, when in fact it is not. Most books on hysterectomy reflect this controversy and are extremely one-sided. The message is either, never have a hysterectomy under any circumstances, your life will be ruined, or, youre having a hysterectomy... heres what to bring to the hospital!

While most hysterectomies are appropriate and beneficial, there are still women who have unnecessary surgery or who are not offered less invasive alternatives. Surgical technology has exploded in the last five years, and Ive written this book as the source women can turn to in order to learn about uterus-sparing alternatives to hysterectomy, such as thermal ablation and uterine artery embolization, and new surgical innovations such as laparoscopic outpatient hysterectomy. Weve come a long way since I did my first hysterectomy twenty years ago, and my fellow residents and I laughed at the notion that a uterus could be removed through a one-inch laparoscopic incision. Little did I know that one day I would perform most of my hysterectomies using that technique.

If you have been advised to have a hysterectomy, this book will serve as a comprehensive guide to the choices you should be aware of and discuss with your surgeon. Topics not typically covered in other books about hysterectomy are also addressed, such as pregnancy after hysterectomy, prophylactic surgery for women genetically at risk for gynecologic cancers, plastic surgery at the time of hysterectomy, sex, and exercise after surgery.

The following pages present treatment options in a balanced, objective, and scientific manner so that women looking for alternatives wont feel that they are being sold a procedure they are trying to avoid, and women who desire a hysterectomy will know what to expect. It is time to take the hysteria out of hysterectomy and empower women with accurate, unbiased information, so they can make appropriate decisions regarding the health issues that affect themselves and their families.