Hysterectomy and Female Castration: the Enablers Part III

Emory University Hospital, Atlanta, Georgia

This is the third part in a series of Posts to highlight omissions of fact and misinformation about hysterectomy currently being provided to women on hospital, doctor, and medical school websites.

In Part I of this series we investigated some of the errors, omissions, and contradictions on the University of Pittsburgh Medical Center’s (UPMC) website. To read Part I (and comments from women around the country) click here. And in Part II we highlighted the seriously deficient online patient education product known as “X-Plain” at Gundersen Lutheran Medical Center in La Crosse, Wisconsin. To read Part II click here.
Part III of this series highlights Emory University Hospital’s website. As you will see, Emory provides little of the basic information that women need in order to make informed decisions about hysterectomy, while directing them to visit other websites that contain gross misinformation that is potentially damaging to women.

This is a frightening trend in hospital websites all over the country. Hospitals and doctors point their patients to some other source of hysterectomy misinformation (such as the Patient Education Institute’s product X-Plain, obgyn.net, or acog.org), thereby washing their hands of accountability for omitting the requisite information for hysterectomy informed consent on their own websites. The stated purpose of these sites is to provide information to women who’ve been told they need the surgery, but they don’t inform them of the consequences that women need to know. Instead of providing correct information, they potentially put women into harm’s way.

“The Emory Department of Gynecology and Obstetrics,” they tell visitors, “is dedicated to providing health information and education to women in the Atlanta community, the region and the nation.” But we couldn’t find any hysterectomy patient education materials on their website that educate women about the consequences of hysterectomy—the most common non-obstetric surgery performed in the United States. The “.edu” suffix on their website URL indicates that Emory is in fact an educational institution, so what better place for them to do so than right on their own hospital website where they make the claim?

The reason we selected Emory, Gundersen, and UPMC as the three hospital websites to be investigated isn’t because they’re the only hospitals providing misinformation and omissions of fact. On the contrary, they were chosen because these three websites are typical of patient education information published on hospital websites throughout the country.

In the top right corner of the Emory University Hospital home page (http://www.emoryhealthcare.org/departments/), click on “SEARCH.” Type in the search term “hysterectomy” and then click on “search now.” You’re taken to a page with a long list of press releases and articles.

The first press release we came to on the list was dated June 2, 2004. It goes into great detail about how “vaginal hysterectomies are more advantageous” than abdominal hysterectomies without any reference to the consequences of removing the female organs. What they don’t mention is that many of the most devastating adverse effects are the same no matter how the uterus is removed. Click here to watch “Female Anatomy: the Functions of the Female Organs” for information that every doctor and hospital should provide to every woman who is told she needs a hysterectomy.

The next link on the list takes visitors to an online article titled Uterine Fibroid Embolization (UFE). Even the title of this article is misleading. First, it’s not the fibroid that’s occluded with embolic material, it’s the uterine artery. It’s convenient for doctors and hospitals to refer to it as UFE, because Uterine Artery Embolization (UAE) alerts and alarms women that something is being injected into the artery—their vascular system. The reason doctors began calling it UFE is to make it sound more benign than UAE. They don’t tell women that the embolic material injected into the uterine artery has been found to migrate to the ovaries, uterus, lungs, and other vital organs. For this reason UAE should be contraindicated for women who want to have children. When the embolic material and/or radiation causes the ovaries to cease to function, it results in a de facto castration.

Second, it’s odd that an article that seems to want to educate women about “What are uterine fibroids?” falls under the title of one of the most dangerous treatment options. Women might expect that the patient education materials of a teaching hospital would label this section “What are fibroids?” with UAE mentioned only as a treatment option with serious potential adverse effects, including death, loss of ovarian function, necrosis (death of the tissue) of the vagina, labia, bladder, bowel, and kidney.

Further obscuring the facts, Emory tells visitors, “Symptomatic uterine fibroids trigger approximately 150,000 hysterectomies each year.” In fact it’s the fear that doctors instill in women regarding benign conditions such as fibroids, along with misinformation about treatment options, that “triggers” hysterectomies. The number of hysterectomies performed for fibroids each year in this country is more like 400,000, but fibroids can’t pull the trigger on hysterectomies. Only doctors can pull that trigger.

Finally, the only reference to hysterectomy in the UAE article is one that uses language reminiscent of the U.S. Army’s recruitment theme—Emory claims that their “goal is to help you to live the best as you can be.” We would no more recommend that you search for all that you can be on an operating table than on a battlefield. The best that you can be is whole and intact, far away from anyone who wants to damage or remove your sex organs.

Emory offers other online articles that focus on endometriosis and gynecological services, but none of them discusses the well-documented consequences of hysterectomy.

Back on the home page, if you click on “Departments” and then scroll down to the bottom right and click on “Gynecology & Obstetrics” under the subheading “Women’s Health Services,” you’re taken to a page titled “Emory Women’s Care.” On this page you’ll find the following ad:

It’s cruel irony that a website that women come to because they were told they need a surgery to remove their female organs (which they will have to pay for), are confronted with an ad offering to pay them to allow a doctor to extract their eggs. Rather than provide visitors with information about the adverse effects of the most commonly performed non-obstetric surgery in America and the fact that the ovaries will be removed from 73% of those women, they choose to give space to advertising their egg “donor” program. And here the medical euphemisms continue, because it’s nothing like a donation.

Women are paid a lot of money for their eggs because the process is invasive, risky, and often very painful. To stimulate egg production, women are given dangerous drugs to hyper-stimulate their ovaries. The side effects of the drugs range from thinning of the bones to cognitive loss. And once the ovaries are hyper-stimulated to produce an abnormal quantity of eggs, the hyper-stimulation sometimes continues after women stop taking the drugs. The result is that the drug-induced hyper-stimulation puts a woman at risk for ovarian cancer. Cancer of the female reproductive sex organs is one of the main scare tactics that doctors use to get women onto operating tables. And it’s one of the main reasons why women seek out websites like Emory’s only to be bombarded with advertisements for quick money. If women answer this ad they’ll be subjected to a procedure that will increase their risk of ovarian cancer.

People don’t get paid to donate. It’s not a contribution, it’s a business transaction, and the product is women’s eggs. It’s objectionable to disguise it as such…especially when Emory fails to provide the one thing they claim to make available to women—patient education. Why not simply ask visitors, “Are your eggs for sale? If so, we’d like to buy them. And we’re willing to pay a handsome price because it’s a frightening, painful, and potentially fatal procedure for both you and the woman who your eggs will be later injected into.”

For women who are about to have (or have had) the door shut on the option of having children, it’s extremely insensitive to advertise the hope of pregnancy and childbirth on a site where women seek information about hysterectomy.

As we said, this investigation into Emory’s website is Part III of a series. What was remarkable about Part I was that the University of Pittsburgh Medical Center (UPMC) website contained glaring contradictions. Although we informed them of numerous anatomical errors on their website, and although UPMC did drop one of their hysterectomy pages to eliminate the most glaring contradictions, they continue to provide potentially damaging information to women. What was remarkable in Part II of the series was the Gundersen-Lutheran Hospital’s patient education tutorial called X-Plain. X-Plain requires women to answer questions falsely in order to proceed through their error-riddled tutorial. They have ignored letters from HERS informing them of their misleading information, but they continue to misinform women with the same potentially damaging information. And now what stands out to us in Part III is that Emory claims to provide information about hysterectomy but actually provides almost none at all. What’s remarkable isn’t the startling misinformation we found on the other two hospital websites, but the extent to which Emory promotes invasive procedures while directing visitors to look elsewhere for facts that they obviously have no intention of providing to women on their own website that gushes with recommendations for surgery.

On that same Emory Women’s Care page mentioned above, there’s a list of options on the left. If you click on the fifth one titled Patient Education you’re taken to a page that claims that they provide health information, but you won’t find any information about hysterectomy, in spite of the fact that it’s called Patient Education. On the bottom of that page, visitors are given three options for information about hysterectomy:
1. the American College of Obstetricians and Gynecologists
2. the Universe of Women’s Health
3. a phone number at Emory

1. The American College of Obstetricians and Gynecologists’ website (www.acog.org) sounds reliable enough, but what do visitors to Emory’s website find if they follow the link and are redirected there? Researching ACOG’s site for hysterectomy revealed a list of links to printed “educational” materials. The first one is “Understanding Hysterectomy.” It can be purchased from the ACOG website, but the minimum order is 50…with a discount for ACOG members. Click on the link and it takes you to this brief summary:

“Understanding Hysterectomy Description"
"Hysterectomy—removal of the uterus—is a way of treating problems that affect the uterus. Many conditions can be cured with hysterectomy. Because it is major surgery, your doctor may suggest trying other treatments first. For conditions that have not responded to other treatments, a hysterectomy may be the best choice. It depends on the effect of the condition and the surgery on your life. You should be fully informed of all options before you decide."

"This pamphlet explains:
* Reasons for having a hysterectomy
* Ways hysterectomy is performed
* Risks of hysterectomy
* Recovery after surgery”

Although they may refer to women when saying “you decide,” ACOG offers almost no information to women about the lifelong consequences of hysterectomy on their website, which may leave you wondering why “college” is part of this organization’s name. In fact, their own website demonstrates that if ACOG is a college it’s a scalpel school with members who get rich by removing female organs.

2. The second option—the Universe of Women's Health—takes visitors to www.obgyn.net. At the bottom of each page of this website you’ll find pro-hysterectomy Google ads. On the “Select a Topic” drop-down menu on OBGYN.net there are three hysterectomy topics. First is the Hysterectomy Resource Center. Here, the pelvic anatomy lesson offered says:

"The uterus, sometimes called the womb, is a muscular organ located in the pelvis. It is approximately the size and shape of a pear. This is where a fetus is carried during pregnancy."

It doesn’t mention that the uterus is a hormone-responsive sex organ that supports the bladder and the bowel or that women who experienced uterine orgasm before the surgery won’t experience it after the uterus is removed. If they did mention those facts and the many other functions of the uterus then women would know that there’s a lot more to lose than the ability to become pregnant. But OBGYN.net, apparently, views the uterus as nothing but a pear-shaped baby bag.

The “Indications” link invites visitors to a page with a video to learn about the different types of hysterectomy. At the bottom of the page visitors are reassured that they’ll be in good company if they have their sex organs removed. They seem determined to make a surgery that is very damaging sound like a walk in the park—nothing to it. There is sometimes safety in numbers, but to suggest that women can feel good about hysterectomy and castration because that’s what OB/GYNs have been promoting to countless other women for years is appalling:

"It is important to remember that you are not alone. In the U.S.there are over 600,000 hysterectomies performed each year, about 1,643 a day. In fact, by the age of 60, 1 in 3 women will have had a hysterectomy. You may be feeling anxious, but remember that there are 599,999 other women this year who will feel like you. In addition, you can take comfort in knowing that recent medical advances have made this common procedure much less invasive."

Less invasive? No matter how it’s done, they’re removing female sex organs. There’s nothing non-invasive about it.

They then invite visitors to click on the link “What is a hysterectomy?” where they say:

"A hysterectomy is an operation to remove a woman’s uterus. Depending on the surgical approach and the woman’s symptoms, the ovaries, fallopian tubes and/or cervix may be removed as well. You should discuss with your physician what will be removed."

Whether the ovaries are removed or not shouldn’t depend upon the surgical approach or symptoms. A symptom isn’t a disease. OBGYN.net is a potentially dangerous website that lures women in by holding themselves out as a reliable source, but then they don’t provide the information that women need to make a decision about their own bodies. And once again removal of the ovaries is made to sound as trivial as a doctor’s whim, when in fact the ovaries are the female gonads and their removal is castration, the same as removal of the testicles is castration. The ovaries produce hormones all of a woman’s life. There’s no age or time in any person’s life when the gonads aren’t needed. It’s unconscionable that this website doesn’t mention those vital facts.

There’s also a subheading called “Conditions that may require a hysterectomy.” They then provide a list of “conditions” that should never require a hysterectomy. In fact, a hysterectomy is never required. If it was required that would mean that you have no choice, that it will be done to you whether or not you agree to it. But even if you have cancer it’s your right to say no to surgery. You have the right to refuse consent.

The link to “Patients stories” directs visitors to a blank page. This may be the best link of all, because on OBGYN.net no news about hysterectomy is good news. And the link to “Patient Brochures” has one brochure, and it’s about Laparsocopic Supracervical Hysterectomy. No helpful information there either.

There was no information about the devastating, predictable, lifelong adverse effects of hysterectomy. Many of the links funneled visitors toward the MedlinePlus website. Visit http://hersfoundation.org/docs/Medline-press-release.pdf to read the HERS Foundation’s press release titled “Medline Plus a Minus for Women.” MedlinePlus (a “service” of the National Library of Medicine) also points visitors to X-Plain which, as we have said, is rife with misinformation that is largely unsupported by anatomical fact.

OBGYN.net has far too many errors and omissions of fact to mention them all in this blog, but suffice to say that the OB/GYNs who wrote it have created a landmine of misinformation at best…which shouldn’t be surprising, because hysterectomy is the goldmine of gynecology.

3. The last option for visitors to Emory’s website who are looking for hysterectomy information is their suggestion to “please call” 404-778-7777. So HERS president, Nora W. Coffey did just that. In fact, Nora made three separate calls, during which she took detailed, verbatim notes.

The first call was made on March 20, 2008. A nurse answered the phone, but she seemed confused by simple questions like, “Can a woman have a uterine orgasm without a uterus?” The RN then put Nora on hold for several minutes so she could get some literature on the subject. When she returned, she read Nora the information that she had found on hysterectomy.

As the nurse read the hysterectomy information to Nora, it sounded oddly familiar. Some of the language she was using was uniquely HERS—it was coined at the HERS Foundation. For example, she referred to the uterus as “hormone-responsive” and referred to women who had undergone the surgery as “hysterectomized,” a verbalization of “hysterectomy” that was coined at HERS to describe the fact that women don’t get a hysterectomy the way that they get their nails done—they’re hysterectomized by doctors. Fortunately she spoke haltingly and slowly, so Nora was able to type up every word that the nurse said. This is verbatim from the nurse:

"The uterus is a hormone-responsive reproductive sex organ, and the ovaries produce the majority of estrogen and progesterone that is available in genetic females of reproductive age. According to the National Center for Health Statistics, of the 617,000 hysterectomies performed in 2004, 73% also involved the surgical removal of the ovaries. In the United States, 1/3 of genetic females can be expected to have a hysterectomy by age 60. There are currently an estimate of 22 million people in the United States who have undergone this procedure."

Most of this information is actually correct, but it slowly began to dawn on Nora where the nurse was getting this information from—Wikipedia.

Wikipedia is an encyclopedic website that is “written collaboratively by volunteers from all around the world.” They have an entry for hysterectomy, and because some other “volunteer” was supplying Wikipedia with erroneous hysterectomy information that was unsupported by anatomical fact and medical literature, Nora edited the hysterectomy entry to get as much correct information on there as the Wikipedia moderators would allow. But why was this Emory nurse, a medical professional from a teaching hospital, responding to a request for patient education information by reading from Wikipedia? It’s baffling, really. Although Wikipedia does offer some accurate information, it’s by no means a reliable source of information for anyone seeking medical advice. Even still, women who call Emory are ostensibly very likely to get information that is no more reliable than an online encyclopedia written by volunteers from around the world who may or may not know what they’re talking about.

And then, in one of her concluding comments about the impact of hysterectomy on female sexual pleasure, the nurse told Nora verbatim, “But um, uh, it’s always like in a non-medical way that I’ve always heard it’s like taking away the baby carriage but leaving the playpen.”

It’s a common refrain that women have told HERS they’ve been hearing from gynecologists all over the country for more than 50 years—“Don’t worry, I’m going to take out the crib, but I’ll leave the playpen.” In other words, you won’t be able to have children, and you won’t be able to have uterine orgasms, but a pouch will still exist for your husband to insert his penis. Thanks, Emory.

Before the end of the conversation Nora asked the nurse to send her the information that she was reading from. Two days later HERS received a package in the mail from the nurse patient-educator at Emory HealthConnection—it was a 7-page printout with the Wikipedia URL on the top and on the bottom of each page. She merely printed out Wikipedia’s hysterectomy web entry and added nothing else.

The next day Nora made her second call to the number listed under Emory’s Patient Education banner. Again she spoke with a nurse who Nora asked a few simple questions. And again the nurse seemed confused by Nora’s questions and put her on hold.

When the nurse returned she said, “Thank you for being so patient. I was just talking with Paula my supervisor and there is a certain area that I can go into and mail you information about the hysterectomy.”

“Okay,” Nora said, “but you can’t give me any information?”

“Well, it’s just that there’s so much information on it we really don’t have the time to be talking all about it. You see what I mean? We’d be on the phone for the next hour.”

“Really?”

This was a curious comment for a “health professional” to make, considering the fact that the HERS Foundation developed an anatomy lesson that is the minimum information a woman needs to make an informed decision about hysterectomy…and that video lesson is only 11 minutes and 45 seconds. The nurse then took the mailing address, after which Nora said, “But I’m disappointed that Patient Education can’t give me any information on the phone.”

The nurse’s response was a very disappointing, “Okay,” followed by, “What I’m going to give you right now is…let’s see. I’m going to ask you exactly what you would like.”

So Nora repeated her request: “I would like to know what the effects of hysterectomy are.”

Instead of Nora, the caller of course could’ve been any woman faced with the decision of whether or not to have surgery. The fact that the nurse asked Nora what she would like to know is baffling. After all, how does the patient know what they need to know? It’s like a woman asking a doctor, “Would you please tell me what the consequences of hysterectomy are?” and the doctor responding, “Okay, what would you like to know?” What’s obvious from these calls is that women need to know the answers to their questions before they ask them, which renders this Emory’s patient education meaningless at best…and potentially very harmful.

The nurse then repeated herself, saying, “There’s just so much information here,” but she never did talk about the consequences of hysterectomy. The best she could do was to define “abdominal hysterectomy” as a hysterectomy where the uterus is pulled out through the abdomen, and other self-evident information. She then said, “Okay?” as if that was all the information she had for Nora and she was prepared to end the conversation there.

As any woman seeking information from a teaching hospital might, Nora grew frustrated. She said to the nurse, “But we really didn’t talk about the consequences of the surgery!”

The nurse’s response? “Uh hm….”

Undaunted, Nora asked, “Are there any changes…are there any sexual changes…are there any other changes that are pretty common?”

“Well,” the nurse said, “I’ll be honest with you. If it was me having this surgery, I’d be talking with my doctor... A hysterectomy…takes care of any problems you may be having with your uterus… Truly it’s the surgeon’s responsibility to give you informed consent about what is going on with your surgery.”

Sure, but she’s a nurse taking calls on a number listed under patient education. So Nora said, “You know I didn’t get very many answers to my questions, which is why I looked on the website to see if you have patient education and this is the number on Emory’s gynecology website page.”

The nurse said only, “Yeah? Can you hold one second please?”

While Nora was on hold, she was subjected to ads for other treatments being advertised by Emory. Like most hospitals, Emory is about making people feel good about the drugs and treatments and surgeries they offer.

Finally the nurse returned. She explained to Nora that all women are unique, so she should talk with her doctor. Amazed that this final option on Emory’s website turned out to also be a dead end, Nora asked why, if they don’t have any information, Emory provides this number for Patient Education?

“Well,” the nurse said, “I do have information here that I’m going to mail off to you.”

About a week later Nora called the HealthcareConnection again.

The person who answered said, “Thanks for calling Emory HealthcareConnection, this is Helen, how may I help you?”

“Hi,” Nora said, “is this your patient education department?”

“Yeah…no…this is actually a doctor referral line?”

Now this was an interesting development—Nora had called twice before and was told that she had called the Patient Education number and that it was staffed by nurses. In each of those calls a nurse struggled to answer Nora’s questions, and now a week later this?

“Okay,” Nora said, “so are you aware that on the Gynecology and Obstetrics website for Emory they give this number for Patient Education?”

“Well, we answer a lot of things here,” the nurse said. “What were you trying to do under patient education?”

Nora was very soon placed on hold again. While on hold Nora listened to an ad for a free educational seminar on the effective non-surgical treatment of uterine fibroids. In other words, it’s a free opportunity for women to be told about the profitable treatment known as UAE, but none of the patient education options available to women would even mention the adverse effects of any of these treatments that have been well-documented in medical literature.

In the first two calls the nurses acknowledged that they knew that they were answering a Patient Education phone line, but now when this nurse returned to the phone she told Nora, “Well, see, we do a lot of the seminars as far as registering people who want to attend the seminars at Emory.” Then she said that health information isn’t really what they do, but, “We have information in our database where we can pull up the health library and under MedlinePlus…we can type in hysterectomies, but if women want printed information,” she said, “you know it would have to be printed off of there… Well, I mean that’s all we have to offer, apparently.” She then elaborated to say, “We’re actually under marketing… The department I’m with is the Emory HealthConnection.”

We are well aware of the fact that they heavily market their surgeries and procedures, but but Emory’s website says:

"Emory HealthConnection serves as your vehicle to access the world of knowledge and expert care encompassed within the many components of EMORY HEALTHCARE. The Emory HealthConnection staff includes registered nurses and consultation representatives who have a library of information at their fingertips and can provide you with the latest information on the services provided by EMORY HEALTHCARE."

A “world of knowledge,” they claim? The worldwide web, maybe, but you don’t need Emory’s help to wander around that endless landmine of misinformation. “Library of information,” they say? Their nurses and patient education materials couldn’t answer one simple question from Nora.

If you have undergone a hysterectomy at Emory or their affiliated hospitals after relying on information from X-Plain, contact HERS at hersfdn@earthlink.net.

Hysterectomy and Castration: the Enablers

Hysterectomy and Female Castration: Who are the enablers?
Part I—University of Pittsburgh Medical Center

*** ANNOUNCEMENT ***
Part I of this series was posted on January 1, 2008. Regarding the information below, HERS acknowledges that on or before February 6, 2008 UPMC deactivated the link to the “Hysterectomy” and “Preparing for a Hysterectomy” sections of their Patient Education Materials, thereby eliminating contradictions with the “Hysterectomy” section of their Procedures materials, which remains active.


One of the most frequently asked questions at HERS is, “How do doctors get away with removing the female organs from more than 600,000 American women each year without informing them of the consequences?” The answer is complex, but the responsibility largely falls on doctors, medical schools, and hospitals. One hand washes the other in the 17 billion dollar a year hysterectomy industry built on the profits made from removing the sex organs from more than 22 million American women alive today.

The internet is a minefield of both helpful and harmful information on any topic, including hysterectomy and female castration. The fact that the University of Pittsburgh Medical Center (UPMC) publishes contradictory statements, for example, is easily demonstrated by comparing the information provided on their own website. As you will see, on the one hand UPMC claims that sexual intercourse isn’t affected by hysterectomy and that sex may even be improved by the removal of a sex organ, but on the other hand they say that the uterine contractions associated with orgasm aren’t possible when the uterus is removed. Both statements can’t be true. Therefore, the untrue information is contradictory and potentially dangerous.

We would rather believe that no hospital would put its name on contradictory medical information. But it’s irrefutable when, in their own words, UPMC publishes potentially dangerous information about the functions of the female organs. UPMC’s own website provides the proof that the information about hysterectomy is unreliable.

No matter how smart and savvy a woman is, if she isn’t accurately informed about the functions of the female organs before she sets foot in a doctor’s office she won’t be able to evaluate the validity of the information that a doctor or hospital gives her. Medical schools institutionalize and sanction an educational environment that uses advertising to attract customers to hospitals that provide professors and students with the live bodies of women to practice on. Teaching hospitals and large corporate hospital chains alike provide the equipment, staff, and facilities to implement hysterectomies on women. If those women rely on UPMC’s online “Patient Education Materials,” they may be misinformed of the aftermath of the removal of the uterus and/or ovaries. Medical schools, doctors, and hospitals who hold themselves out as experts form a circle of power that has a unique responsibility to provide accurate information about hysterectomy. That circle of power, however, often obscures information, omits facts, and reinforces harmful myths about hysterectomy.

This is the first of several posts that will highlight omissions of fact and misinformation about hysterectomy currently being provided to women on the websites of doctors, medical schools, and hospitals. As UPMC’s website (http://www.upmc.com/home.htm) demonstrates, the degree of accuracy of the information you will receive about hysterectomy depends in part on how you search their website, which is the reason why the following is broken into two sections.
_____________________________

Section A:

From the UPMC home page, if you click on “Health A-Z” a list pops up on the left side of your screen. Under “Personal Health,” if you click on “Women” it takes you to the “Health Library.” Next, click on “UPMC Patient Education Materials” then “Women’s Health.” Finally, from the bottom of that long list select “What is a hysterectomy?” Or, after you click on “Women” from the “Personal Health” section, you can find it by clicking on “Health Reference,” then “UPMC Patient Education Materials,” then “Women’s Health,” then “What is a hysterectomy?” The “What is a hysterectomy?” link takes you to http://patienteducation.upmc.com/Pdf/Hysterectomy.pdf . The following excerpts were taken from that web page on 1/1/08.

UPMC begins by defining three types. “Partial hysterectomy,” they tell us, “is the removal of the top part of the uterus (the fundus uteri), leaving the lower part of the uterus (the cervix) in place.”

HERS comment: If they said, “Partial hysterectomy involves severing the nerves, ligaments, and blood supply that attach to the body of the uterus, leaving the cervical stump,” then it would alert the reader immediately that this is a major surgery resulting in far-reaching anatomical and functional changes.

They also tell us, “A hysterectomy does not include the removal of the fallopian tubes and ovaries. Your doctor may recommend that these organs be removed at the same time,
depending on your age and the condition of the organs. Your doctor will talk with you about this.”

HERS comment: In order for UPMC to provide accurate information to women about female anatomy, they could say, “Your doctor may also recommend the removal of your ovaries. Just as the testicles are the male gonads, the ovaries are the female gonads. Removal of the gonads is castration.” If they said that, then women would understand that the removal of the ovaries is life-altering. UPMC implies that age is a disease. The gonads in both women and men continue to function throughout the human lifespan, and age is never a justification for removal of the ovaries. Women who understood this would be unlikely to consent to castration. It’s important for women to be informed of the correct medical terminology and consequences.

In the section titled “Removal of the ovaries,” the UPMC website tells women, “In general, ovaries are removed only if there is a problem with them. Two factors in this decision are a woman’s age and another is whether she has gone through menopause. In women who have not gone through menopause, the ovaries are important… The ovaries stop working after menopause, so they may be removed during hysterectomy in women who have completed or are close to menopause. Removing the ovaries reduces the risk of ovarian cancer, which is difficult to detect in its early stages. When a woman who has not completed menopause has both ovaries removed during hysterectomy, a condition called ‘surgical menopause’ occurs. Women who experience surgical menopause may have the same symptoms as those who have had natural menopause. These include hot flashes, night sweats, and shrinkage of vaginal tissue.”

HERS comment: This section begins with a contradiction. Whereas in the introduction to “What is a Hysterectomy?” we’re told, “Your doctor may recommend that these organs be removed at the same time, depending on your age…” this section says, “In general, ovaries are removed only if there is a problem with them.” So which is it? Do they mean to say that age is a disease or that the ovaries should only be removed if they are diseased? It can’t be both.

UPMC states that the ovaries “stop working after menopause,” although it’s well documented in medical literature that the ovaries continue to function in post-menopausal women. The ovaries are “important” to a woman’s health and wellbeing all of her life.

UPMC goes on to tell women that ovarian cancer is difficult to detect. But they fail to mention that the incidence of ovarian cancer is less than .01% of the population at risk and is listed by the National Institutes of Health as a “rare disease.”

Finally, UPMC also fails to use the word “castration,” which is the medically correct term for removal of the ovaries. Instead they use the euphemistic oxymoron “surgical menopause.” It is in fact impossible for a woman to become surgically menopausal. A menopausal woman has functioning, hormone-producing ovaries in her body. A woman whose ovaries have been removed doesn’t have the benefit of the natural hormones and other substances produced by her gonads. There is no comparison between castration and menopause, and the functions of the ovaries can’t be replaced.

Under the heading “Physical changes after hysterectomy,” UPMC states, “Unless extensive surgery is performed, the vagina remains the same after a hysterectomy. Once healing has occurred, the vagina will continue to function normally. Sexual inter-course [sic] is not affected by a hysterectomy.”

HERS comment: A majority of all hysterectomies are “total,” where the top of the vagina is cut into around the cervix in order to remove the uterus. After the surgeon removes the cervix, the vagina is then made into a closed pocket. The surgeon does this by pulling the walls of the vagina together to close the hole created in the top of the vagina and suturing it back together. Also, much in the same way that a seam created by sewing fabric together results in diminishing the pre-sewn size of the cloth, in addition to filling in the hole where the cervix had been the surgeon shortens the vagina when the seam at the top of the vagina is created by suturing it shut. Therefore, the vagina is altered in depth, shape, and elasticity.

And for those women who experienced uterine orgasm before the surgery, they won’t experience it ever again without their uterus. It would be informative for UPMC to explain how “sexual inter-course is not affected by” removing a sex organ. The possibility of uterine orgasm is eliminated, sensation in the vagina and external genitalia is diminished or lost entirely, the vagina is shortened, and the uterine ligaments, blood supply, and nerves that radiate throughout the pelvis are severed. Hysterectomy causes profound changes in sexual function.

In the section “Emotional effects” UPMC states, “A woman’s sexuality and femininity are not changed by a hysterectomy. During the recovery period from surgery, anxiety, fatigue, and fear of pain can cause a lack of sexual desire. Allowing time to heal and recover, sharing your feelings with your partner, and using a gentle approach can help you achieve sexual pleasure.”

HERS comment: A sex organ can’t be removed without altering sexuality and femininity. As we have said and is well-documented in medical literature, when the uterus is removed uterine orgasm can’t occur. The vagina is shortened, sutured shut at the top, and women develop adhesions that are often very painful. This scarring, shortening, and loss of elasticity in the vagina often makes sex extremely painful during intercourse. Furthermore, the nerves that attach to the uterus branch out to the vagina and external genitalia. Those nerves must be severed to remove the uterus. When they’re severed it causes not only a loss of physical sexual sensation, but it also often causes pain in the buttocks, groin, pelvis, and vagina. Severing of the ligaments affects skeletal structure, commonly causing pain in the lower back and hips. “Sharing your feelings with your partner” and “using a gentle approach” won’t replace the functions of the nerves, ligaments, blood supply, or sex organs. Nor will they stop the painful aftermath of hysterectomy. Lack of sexual desire is to be expected when a sex organ is removed.

In the section titled “Myths associated with hysterectomy,” UPMC refers to “Sex will be less enjoyable” as a myth. They elaborate by stating as fact that, “The ability to enjoy sexual intercourse should not be affected by a hysterectomy… Once healing has occurred, the ability to enjoy sex and achieve orgasm will return to normal and may even improve. Some women have a temporary loss of vaginal sensation and less lubrication during sexual activity. These are common side effects of the surgery. Vaginal sensation and lubrication will return to normal when healing is complete.”

HERS comment: No—sex can never return to “normal” after hysterectomy. That’s impossible because a sex organ has been removed. Even if you never experienced sex before the surgery, the potential to experience sexual satisfaction and uterine orgasm will no longer be possible. Sex isn’t improved by the removal of sex organs or by shortening the vagina. The loss of sensation to the vaginal and external genitalia isn’t temporary, it’s permanent. The nerves that made physical sensation possible are severed during hysterectomy and they can’t be reattached. The permanent loss of physical sensation and uterine function is universal. But sexuality and sensuousness aren’t limited to sexual acts. All of human interaction, sexual energy, and vitality are diminished by the removal of the female organs.

There are two “UPMC Patient Education Materials” about hysterectomy. The misinformation in “What is a Hysterectomy?” is reinforced and expanded in the “educational” document from the same list called “Preparing for a Hysterectomy.” On the third page, under the heading “Will a hysterectomy affect my sex life?” it says at the end of the first paragraph and into the second paragraph, “At this point in recovery your ability to enjoy sex and achieve orgasm will return to normal and may even improve. Because of the temporary shrinkage of tissues that occurs after surgery, your vagina may feel shorter or narrower even though no tissue has been removed.”

HERS comment: No woman can experience uterine orgasm without a uterus. A woman whose pain was relieved by removal of her uterus may be glad to be rid of that particular pain, but that doesn’t mean that she would have consented to the surgery if she had known that she would experience a total loss of uterine orgasm and diminished or lost sensation to the vagina and external genitalia.

The shortening of the vagina in a total hysterectomy is not temporary. It is an irreversible consequence of cutting a hole into the top of the vagina that is then sutured shut. The vagina is permanently shortened.

“This educational material,” UPMC tells us, “was developed by a team of women’s health care experts throughout UPMC, including Magee-Womens Hospital, a National Center of Excellence in Women’s Health as designated by the U.S. Department of Health and Human Services.” Visitors to Magee-Women’s Hospital of UPMC are provided with a prominent link back to this hysterectomy information on UPMC’s main website. In the “About Us” page on Magee’s website they say that part of their “WOMANCARE PHILOSOPHY” is being “committed to…empowering [each woman] through education.”
_____________________________

Section B:

UPMC’s contradictory information about hysterectomy becomes clear by clicking on a different link on the same website. It was “last reviewed January 2007.”

From the UPMC home page, click on “Health A-Z” and then “Women.” But this time, instead of clicking on the link to “UPMC Patient Education Materials,” click on “Procedures.” Once there, you’ll see a long list of “Procedure & Surgery Fact Sheets.” Next, scroll down the long list of “fact” sheets to the link for “Hysterectomy” where, in addition to reading about the surgery, you can view an animated hysterectomy, although this animated version does little to convey the extreme physical assault to a woman’s body.

The first paragraph narrowly defines hysterectomy as “the surgical removal of the uterus, resulting in sterility, or the inability to become pregnant. It may be done through the abdomen or the vagina.”

HERS comment: In addition to the comments above that demonstrate that this definition is incomplete, by omission it informs women only about the loss of childbearing, not the many other important functions of the uterus.

In the section titled “Parts of the Body Involved,” UPMC lists the following:
• Partial or Subtotal Hysterctomy [sic] – Removal of the uterus
• Total, Complete, or Simple Hysterectomy – Removal of the uterus and cervix (the opening of the uterus leading to the vagina)
• Radical Hysterectomy – Removal of the uterus, ovaries, fallopian tubes, upper part of the vagina, and the pelvic lymph nodes
• Salpingo-oophorectomy – Removal of the ovaries and fallopian tubes (may be combined with any of the above procedures)

HERS comment: In the first definition, although the cervix is not wholly removed during a “subtotal” hysterectomy, it is “involved.” The uterus is amputated from the cervix, which leaves a cervical stump. The description of “radical” hysterectomy fails to mention that the paraaortic lymph nodes and the omentum are often removed. And in defining salpingo-oophorectomy they fail to define removal of the ovaries as female castration. Rarely would a woman consent to being castrated.

It would be much more informative for people who hold themselves out as women’s health experts to say, “No matter how or what type of hysterectomy is performed, every cell in a woman’s body is involved. The endocrine system (of which the uterus and ovaries are major components) helps regulate every part of a woman’s body to maintain health and wellbeing in far-reaching ways, such as hair follicle stimulation, sexual function, bone structure, metabolism, sleep, insulin production, cardiovascular health, and all of the known (and unknown) functions of the female organs throughout every woman’s anatomy. For example,” they might add, “hysterectomized women have a three times greater risk of heart disease, and women whose ovaries are also removed have a seven times greater risk of myocardial infarction.” But UPMC fails to mention those facts.

Under the subheading “Description of the Procedure,” in the section titled “What to Expect,” we're told that during an abdominal hysterectomy, “A cut is made in the lower abdomen to expose the tissues and blood vessels that surround the uterus and cervix. These tissues are cut and the blood vessels are tied off to remove the uterus. Stitches are placed in these deep structures, which will eventually dissolve and do not need to be removed. The uterus is removed from the top of the vagina, and the vagina is closed to prevent infection and to keep the intestines from dropping downward.”

HERS comment: UPMC fails to inform women that the tissue and blood vessels not only surround the uterus and cervix but are attached to it. They fail to mention a fact of significant importance—a large bundle of nerves and broad bands of ligaments that are attached to the uterus must be severed to remove it. By stating that blood vessels are tied off it doesn’t convey that the rich blood supply that provides blood flow to the uterus and throughout the pelvis and lower extremities is severed. It also doesn’t mention that one of the ligaments that must be severed is the utero-sacral ligament that attaches to the uterus and to the sacrum in the lower back, which may be one of the reasons why hysterectomized women experience chronic back problems.

And once again UPMC fails to inform women that during a total hysterectomy the top of the vagina is cut around the cervix and the body of the uterus and the cervix are removed. It states that the vagina is closed to “keep the intestines from dropping downward.” In fact the intestines do move down to take up the space where the uterus had been, but because they’re no longer in their natural location behind the uterus they now sit directly on top of the surgical scar at the top of the vagina where adhesions develop. So suturing the top of the vagina shut doesn’t prevent the intestines from dropping downward, it only prevents them from falling through the hole that the surgeon has made into the top of the vagina.

The same facts apply to their definition of “Vaginal Hysterectomy.” In the second sentence of the paragraph describing what is done to women during vaginal hysterectomy, UPMC tell us, “The doctor does, however, make an internal incision at the top of the vagina around the cervix.”

HERS comment: If the precise language was used in all of the descriptions of “total” hysterectomy, then women would understand that their vagina will be cut into and sutured shut at the top, whether the surgery is performed abdominally, vaginally, with the use of a laparoscope, by a robot, or any other method.

This section is also inaccurate when discussing the dislocation of the intestines, as mentioned above. They don’t mention that there’s also a loss of the natural barrier of the uterus between the intestines, the vagina, the bladder, and the bowel, which is one reason why hysterectomized women usually experience bowel and bladder problems.

In the subsection titled “Possible Complications,” UPMC provides the following list:
• Reactions to anesthetics
• Pain
• Infection
• Bleeding
• Fatigue
• Injured pelvic organs (bowel and/or bladder)
• Urinary incontinence (problems holding your urine)
• Loss of ovarian function and early menopause
• Depression
• Sexual dysfunction

HERS comment: When the blood supply to the ovaries is damaged during the surgery causing the ovaries to cease to function (which occurs as often as 35-40% of the time), the doctor’s actions result in a de facto castration (a total loss of ovarian function) even if the ovaries aren’t removed at the time of hysterectomy. Loss of ovarian function is not comparable to menopause. A menopausal woman has ovaries that produce hormones her entire lifetime. She also has a functioning uterus. Menopausal women have not had their female organs removed.

In the section titled “Outcome” there are several subheadings. The first is “Physical,” in which the last paragraph begins, “If the ovaries are removed (oophorectomy), your body's main source of estrogen and other sex hormones is gone. If you were not already postmenopausal, this sends your body into an instant menopause…”

HERS comment: Again it incorrectly defines the removal of the ovaries as being the same as menopause and not castration.

Next is the subheading “Emotional.” Here UPMC tells us, “Some women have strong emotional reactions, including depression, in response to the loss of their uterus.”
HERS comment: This statement would be correct if it said that women experience depression because of the loss of the functions of the uterus and ovaries.

Finally, the last subheading is “Sexual.” In this subsection UPMC tells us, “Some women notice a change in their sexual response after a hysterectomy. Because the uterus has been removed, uterine contractions you may have felt during orgasm will no longer occur. If the ovaries have been removed, vaginal dryness may be a problem, but this is usually relieved with the use of estrogen. Some women report an increase in their sexual enjoyment, possibly because they are relieved of the pain from the condition that prompted this procedure, or no longer need to worry about an unintended pregnancy.”
HERS comment: Women who happen to find this link on UPMC’s website will at least be informed that the uterus is a sex organ and that uterine contractions that occur during orgasm can no longer occur without a uterus. But if they click on the Patient Education Materials link they’ll be told the opposite…that the “ability to enjoy sex and achieve orgasm will return to normal and may even improve.” This contradictory information is potentially dangerous and damaging. UPMC is one of the rare hospital websites that educates and informs the public about uterine contractions that occur during orgasm and that they will no longer occur without a uterus. It is unfortunately the last statement in this long description of hysterectomy and contradicts earlier statements. It should be one of the first, most prominent statements and mentioned throughout, not buried at the end. The loss of uterine orgasm is of vital importance to women.

Visitors to the UPMC website must wonder why it is that the question “Will a hysterectomy affect my sex life?” is answered in the Patient Education Materials page titled “Preparing for a hysterectomy.” This is information women need to be told prior to deciding whether or not they’ll proceed with the doctor’s recommendation for a hysterectomy and not while preparing for the surgery itself. As we have discovered, UPMC admits that in a total hysterectomy the cervix is removed, the vagina is incised and closed at the top, and uterine contractions that occur during orgasm can’t occur without a uterus. Why is it, then, that UPMC fails to provide the correct information when they themselves ask the question “Will a hysterectomy affect my sex life?” It’s baffling that they then answer that question by stating that sex “will return to normal and may even improve.”

“References” for these “facts,” UPMC tells us, were obtained by accessing the websites of the American College of Obstetrics and Gynecologists, the American Medical Association, and the National Women’s Health Information Center on October 14, 2005.

There are many contradictions throughout UPMC’s website, but for the purposes of this discussion we will point out just a few more. “UPMC Patient Education Materials” don’t provide a separate information page for oophorectomy—female castration, the surgical removal of the ovaries. But in their “Procedure & Surgery Fact Sheets” UPMC has a page titled “Oophorectomy.”

They define oophorectomy as follows: “The surgical removal of one or both ovaries, called bilateral oophorectomy. This procedure may be combined with the removal of the fallopian tubes, in which case it is called a salpingo-oophorectomy. Removal of the ovaries and/or fallopian tubes is often done as part of a complete or total hysterectomy.”

HERS comment: Again, because these are presented as “fact” sheets from those who hold themselves out as medical experts, if they used the medically correct definition for the ovaries it would convey an immediate understanding that the consequences of removal of the ovaries is serious and damaging. The ovaries are the female gonads. Removal of the gonads is castration. By omission UPMC fails to provide the critical information needed for women to decide whether they will consent to being castrated.

Under “Parts of the Body Involved,” UPMC provides a drawing of the “Female Reproductive System.” It would be accurate to say that the brain (chiefly the hypothalamus and the pituitary), the breasts, and other “parts” of the female anatomy (such as the adrenal glands and all of the connecting tissues, vessels, and nerves) complete the female reproductive system, along with the uterus, ovaries, fallopian tubes, and vagina. But not only are the brain, breasts, adrenals etc not included in UPMC’s artist rendition of the female reproductive system, the uterus itself isn’t labeled. The drawing only labels the ovaries, fallopian tubes, bladder, and vagina.

HERS comment: Their failure to label the uterus while labeling the bladder in a anatomical drawing of “The Female Reproductive System” is shocking. The uterus is a hormone-responsive reproductive sex organ, without which (UMPC makes clear elsewhere) reproduction isn’t possible. Under the anatomical drawing used on UPMC’s website it says, “Copyright © 2005 Nucleus Communications, Inc.” We visited the Nucleus Communications website and found many drawings of the female reproductive system, but we couldn’t find one where the uterus wasn’t labeled. In fact, the only Nucleus Communications drawing that we could find that resembles the drawing that UPMC uses on their website is called “Nerve Distribution of the Bladder and Uterus - Medical Illustration.” Not only is the uterus labeled on this drawing, but the “Pelvic Nerve Plexus” is labeled along with the “Left Inferior Hypogastric Nerve Plexus.” As evidenced by yellow-colored neural pathways that literally engulf the reproductive organs, it’s clear to see that these are some of the very nerves that radiate throughout the pelvis and enervate the sex organs. Why would UPMC choose to use an anatomical drawing that doesn’t label those too?

At the end of the “Procedure & Surgery Fact” sheet on oophorectomy, UPMC credits EBSCO Publishing. EBSCO is a privately held corporation out of Ipswich, Massachusetts. On their website, under “Consumer Health Complete Database Coverage List,” among many other publications they offer an “Evidence-Based Fact Sheet” called “Hysterectomy: Surgical Removal of the Uterus [or Womb], Vaginal Hysterectomy, Abdominal Hysterectomy” from “Great Neck Health Publishing.” They also offer “Health Animation” from “Blausen Human Atlas.” Blausen offers many short videos. In the one called “Ovariectomy” it says, “A woman’s reproductive system includes the uterus, the ovaries, the fallopian tubes, and the vagina.”

In the section titled “Possible Complications,” UPMC lists “changes in sex drive.” This fact, however, isn’t listed in the “Outcome” section.

HERS comment: Changes in sex drive are to be expected after removal of sex organs. It’s an outcome, not a complication. UPMC repeatedly makes the point that removal of the ovaries often accompanies removal of the uterus. In fact, the NIH reports that about 75% of all hysterectomized women are castrated at the time of hysterectomy. It’s baffling then, that elsewhere UPMC makes the blanket statement that sex will return to normal and may even improve after hysterectomy.

Under the heading “Postoperative Care,” UPMC states that, “If both ovaries are removed, your body goes immediately into menopause. If you are not being treated for breast cancer, your doctor will prescribe hormone replacement therapy (HRT), either estrogen alone or with progesterone, to help manage the symptoms of menopause.”

HERS comment: Castration—removal of the ovaries—results in the loss of the production of the many hormones and other substances produced by the ovaries. “Hormone replacement” is a misnomer, because it isn’t possible to replace the natural, complex, lifelong functions of the ovaries with any other substance produced outside of the body. This would be an ideal place for UMPC to mention the largest randomized HRT study ever conducted on healthy post-menopausal women. The NIH’s Women’s Health Initiative study was abandoned when researchers determined that the risks of HRT outweighs the benefits. A significant number of the study’s participants experienced serious complications, including breast cancer, strokes, heart disease, ,endometrial cancer, and other adverse effects.

“References” for the “facts” mentioned on UPMC’s website regarding the surgical removal of the ovaries, they tell us, were obtained by accessing the websites of the American College of Obstetrics and Gynecologists and the National Cancer Institute. It goes on to say that this information was last reviewed by them as recently as January 2007. “Copyright © 2007 EBSCO Publishing. All rights reserved.” Visitors to UPMC’s website must wonder what the organizations referenced throughout this website have to say about having their organizations’ reputations attached to these confusing contradictions and omissions that are published by a major medical teaching hospital.

Let the reader beware. Before you make any decision about female surgery watch the
12-minute video “Female Anatomy: the Functions of the Female Organs” at www.hersfoundation.org/anatomy.

Email HERS at hersfdn@earthlink.net if you know of a doctor, medical school, or hospital website that you think should be highlighted on this blog.

If you would like to talk with women about the consequences of hysterectomy, HERS provides a network of women who will talk with you about their experiences. If you have undergone a hysterectomy at UPMC or their affiliated hospitals since 2003, contact HERS at hersfdn@earthlink.net.