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THE NO-LONGER UBIQUITOUS UTERUS: NECESSARY LOSSES?
This paper was revised twice for publication, once appearing as a three-part series in Uptown Express and again revised for a two-part series in A Friend Indeed. The A Friend Indeed version was edited so extensively, in order to bring it to a size suitable for the publication, that much was lost. Though longer than the A Friend Indeed version, the Uptown Express version was also edited for size. If you are only going to read one version, I would recommend the academic paper below, which did not suffer from restraints of size and, as a result, has a fuller discussion and listing of source materials.
Once upon a time all girl babies were born with a special organ called a uterus. It was very special, because little boys had nothing like it. It was something with which they were born and something with which they would die.
Under the entry for "uterus," The Oxford Modern English Dictionary simply states "womb" (Swannell 1992, p. 1213). Under womb, is found: "1. the organ of conception and gestation in a woman and other female mammals; the uterus. 2. a place of origination and development" (Swannell 1992, p. 1260). Jane Mills (1989) traces the etymology of the word "womb" to its first use in the English language ca. 825 to denote the uterus (p. 269). Exactly what the uterus was called prior to that time is not noted.
The use of the word "womb" in our language is rich in metaphor--frequently and elegantly used in literary reference. It is a word of poets and mystics, a word that inspires visions of warmth, nurturance, growth--life! Uterus, on the other hand, is a body part--blood and tissue, stained underwear, cramping. It is the term used by doctors and scientists. How did the two terms become so emotionally divorced?
Though poised on the brink of enormous change, our society (and particularly North American society) continues to value left-brained, masculine thought, subjugating the feminine, right-brained thinking to the closet where we keep the unexplained, the undefinable, the enigmatic--anything that does not submit to the rigors of our scientific, reductionist thinking. After centuries of the "scientific method," of taking things apart in an attempt to understand how nature works, humankind is entering a new era of science and philosophy. This new epoch is marked by the remarriage of the parts, the recognition that parts in isolation behave differently from parts working in concert. This new thinking--or perhaps, more accurately, return to old thinking--is labeled wholistic.
Reductionist science and left-brained medicine have not been valueless. It is not the participation in these activities that has created problems, but rather a peculiar thing that happened on the way to the Forum: As the body of knowledge grew through scientific research, we began to behave as if we knew everything. That which we knew was fact; that which we did not know was fiction, or all too frequently, nonexistent--a figment of psychological disturbance. Our uteri became victims of this linear and limited thinking. For our uteri--our wombs--the effects of our devotion to modern medicine have been devastating, particularly since the early 1970s.
As the only organ unique to women, one might say that it is the defining characteristic of a woman. Winnifred B. Cutler, Ph.D., author of several books on human sexuality, stated:
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. (Cutler 1988, p. 29)
Stanley West, M.D., uterus advocate and author of The Hysterectomy Hoax (1994), described a woman's reproductive system as "a beautifully crafted apparatus powered by the ebbs and flows of a variety of hormones" (West 1994, p. 13). Cutler (1988), equally poetic, stated "The functioning of a woman's body is elegantly symphonic in nature" (p. 8).
Over 600,000 uteri were expected to be removed from the bodies of American women in 1994 (West 1994, p. 17). Though this is lower than the 1977 statistic of 702,000 hysterectomies, the Staff of the Subcommittee on Aging prepared a 1993 report projecting annual increases and reaching 824,000 hysterectomies in 2005 (p. 1). 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 Mysterious Loss
I awoke one recent morning 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 rationalized that it was the loss of choice--the door slammed in my face--that caused my terrible grief. Then, I was bewildered; now, I find that my experience was far from unique.
Following her hysterectomy, a physician described a feeling of "chronic sorrow" (Reider 1994, p. 319). The following account by a 57-year-old woman was published in The New Ourselves, Growing Older (Reider, 1994):
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. (p. 319).
Another account was published in Natural Menopause (Perry & O'Hanlan, 1992):
After the hysterectomy, Robert and I had some counseling just to deal with the grief part of this. The culminating episode, the one that really pushed me over the edge, was when a good friend had a baby. I went to the hospital and held the baby and coo-cooed it. That night when I came home I was very angry and I didn't know why. I was picking on Robert; I shouted at the dog. Then I finally burst into horrible, horrible, deep grieving sobs. I recognized and came to a deep understanding with myself that it would never be possible for me to have a child. (p. 72)
Just recently, I was listening to an audiotape of a workshop on chakras, and I was surprised with the following account:
I know that when I had the hysterectomy, which was a very difficult thing for me, 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, I didn't think. 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. (Small, 1985).
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? Why do we grieve it as if we had lost a child at birth?
I had always thought that the loss of the ovaries was the only real loss in the surgery. I was given Premarin, an estrogen tablet, to replace the estrogen 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. One woman had had one ovary removed, a year later had a baby, and then had a hysterectomy and removal of the remaining ovary when her child was nearly two years old. Another woman had undergone hysterectomy, and then a few years later, had her ovaries removed. Both women had a similar story--a story of hot flashes and fatigue after removal of ovaries and an emotional slump following removal of the uterus. My interest suddenly turned from ovaries to uterus. In my reading, 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.
The Value of the Uterus
It is common knowledge 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 took 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 (West 1994, p. 9).
In 1957, Katerina Dalton, a British physician, reported in The Proceedings of the Royal Society of Medicine her findings from 10 years of continuous observation of a number of women patients. She 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% (Cutler 1988, p. 3). "Despite Dalton's findings more than thirty years ago," said Cutler (1988), "many women and their doctors today erroneously believe that the uterus has no importance beyond enabling the bearing of children" (p. 3).
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 well past menopause (Cutler 1988, p. 8). Reider (1994) 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" (p. 318).
Though the evidence of the uterus as a hormone-producing organ was published as early as 1974 (Christian, et al. 1980, p. 292), physicians have continued to cling to their outdated view of the uterus as "nothing but a big, unresponsive blob" (Rothberg, 1986).
West (1994) claims 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" (p. 2).
West (1994) was fortunate. As a young doctor in 1966, he 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 1994, p. 4)
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. (West 1994, p. 5)
Uterine Influence on the Nervous System
According to Cutler (1988), 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.
The Uterus in Sexual Response
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 (1988) described what, for some women, are "intensely pleasurable feelings" as the thrusting penis taps these nerve endings (p. 32). The second aspect is uterine contractions during orgasm, experienced by some women, which contribute to their pleasurable experience (Cutler, p. 33). The contribution by the uterus which is experienced by all sexually active intact women is lubrication. Cutler stated, "Lubrication during intercourse derives from two sources: cervical mucus and the vaginal transudate. Cervical mucus, produced at the tip of the uterus, contributes a significant portion of the vaginal lubrication" (p. 33).
Rothberg (1986) reported that
the uterus is an integral part of the female sexual response. In fact, it is involved in every phase of female sexual arousal--excitement, plateau, orgasm and resolution--as defined by sex researchers William Masters and Virginia Johnson.
"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 West (1994, p. 18). 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 by their women on the uterus. At one time, it was believed that tuberculosis in women originated in the uterus. In 1848, the introduction of anesthesia made way for the cure for all female complaints: hysterectomy! (West, p. 18). "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'" (West, pp. 18-19). Hysterectomy became the Victorian sexual lobotomy--a cure for uterine disease in young women which was believed to be caused by reading romantic novels. And then there was the theory that higher education would cause the uterus to atrophy (West, p. 19).
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. 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" (West 1994, p. 19). "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" (p. 19).
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" (West, p. 20).
The Aftereffects of Hysterectomy
Most of the symptoms women suffer following hysterectomy have long been thought to be psychological, to the exclusion of any physiological basis. It has been suggested by some psychoanalysts that these problems are based in an infantile overattachment to the uterus, "a sign that a woman's sexuality is inappropriately confused with her ability to reproduce" (Reider 1994, p. 316). "Most gynecologists and some psychiatrists still believe this," stated Reider (p. 316).
Written in 1980, the coverage of hysterectomy in Surgery and Its Alternatives attempted to take the middle road, acknowledging that hysterectomized women "suffer some psychological effects within the years following surgery" (Christian, et al. 1980, p. 327). While the tune was more sympathetic, the song was the same.
West (1994) stated: "It is interesting to note that except when dealing with women's problems, doctors are trained never to attribute symptoms to psychological factors unless we have ruled out all possible physical causes" (p. 9). He reminds us of the time in the not-too-distant past when doctors thought menstrual cramps were a psychological manifestation found only among neurotic women and that the symptoms of premenstrual syndrome (PMS) were a manifestation of female emotionalism (West 1994, p. 10).
Very little is known about why certain symptoms consistently occur following hysterectomy. West (1994) stated:
. . . because we have no medical answers--and no useful help--to offer patients, these complaints often are dismissed as psychological. Indeed, medical students are taught that women who attribute symptoms to hysterectomy must be neurotic, hysterical, or obsessed with their uterus. But . . . these problems are very real and have absolutely nothing to do with a woman's mental stability. (p. 2)
Present knowledge of the uterus has primarily been gleaned from observing and listening to hysterectomized women. The list of aftereffects of hysterectomy is long:
1. An alteration in the hormonal environment. Hysterectomy alters circulating levels of estrogen, progesterone, testosterone, androstenedione, luteinizing hormone, follicle-stimulating hormone, and the beta endorphins (Cutler 1988, pp. 3-4).
2. Earlier aging. Hysterectomy causes 5 years earlier menopause when ovaries are kept; with oophorectomy, postmenopausal women age even more rapidly (Cutler 1988, p. 4).
3. A high likelihood of serious postoperative depression. Hysterectomy significantly increases risk for depression, which often emerges as much as two years after surgery (Cutler 1988, p. 4; Christian, et al. 1980, pp. 292, 326-327.; Reider 1994, p. 318; West 1994, p. 2)
4. A deterioration of bone health. Hysterectomy accelerates loss of bone mass and increases osteoporosis likelihood (Cutler 1988, p. 4; Rothberg, 1986).
5. Decreased cardiovascular health. (Cutler 1988, p. 4, Christian, et al. 1980, p. 292) Heart attack rate among women is 0% premenopausal, 33% of mature women with surgical menopause, 12% of mature women with natural menopause; increased risk of atherosclerosis and coronary heart disease among hysterectomized women is three to seven times that of age-matched women who have not had the surgery (Cutler 1988, p. 5).
6. Reductions in sexual functioning. Hysterectomy reduces libido, arousal, vaginal lubrication and orgasmic capacity (Cutler 1988, p. 5; Christian, et al. 1980, pp. 292, 327; Reider 1994, p. 318).
7. Increased incidence of urinary incontinence. (Cutler 1988, p. 5; Reider 1994, p. 318; Christian, et al. 1980, pp. 326-327; West 1994, p. 2).
Other symptoms reported are fatigue, memory loss, insomnia, vaginal dryness and thinning, loss of firm body tone, hair loss, premature graying, weight gain (despite dieting and exercise), unpleasant vaginal odor, protruding abdomen, constipation, bloating, recurrent vaginal yeast infections, dry eye syndrome, lower resistance to colds and infections, less intense emotions, loss of maternal instinct, hot flashes, headaches, and dizziness (Christian, et al. 1980, pp. 326-327; Reider 1994, p. 318; Rothberg, 1986; West 1994, p. 2).
The Reasons for Hysterectomy
With so many women suffering such life-altering, devastating effects from loss of the uterus, why do half a million women continue to go under the knife each year to yield organs that, according to Stanley West (1994), "define you as a woman and are essential to your physical, emotional, and sexual well-being" (p. 1)?
Many women believe that their surgery is essential to their continued health, indeed to their continued life. West (1994) disagreed: ". . . more than 90 percent of hysterectomies are unnecessary. Worse, the surgery can have long-lasting physical, emotional, and sexual consequences that may undermine your health and well-being. . . . Most of the 'female problems' that lead to hysterectomy are medically trivial" (p. 1).
Though hardly a "reason" for hysterectomy, geography appears to have considerable bearing on a woman's chances for hysterectomy. Women in the southern and central regions of the United States have a two to three times greater chance of having a hysterectomy than women living in the northeast or on the west coast (Cutler 1988, p. 46). The U.S. rate for hysterectomy is twice as high as Great Britain and four times as high as France. Yet the death rate from conditions treated with hysterectomy are no greater in these countries than in the United States (West 1994, p. 27).
The largest number of hysterectomies (30%) are performed as a treatment for fibroids, followed by endometriosis (24%), prolapsed uterus (20%), endometrial hyperplasia (6%), and menstrual disorders & other (20%) (Reider 1994, p. 316). West (1994) maintained that fully 90% of all hysterectomies are unnecessary, in that only 8% to 10% of conditions resulting in hysterectomy are life-threatening (p. 1).
The literature reveals a number of other "hidden," nonmedical reasons for hysterectomy.
Profit. It has been suggested that physicians, hospitals, and insurance companies stand to profit from a high hysterectomy rate (Reider 1994, p. 315-316; Rothberg, 1986; West 1994, p. 13). "Gynecologists are surgeons," stated West. "We make our living by performing operations. If hysterectomy is the operation a surgeon knows best, it is the one he or she will recommend and perform most often" (p. 13). Reider proposed that hospitals and physicians are trying to compensate for the declining birth rate, with an accompanying loss of hospital and obstetrical fees. "The tendency to recommend unnecessary surgery," she said, "is greater where there is an overabundance of surgeons and hospital beds" (p. 316). West saw insurance companies as having a financial interest. "As long as a woman has her uterus, she can develop problems that her insurance must cover," he wrote (p. 13).
Training. In order to maintain status as a good teaching hospital, an institution must be able to offer a rich experience to young interns and residents preparing themselves for a future in the practice of medicine. As the profession is practiced today, a successful gynecologist must be proficient at hysterectomy. If the number of hysterectomies were dropped by 90%, as West has suggested they should be, there would not be a sufficient number of hysterectomies to guarantee that each resident would have a hands-on opportunity to learn her or his craft (Reider 1994, p. 315; West 1994, p. 13). West's story of Sarah, the young woman who had been given a hysterectomy and oophorectomy when the doctor told her she was having a cyst removed from her ovary, is an example of surgery for the sake of medical training. When West received Sarah's medical records from the prestigious teaching hospital where her surgery had been performed, the pathology report indicated her uterus and fallopian tubes were normal and that a corpus luteum cyst of the ovary had been found. These cysts, West stated, are "a common and normal occurrence among young women," and "usually disappear on their own after one or two menstrual cycles." He finally concluded that Sarah's health had been sacrificed to give a resident in gynecology a chance to perform a hysterectomy (West, p. 3).
Population control and birth control. Population control on poor and minority women, who were not informed, was openly practiced as recently as 15 years ago. Though it is generally thought that such practice no longer exists, there are some who believe that it continues clandestinely under the guise of medical necessity (Reider 1994, p. 315). In the mid 1970s, the heyday of hysterectomy, hysterectomy was a popular alternative to tubal ligation as a means of permanent birth control. Christian, et al. reported in 1980 that 10% of hysterectomies were done for sterilization (p. 306). "It's like cracking a nut with a sledgehammer," said Dr. Stanley Birnbaum (Christian, et al. 1980, p. 306). "[S]ubjecting a woman to this relatively dangerous operation for sterilization alone is an outrage," said Dr. Sidney Wolfe (Christian, et al., p. 306). Under assault by such criticism, the federal Department of Health, Education and Welfare withdrew its pamphlet, "Your Sterilization Operation: Hysterectomy" (Christian, et al., p. 306). With so many physicians continuing to advise their patients that hysterectomy is routine, safe, and of no damage to their health, it is likely that sterilization hysterectomies still occur.
Abysmal Ignorance. In a discussion of the hidden reasons for hysterectomy, it would be remiss to omit ignorance, even though it does not appear in the literature. Reluctance to accept new information and new treatments in the face of such overwhelming evidence can only be classified as abysmal ignorance. This contention is supported by the fact that the hysterectomy rate within physicians' own families is very high (Christian 1980, p. 288; West 1994, p. 23).
Surgical Risks in Hysterectomy
Because hysterectomy is so common, most of us tend to view it as a routine surgery. It is not; the risks are significant. Postsurgical complications after hysterectomy are relatively common; one of the more common complications is the accidental severing of a ureter (Christian, et al., pp. 291-292). Approximately 800 women die in the United States each year from hysterectomy, a rate of about one to two per thousand. Half of these deaths are from anesthesia (Reider, p. 329). Accepting West's estimate of 90% unnecessary hysterectomy, 720 women each year die as the result of a medical treatment that they did not need.
Closing the Barn Door After the Horse is Gone
For women looking back at a possibly unnecessary hysterectomy and surveying the health wreckage, can anything be done? The answer is a resounding "Yes!" It is never too late to take charge of your health, educate yourself, and institute positive changes. "The doctor-knows-best attitude is flattering to physicians, but it can be dangerous to patients," stated West (1994, p. 12). West makes a key point. We are medical consumers, and the market will react to our demands. If we choose to abandon our own abysmal ignorance, we have much to gain--primarily our health. Both West (1994) and Cutler (1988) encourage women to do their own research and design their own health programs. This doesn't necessarily mean that women become their own doctors, but it does mean that when they need a doctor, they will be more likely to be able to judge the competence and knowledge of the physician they choose.
There is no dearth of information on the subject of hysterectomy. There are many fine books on the market, and a number of organizations that act as support to women who are facing a life without a uterus. Hysterectomy Educational Resources and Services (HERS) and National Women's Health Network are two of many organizations that offer excellent services. A basic resource is the book The New Ourselves, Growing Older (Reider, 1994) or , for younger women, The New Our Bodies, Ourselves. Both of these books are readily available in bookstores and libraries. They contain current reading lists, as well as the names and addresses of support organizations.
Reider (1994) offered the following suggestions to the woman who has already had a hysterectomy:
1. Give yourself time to grieve your loss. Use your anger to help other women.
"I'm afraid that the American way of hysterectomy tells us a lot more about doctors than it does about disease," stated West (1994). "The surprisingly outdated attitudes doctors harbor toward female patients are a big part of the problem. Some very old-fashioned views remain embedded in medical training. It may take a few more decades and more medical consumerism on the part of women before the old attitudes give way to a more rational and scientific basis for hysterectomy" (pp. 17-18).
Take charge of your body. Accept responsibility for your health choices. Become an educated medical consumer. Said Cutler (1988):
[P]eople who feel helpless do not have strong immune systems, and a new scientific field called psychoimmunology is forming. Taking action--that is, taking control of your life--is likely to build your sense of empowerment and to enhance your immune strength.
A Spiritual View
In natural menopause, body changes are gradual. The climacteric, the period during which a woman's body begins changes in anticipation of menopause, begins around age 35, and continues till menopause (the last menstrual bleeding) at around age 50. There is a gradual and progressive physical change, both before and after the actual menopause, that prepares a woman physically and emotionally for the new life after the childbearing years. Surgical menopause leaps the chasm of the years yet to be lived to menopause, catapulting a woman into a foreign physical and emotional state, one that she would normally take many years for which to prepare herself. As can be seen from the information presented here, even post-menopausal amputation of the uterus has profound effects. But, as Cutler said, "Because the life of the spirit is not the subject of scientific research, there are no data to guide us" (Cutler 1988, p. 114).
On a strictly anecdotal basis, I have observed that the period of "depression" that follows hysterectomy is frequently marked by psychological crisis and spiritual growth. The depression frequently takes the form of deep contemplation. One woman, in her mid thirties, reported a kundalini-rising experience that shocked her system and left a circle of white hair at her crown. Another, in her early thirties, began having dreams that unearthed repressed memories of early childhood abuse.
Studies on natural menopause have found that, though atrophied, the uterus and ovaries continue to function for about 25 years after menopause. A woman's hormonal status, with accompanying body changes, rapidly transforms for the first two years after menopause, then remains unchanged until age 75. A change at this stage of life suggests that the entire process of preparation for the spiritual tasks of age is not complete until age 75.
A young man of my acquaintance, who has spent much time in spiritual reflection over the past 11 years since learning of his HIV-positive status, shared with me his theory of the uterus as the container of the soul. When the uterus is gone, the soul has to stretch, leave its safe container, and grow to fill its new, larger container--the entire body. This theory makes even more intriguing a line from Alice Walker's (1992) Possessing the Secret of Joy: "I have the uncanny feeling that, just at the end of my life, I am beginning to reinhabit completely the body I long ago left" (p. 108).
Let's imagine, for a moment, that the soul does inhabit the uterus. Now imagine a woman in her thirties, barely into her climacteric (or not quite there) undergoing amputation of her uterus. The 40-year process intended by nature, extending from the beginning of the climacteric at age 35 to the final hormonal changes at age 75, has been drastically accelerated--the soul has been forced to premature birth.
My experience, and the experiences of other women recounted here, of a posthysterectomy grief related to loss of childbearing ability (even when it made no logical sense) supports the idea of spiritual prematurity. It is a time of great challenge, psychologically and spiritually.
This notion of housing the soul in the uterus creates challenging thoughts concerning life tasks. Women would not be free to pursue their spiritual path until the uterus transforms. That nature attached a mothering instinct to the uterus to aid us in completing our early tasks is not beyond reason. The intensity of loss felt by women at hysterectomy suggests the uterus contains special qualities of life that are poorly understood, both scientifically and spiritually.
Barbara Hand Clow (1991) in Liquid Light of Sex suggested that men and women do not proceed to their spiritual path until reproductive and building functions have been completed. Clow, descendant of Cherokee Indians, has combined astrology, kundalini energy, and Native American teachings to formulate her theories of life passages toward a spiritual goal.
Susun Weed, author of Menopausal Years, The Wise Woman Way, described a woman's progression through climacteric and menopause as a rising of kundalini energy, and she described the uterus as a holder of the heat of the kundalini. "Women recycle this energy throughout their lives in childbirth and menstruation," said Weed in an interview. "When menopause occurs, the energy is redirected" (Peyser 1994, p. 25). Weed attributed hot flashes to rising kundalini energy, and she described the process as "crone-ing" (Peyser 1994, p. 26).
One theory that I have pondered is that body, mind, and soul represent three cycles, naturally progressing, in parallel fashion and in harmony, throughout life. Disharmony results when one of these cycles is disturbed, yet the others sing on. Removing the uterus disrupts a natural body cycle, throwing it out of tune with mind and soul cycles. Until the latter catch up, the woman bereft of uterus will inevitably pay the price of singing off key.
The Big Picture
A discussion of spirituality would be incomplete without looking at The Big Picture--the meaning of events in relation to the spiritual progresson of the group soul of humankind. Assuming that there is purpose in all things, what could be the purpose of millions of women living most of their adult lives without a uterus?
Weed stated that a record number of women will be reaching menopause at the millennium. When a woman reaches menopause, Weed said, "The hot flash takes that hot energy from the uterus and moves it up from the root chakra, up through the spine, through every energy center of the body and out the crown, where it then circulates back into the earth. . . . During menopause, a woman can learn through hot flashes and other means, to change the link between herself and the earth" (Peyser 1994, p. 26). Weed saw the large number of women coming to menopause at this particular point in history as a force to heal the earth.
But why would so many women be coming into their time of menopause without a uterus? Hysterectomy has not been a part of any traditional culture. We have no spiritual heritage from which to draw to understand this phenomenon.
Some prophets of the millennium predict a transmutation of the human race--the ascension to a totally new species. Could the removal of uteri be a movement toward androgyny?
There is also the perception that time and the events it contains are speeding up. Children are being born with different nervous systems--nervous systems that can adapt easily to the speed of change. Could mass hysterectomy be the means to create a body of women who must spiritually mature before their time in order to be prepared for coming changes?
There is still very little known about the uterus. "We are only beginning to identify and do not yet fully understand the many ways these organs affect our health and our sexuality," stated Reider (1994, p. 315).
Perhaps if, as the dictionary, we think of our uteri as wombs, we will be reminded of the respect that this uniquely female organ deserves. It really doesn't make any difference what came first--the disrespect or the separation of the word from its right-brained meaning. Clearly the importance of the uterus is making itself known through the painful experiences of millions of women who have gone through hysterectomy.
"The uterus plays a powerful role in keeping the ovaries working," said Cutler (1988, p. 8). Despite the current emphasis on the ovaries, we may be ignoring a hidden power--the real power behind the throne of the ovaries.
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Clow, B. H. (1992). Liquid light of sex: Understanding your key life passages. Santa Fe, NM: Bear & Company, Inc.
Cutler, W. B. (1988). Hysterectomy: Before & after. New York: Harper & Row.
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Peyser, R. (1994, November). Susun Weed, author of Menopausal Years, The Wise Woman Way: An interview with Randy Peyser, Heart Dance (p. 24-25).
Reider, D. K. (1994). Chapter 22: Hysterectomy and oophorectomy. In P. B. Doress-Worters & D. L. Siegal (Eds.), Ourselves, Growing Older: Women Aging with Knowledge and Power (pp. 315-322). New York: Simon & Schuster Inc.
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