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Part 1 of 3
published in Uptown Express, Feb/Mar 1995
This article is a downsized version of an unpublished academic paper completed in January 1995 and was the basis for a shorter two-part series published in A Friend Indeed in February and March 1996. If you are only going to read one version, I would recommend the academic paper, which did not suffer from restraints of size imposed by publishers and has a more complete discussion and fuller listing of source materials.
Once upon a time, all girl babies were born with a special organ called a uterus. It was very special, and little boys had nothing like it. It was something with which girls were born and something with which they would die. Once upon a time, but no more. Last year about 600,000 uteri were amputated from the bodies of American women. From 8% to 10% of these surgeries were for life-threatening disease. Why were the other 540,000 uteri separated from their owners' bodies? The answers are fascinating--and sometimes disheartening.
As women, quietly and behind doors, blamed the penis for wars and pestilence, so men, adorned in white robes or white coats, through the centuries have blamed any inconvenience caused them by their women on the uterus. At one time, it was even believed that tuberculosis in women originated in the uterus.
"The Greeks coined the word hystra to explain 'suffering caused by the uterus,' which they believed included just about any physical or psychological malady imaginable," wrote Stanley West, M.D., author of The Hysterectomy Hoax.
In 1848, the introduction of anesthesia made way for the cure for all female complaints: hysterectomy! "Doctors of the day were convinced--and managed to persuade their patients--that hysterectomy had a calming effect that would render women more 'tractable, orderly, industrious and cleanly,'" stated West.
Hysterectomy became the Victorian sexual lobotomy--a cure for the unseemly sexual interest of certain women (lacivious, they labeled a woman who dared to enjoy sex) and a cure for the uterine disease in young women that was believed to be caused by reading romantic novels. And then there was the theory that higher education would cause the uterus to atrophy.
The rise in the popularity of hysterectomy in the 1970s was accompanied by a brilliant burst of new blame-it-on-the-uterus theories that rivaled Victorian times. West described what he believed to be the most outrageous among these. In 1977, James H. Sammons, M.D., executive vice president of the American Medical Association, stated that hysterectomy was "beneficial to women with excessive anxiety."
"At about the same time," stated West, "Edgar Berman (whose most famous patient was the late vice president Hubert H. Humphrey) announced that women were not fit to be president because of 'raging hormonal imbalances' that rendered them unfit for decision making."
In 1971, at a meeting of the American College of Obstetrics and Gynecology, there was very serious debate concerning adoption of a position set forth by Connecticut physician Ralph W. Wright. Wright maintained that "after the last planned pregnancy, the uterus becomes a useless, symptom-producing, potentially cancer-bearing organ and therefore should be removed." Though Wright's position failed to be adopted, "those who agreed . . . outclapped opponents," wrote West.
As the only organ completely unique to women, one might say that the uterus is the defining characteristic of a woman. Winnifred B. Cutler, Ph.D., in her comprehensive book Hysterectomy: Before & After, states:
The uterus has no counterpart in the male body. All the other reproductive organs have male/female counterparts: the ovaries compare to the testes and the vagina to the penis, but the remarkable uterus is a uniquely feminine structure composed of a powerful outer muscle and an inner lining with glandular (hormone-producing) structures. An extraordinarily complex and rich contributor to the emotional and physical life of a woman, the uterus often plays a significant role in sexual lubrication, orgasmic contraction, and hormone production. The hormones and nerve impulses that it produces in turn affect hormone and neurochemical production in the spinal cord, the brain, the ovaries, and other glands.
Uterus advocate West describes a woman's reproductive system as "a beautifully crafted apparatus powered by the ebbs and flows of a variety of hormones" and explains that the uterine muscle is the same type of muscle as the heart. The uterus even has its own version of a heart attack.
Fibroids, common benign muscle tumors of the uterus, occur in up to 40% of all women. Their cause is unknown, but simply put, they are the result of cell replication run amuck. Growing at an inexplicably rapid rate, erroneous cells pile up on themselves, eventually losing their identity as normal-looking muscle cells and becoming fibroids. "Fibroids are living tissue that depend on an adequate blood supply and the oxygen that blood carries," explains West. "Any tissue deprived of oxygen will die. It is not unusual for a fibroid, or a portion of a fibroid, to degenerate or die off because it has outgrown its blood supply and no longer receives adequate oxygen." West explains that the result is exactly like a heart attack (when a portion of the heart muscle dies) and is extremely painful.
Though some doctors recommend immediate hysterectomy, West prescribes pain killers to help the sufferer through the ordeal, which lasts about 48 hours. Fibroids are not fatal. The treatment of choice is "wait and watch." When necessary, they can be surgically removed by a procedure called myomectomy (removal of myomas, i.e., fibroids).
Though the 1994 statistic of 600,000 uterine amputations is lower than the 1977 statistic of 702,000, the Staff of the Subcommittee on Aging prepared a 1993 report predicting 824,000 hysterectomies annually by 2005. These figures prompt some important questions. What are the physical consequences of owning and disowning a uterus? And in the wholistic view, what are the mental and spiritual consequences, both individually and collectively? What is the meaning of the departure of millions of uteri from this planet, in most instances many years before the departure of their owners?
The New Ourselves, Growing Older, a reference book on women's health, gives an account of a physician who, following her hysterectomy, described a feeling of "chronic sorrow." Chronic sorrow! As I read the words, a sadness stirred in my memory. The next morning, I awoke with a poignantly fresh memory of the terrible loss I felt 23 years ago when I had my hysterectomy. Before the long months of blood loss and sickness that preceded the surgery, I had made a decision to have a tubal ligation. I had made a firm decision that there would be no more children. Why then, did I feel such a deep sense of loss? I finally rationalized that it was the loss of choice that caused my terrible grief. Then, I was bewildered; now, I find that my experience was far from unique.
The following account by a 57-year-old woman also appeared in The New Ourselves, Growing Older:
After my hysterectomy, I grieved over the end of my childbearing potential, although I was fifty-five. Before I left the hospital, my concentration on babies became pronounced. I watched a TV program on adoption and fantasized about a foster child or about becoming a Big Sister or a Foster Grandparent. The woman across the hall told me that she found she could not look at new babies because she was grieving over having had her hysterectomy and never having had children. She was surprised at her grief at being childless because she had, she thought, long ago chosen to be a lesbian and to have no children. Now, she was once again having to reinforce that choice.
The remarkable characteristic of these two women's stories is that they had completed menopause--and without mourning unborn sons and daughters.
Just recently, I was listening to an audiotape of a workshop and was surprised with the following account by presenter Jacquelyn Small:
I know that when I had the hysterectomy . . . because I have a lot of children and I've been through a lot of my childbearing years, I really thought that part of my life was over and I wasn't concerned about it. . . . But what happened for me, the grief I went through when I lost my female organs was not so much about not being able to have babies anymore. It was tied in, in my subconscious mind, with my fear that I could no longer be creative. And I didn't even know that was there 'cause I think of myself rationally as being a very creative person. But in my subconscious mind I had a connection between my creativity and my childbearing ability, and I didn't know that. So I went through a terrible grief and depression for a couple of months that I couldn't understand. And people who knew me really well couldn't understand it. Everyone thought that I should be delighted not to have to worry about babies anymore, and I'm a very creative person and so it didn't make sense, but our unconscious mind doesn't make sense.
It is a certainty, then, that my experience was not unique. Just as I had done, each woman sought a "logical" explanation for her feeling of loss, and each found a reason that helped her deal with the pain until it subsided. There is nothing generalized about these "depressions." They each focus on childbearing, the essential task of the uterus. Does the uterus have memory? life? emotion? Does it have more in common with the heart than a similarity of muscle? Why do we grieve it as a lost child, even when we have all the children we ever intend to have, even when our reproductive life has already ended with menopause?
I had always thought that the loss of the ovaries was the only real loss in the surgery. I was given estrogen to replace the hormone that had been supplied me by my ovaries. That was because I was still "kind of young," my doctors said, and I needed the estrogen to keep my skin youthful and to prevent hot flashes. This was the only discussion ever of the effects of my surgery.
When I recently undertook a study of oophorectomized women--those who had had ovaries surgically removed--I mentioned my study to family and friends and received some immediate and surprising feedback from two women. Each had lost uterus and ovaries in separate surgeries, and each had a similar story--an emotional slump following removal of the uterus (and in one case a total loss of sex drive) and physical symptoms characteristic of estrogen deprivation following removal of the ovaries. My interest suddenly turned from ovaries to uterus. In the books I had been reading, very little was being said about the uterus. Most discussion centered around the loss of estrogen production with the loss of the ovaries. It appeared that I was not the only one to ignore (with apparently disastrous results) the importance of the uterus.
Most of us learned at an early age that the uterus is the place inside a woman's body where a baby grows for nine months before it enters the world through the birth canal. Until very recently, most people (including most medical professionals) believed this to be the sole function of the uterus. It has taken a great deal of stubbornness on the part of the medical community to ignore the mounting evidence that the value of the uterus is far more complex than simply a warm, wet place to hatch new human beings.
In 1957, physician Katerina Dalton reported in The Proceedings of the Royal Society of Medicine her findings from 10 years of continuous observation of a number of women patients. Dalton found that, within 1 year of surgery, 83% of the hysterectomized women that she followed were satisfied with their surgery. Between 1 and 5 years, only 41% remained satisfied; and between 6 and 10 years, the number of women satisfied with their surgery had dropped to 33%. Dalton cited an array of aftereffects reported by her patients. "Despite Dalton's findings more than thirty years ago," said Cutler, "many women and their doctors today erroneously believe that the uterus has no importance beyond enabling the bearing of children."
The uterus produces substances that affect brain function and reduce the risk of cardiovascular disease. Additionally, it carries on a hormonal conversation with the ovaries, playing an important role in the continuing function of these organs up to 25 years past menopause. Dorothy Krasnoff Reider, in her chapter on hysterectomy written for The New Ourselves, Growing Older, stated that "the uterus is a living, functioning organ. . . . When the uterus is amputated, a delicately balanced system (which includes ovaries, fallopian tubes, cervix, vagina, and clitoris and their blood and nerve supplies) is disrupted."
Though the evidence of the uterus as a hormone-producing organ was published as early as 1974, physicians have continued to cling to their outdated view of the uterus as "nothing but a big, unresponsive blob," the description written by Barbara Edelstein, M.D. in her 1982 book, The Woman Doctor's Medical Guide for Women.
Writing in 1994, West claimed that, even today, "prevailing medical wisdom holds that the uterus is a disposable organ that serves no useful purpose once a woman has all the children she wants. What's more, it is regarded as something of a nuisance."
As a young doctor in 1966, West had an experience that changed forever his acceptance of "prevailing medical wisdom." Working in a large, urban hospital, he walked into an examining cubicle one day and met a remarkable patient:
I could see that she was nervous and frightened. Her hands were shaking, and she couldn't sit still. Sarah told me she had not had a menstrual period for three years, not since an operation for an ovarian cyst. She was certain that something was terribly wrong with her. Not only had she not had a period, but she had not been feeling well for some time. She complained about hot flashes, aches in her joints, headaches, fatigue. She also had been avoiding sex because "it hurts." Anyway, she had not been very interested in sex since her operation. She was unemployed because she lacked the energy to hold a job.
West then challenged everything he had been taught in medical school about hysterectomy:
Sarah had not blamed her surgery for her problems because she didn't have any idea that she had had a hysterectomy. She was not hysterical or neurotic. She was just a frightened young woman overwhelmed by the changes in her body. But it seemed a strange coincidence that the symptoms she described were the very ones my medical school textbooks said "neurotic" women complained about after hysterectomy.
West's experience not only changed his views of accepted medical practice in his chosen field of gynecology, it changed his entire approach to assessing patients. Since the information he now sought was not in medical texts or journals, he turned to the only available source: the women who were living the experience. He learned to ask the right questions, and he learned to listen:
I began asking patients who had had hysterectomies how they were feeling. Some were fine, but most told me that since their operations they had been feeling depressed. They talked about tremendous mood swings, lack of interest in their husbands and children. . . . as some of my patients delicately phrased it, their interest in having "relations" with their husbands had diminished since the surgery. Some confided that sex had become painful. So many women said the same thing, sometimes using exactly the same words, that I had to wonder about the cause. I didn't think they were crazy, but I had no medical explanation for what they were experiencing.
According to Cutler, three main areas of connection between the uterus and the nervous system have been identified:
1. Beta endorphin contribution. The uterus produces beta endorphins (substances that contribute to feelings of well-being) in the glands of the endometrium; and through its influence on ovarian cycling, it affects the secretion of endorphins from the brain and pituitary gland.
If beta endorphins, the joy juices made famous by the runner's high, are produced in a woman's uterus, would it be too unscientific to believe that a woman might experience a mood dive if her uterus is removed?
"Women haven't been taught to value their reproductive and sexual organs as a man values his," stated Nora Coffey, founder of Hysterectomy Educational Resources and Services Foundation (HERS), in a 1986 interview published in New Jersey's Woman's Newspaper. Coffey told interviewer Lee Rothberg that her greatest loss was the "ten plus" sex life that she and her husband enjoyed prior to her surgery. It is a loss that is felt by as many as 46% of all hysterectomized women. A 50-year-old woman described her loss in The New Ourselves, Growing Older:
The worst thing since my hysterectomy is the lack of desire. No more delicious cravings and wonderful radiating feelings of exciting anticipation. I always felt that my desire and enjoyment of sex was a special gift, my own private joy that could never be taken away from me even if I lost material things in life. If something turned me on, whether it was a love scene in a movie, a touch, or a thought, my body would feel all tingly and flushed. Even if I didn't get sex right away, I could luxuriate in thinking about it--how I would do it, where, and when. Now there is just emptiness inside. I feel I could go one hundred years without sex and I'm aware of the enormous void. To me it is tantamount to death.
There are three aspects to the uterine participation in sexual acts. The cervix, the "bridge" between the vagina and the uterus, is studded with nerve endings. Cutler described what, for some women, are "intensely pleasurable feelings" as the thrusting penis taps these nerve endings. The second aspect is uterine contractions during orgasm, and the third is lubrication. Though lubrication also originates in the vagina, a significant portion is cervical mucus produced at the tip of the uterus.
Sex researchers William Masters and Virginia Johnson defined three phases in female sexual response, each involving the uterus. Rothberg's 1986 report on hysterectomy published in Woman's Newspaper described these:
During the excitement phase, the uterus fills with blood, much the same way as the penis, and elevates in the pelvic cavity. During the plateau phase, the uterus expands to twice its normal size, thus increasing sexual tension. During the orgasmic phase, the uterus contracts rhythmically. And, during the resolution phase, the uterus gradually loses its sexual tension as the blood recedes.
West even went so far as to say that orgasm should be physically impossible without a uterus. "It is easier to explain why sex is less satisfying after hysterectomy than to account for why some women continue to experience orgasms," he wrote. In what he terms his "pet theory," West proposes that the ability to attain orgasm after hysterectomy may be due to the "phantom limb" syndrome, the phenomenon of continued sensation felt to originate from amputated limbs.
"There have been reports of men driven to drink and drugs because of continuous phantom limb pain," he wrote. "In such cases nerve endings in the stump may be stimulated by painful scars, triggering a memory of, say, pain in the big toe. Similarly, continued 'orgasms' after hysterectomy could be a remembered response to stimulation of the clitoris and nipples."
A fascinating theory. I can only say I am grateful for the pretty incredible "phantom" orgasms I have experienced since my hysterectomy. I am even more grateful that I have not had to live the tragedy of lost sexual loving that nearly half of all hysterectomized women suffer.
It is now 14 years since the American Journal of Obstetrics and Gynecology published a study reporting large numbers of hysterectomized women suffering loss of sexual function. Though this was not the first report (nor the last), it was published in the one source that every gynecologist would be expected to read. If the testimonies of millions of hysterectomized women over the last 147 years means nothing, if the work of famous sex researchers Masters and Johnson mean nothing, if the scientific data of their colleagues mean nothing, what will mean something to the physicians who continue to remove uteri as if there were a bounty on them? Do we need a government subsidy for gynecologists to pay them for the number of uteri they save from extinction?