Another Canadian study showed that there was a five-fold variation in hysterectomy rates across hospital areas in one province. The highest rate occurred when the woman's primary doctor was a gynecologist or surgeon, as compared to a general practitioner or internist.

Unnecessary Hysterectomies

As you may have guessed by now, there are a lot of unnecessary hysterectomies being done. In fact, several studies estimate that between 30 and 50 percent of hysterectomies performed are clearly unnecessary. Another ten to 20 percent could be possibly avoided by using alternative approaches.

Educating yourself about hysterectomies is the best protection. A recent European study showed that rates of hysterectomy fell 25 percent after there was a program to educate the community about hysterectomy compared to a one percent increase in another town where no information was given to the public.

Myths About Hysterectomy

• If your ovaries are left in, your hormone levels are not affected.

In the words of Californian gynecologist, Dr. Vicki Hufnagel, "In more than a third of the cases the ovaries simply die following hysterectomy and menopausal symptoms ensue." It appears that the blood supply to the ovary may be damaged during the surgery (No More Hysterectomies, 1988).

Unfortunately, doctors may dismiss real symptoms of menopause (such as hot flashes, menstrual irregularities, vaginal dryness, depression, irritability, and mood swings) as being psychological in origin, since the ovaries are still in place, and therefore miss the diagnosis altogether.

Dr. Winnifred Cutler says that on the average, premenopausal women who lose their uterus but still have their ovaries go into menopause five years earlier than women who keep their uterus. She estimates that 50 percent of women who had their uteruses out with ovaries left in will eventually suffer from a premature lack of ovarian hormones. However, this effect may not show up until two years after surgery (Hysterectomy, Before and After, 1988).

"Following hysterectomy," says Janine O'Leary Cobb (A Friend Indeed, Feb/92), "ovaries may produce estrogen at levels ranging from adequate to nil. In some cases, ovaries may falter for weeks or months and then rally to produce enough estrogen. In a significant proportion of cases, ovarian functions gradually ebbs and menopausal symptoms ensue."

On a practical level, earlier menopause means earlier aging, increased risk of bone loss, and risk of coronary heart disease. Dr. Cutler concluded that "hysterectomy, with or without the ovaries removed, increases the risk of atherosclerosis and coronary heart disease three to seven-fold over age matched women who have not had the surgery."

• There will be no change in your sex life.

One thing is certain, there will be a change in your experience of sex. Some women find their sex life improved due to lack of pain, bleeding or fear of pregnancy. However, many more women find their sex life altered in a negative way.

Orgasm can result from stimulation of the clitoris or uterus or both. Pressure on the cervix, uterus and its surrounding ligaments and membranes causes highly pleasurable sensations. This is known as the uterine orgasm, and is not possible to achieve after hysterectomy. For women whose orgasms center in the deep uterine contractions produced during that type of orgasm, this loss may be great indeed. Some women experience primarily clitoral orgasms and these women may not notice too much difference in their experience of orgasm after hysterectomy.

If the ovaries fail or have been removed, you may lack the androgen hormones (male type hormones naturally found in a woman's body) 50 percent of which are produced by the ovaries and which are necessary for sexual responsiveness and sexual drive. Dr. Barbara Sherwin, Associate Professor of Psychology at McGill University in Montreal, has been researching the relationship of sexual drive to the level of testosterone for 15 years. She believes that testosterone is the androgen hormone necessary for sexual motivation.