Hysterectomy refers to a surgical operation so as to take out the uterus. However, most of the hysterectomies do not indicate urgent situations thereby entailing enough liberty to the patient to choose from the available alternatives. The uterus in a body of woman support and nurtures a fetus. It generates the menstrual flow or period. The ovaries generate eggs or ova that allow child bearing. It also generates hormones or chemicals that control the menstruation and other attributes of health and sexual welfare. After going through the hysterectomy a woman is unable to have children and menstruation. The ovaries may go on generating the hormones, however in a declined manner. Some hysterectomies also involve removal of ovaries that associates with the reduction of essential female hormones. Hysterectomy is viewed as a solution to many diseases and conditions. It is undertaken to save life in the circumstances of cancer or hemorrhage of uterus or ovaries. (Hysterectomy: New York State: Department of Health)

Hysterectomy is performed so as to enhance the quality of life, to reduce pain, heavy bleeding or other persistent conditions and discomfort. However, there exist several alternatives of treatment and addressing such problems to going through a hysterectomy. Hysterectomy is normally prescribed to get rid of the cancerous organs and in some instances the adjoining organs and structures which are being eliminated so as to prevent the spread of this life threatening disease. Sometimes it is resorted to get rid of fibroids, commonly refer to non-cancerous tumors of the uterus and these are considered as most common causes for recommending for a hysterectomy. Such non-cancerous tumors grow from the muscular wall of the uterus and are composed of muscle and fibrous tissue and many women over the age of 35 have fibroids however having no symptoms. In some instances but, fibroids may result in heavy bleeding, pelvic discomfort and pain and normally high amounts of pressure on other organs. Such symptoms may necessitate treatment but not always lead to hysterectomy.

Endometriosis is considered another common cause of undergoing hysterectomy that indicates the non-cancerous situations of growth of cells from the uterine lining like Islands out of the uterus. Such growth mostly prevails on the fallopian tubes, ovaries, bowel, bladder, and certain other pelvic structures, incorporating the uterine wall. A hysterectomy with repair of supporting structures is commonly prescribed in some serious cases of prolapse that involves pulling downward of the bladder and rectum downward the uterus and thereby a dragging feeling in the pelvic area, problems regulating bladder and/or bowel function and normally projection of one of the organs through the vaginal opening with ages. This may also resorted to as a treatment against precancerous situation of uterus when the lining the uterus overgrows; pelvic adhesions resulting from the irritation of the lining of the abdomen depicting the symptoms of severe pain, bowel and bladder problems and infertility; to combat unusually heavy bleeding; pelvic pain etc. Different types of hysterectomy exist. It may be subtotal hysterectomy that involves removal of only the upper part of the uterus, however, not the cervix. Total hysterectomy involves removal of both the body of the uterus and the cervix. The Radical Hysterectomy involves removal of entire uterus both tubes and ovaries along with the pelvic lymph nodes through the abdomen to counteract a cancerous situation. (Hysterectomy: New York State: Department of Health)

Hysterectomy appears to be the second most common major surgical operation for women in the United States. It has been estimated that about 590,000 hysterectomies are being undertaken annually, however, the recent data depicting a downward trend in the recent years since 1980s. Still there exists a 33% probability of undergoing such an operation for the woman exceeding the age of 60 years. As hysterectomies are undertaken annually on the growing number women with the related morbidity, mortality and cost of the operation this method of treatment involves significant quality care inferences. It is common to have the post-surgical morbidity. The complications vary from 24% in case of the vaginal hysterectomy to 43% for abdominal hysterectomy, irrespective of the fact that a recent study by Carlson, Miller, and Fowler indicated in-hospital complications at 7%. (Geller; Burns; Brailer, 1996)

There is also evidences of long-term medical and psychological complications ranging to even 50% of patients. The studies conducted by Martin, Roberts, and Clayton in 1980 and Melody in 1962 reveal that the proportion of women suffering from postoperative psychiatric problems range from 4% to 66%, irrespective of the revelations made by that the risk of the prevalence of psychiatric disorders is found to be greatest among women with preoperative psychiatric disorders. It is also evident that the rate of Hysterectomy varies considerably within the United States and also between the United States and other nations as well. The studies have shown that the women living in the U.S. are more prone, almost about three times to have a hysterectomy in comparison to those living in England. (Geller; Burns; Brailer, 1996)

It has been observed that about 75% of menstruating women come across premenstrual syndrome — PMS a disorder indicated by highly emotional and physical signs that normally fluctuates between the menstrual cycles. The syndrome normally influences women in the age group of 20s and 30s. About 3 to 5% of menstruating women suffer from premenstrual dysphoric disorder, or PMDD, which is an aggravated form of PMS indicated by the high levels of emotional and physical signs more which are more aggravated during the 7 to 10 days prior to onset of menstruation. (Depression in Women) A study conducted by Osborn M. F, Gath D. H in the university of psychiatry, Warneford Hospital, Oxford reveal that the psychological factors have a profound impact on premenstrual symptoms prior to hysterectomy. The study was conducted on 56 women awaiting hysterectomy for menorrhagia of benign origin. It has been observed that during the three months preceding the date of operation the daily self-ratings on a check list made by women on premenstrual symptoms were interspersed and atypical symptoms were being made. (Osborn; Gath, 1990)

In such manner their knowledge of the premenstrual concentration was reduced. Six months after hysterectomy, the checklists of those women indicated the measurement of serum progesterone levels showing premenstrual symptoms fell considerably proving that the psychological factors are significant determining factors of such symptoms prior to hysterectomy. (Osborn; Gath, 1990) A study during 1982 was conducted by Settnes A, Jorgensen T, and Lange AP on 2301 Danish women to determine the influence of psychological factors and life style variable in hysterectomy. The weight cycling implying recurrent loss and weight gain of more than 5 Kg was observed to be the only considerably important risk factor for hysterectomy. This explains the relation between hysterectomy and psychological factors. (Settnes; Jorgensen; Lange, 1997)

Hysterectomy is the most popularly considered general surgery which is being performed in the United States. The progressive rate of increase of its prevalence in U.S. is quite evident and is thought to be twice its rate in England and Wales. The organic pathology, the kinds of relationships, socio-economic class, the importance related to womanhood and involvements which are of vocational/avocational nature are the prominent factors that influence the way a woman will respond to a needed hysterectomy. The peculiar postoperative symptoms of hysterectomy include, enhanced fatigue, loss in appetite, and physical weakness, that have earlier been regarded psychosomatic are presently taken to be really physical. Depression is regarded as the most commonly prevailing long-term reaction. It is more prone to prevail when malignancy occurs during times of surgery. (Roeske, 1978)

Traditionally, women’s gender identities are related to their sexual reproductive organs. The uteruses and ovaries have even been employed as a synecdoche for women in their entirety. In reality the uterus is considered to be the only part of the body that is unique to women, the one organ that does not have an anatomical equivalent in the male. The theories have been advanced that uteruses and ovaries form the core of women’s gender identity indicating that without these organs an individual may not be regarded as female. In the opinion of Wolf, hysterectomy is regarded a surgical interruption to the self-concept of feminist, since the crucial role played by uterus in the development of the perspective of women as to the body image, social role, and gender role. Women during the post hysterectomy period may feel themselves defeminized psychological and a feeling a biological deficiency. The Biological Essentialist Theory therefore emphasizes that sex is inborn and that gender is the social manifestation of sex. As they point out there can only be two bipolar sexes- male and female and two bipolar genders-masculine or feminine. Studies have extensively made to describe the feelings of natural menopause they have not adequately explored the experiences of women who reach this stage through surgery. (To have and have not: Perspectives on Hysterectomy and Oopherectomy) study has been conducted by A Settnes and T. Jorgensen on the hypertension as a risk factor of hysterectomy. The study involved collection of self report questionnaires from 77% of 2301 Danish women in the age groups of 30, 40, 50, or 60 years. The information comprises of the life styles, hypertension, cardiovascular diseases, and usage of medicine, weight and history of dieting, gynecologic history, psychological factors, and social background. Among all such factors the study revealed that the hypertension and the use of diuretics were crucial risk factors for hysterectomy which are found prevalent among the educated women and women having weight fluctuations. The study thus concluded that the history of hypertension, weight cycling, and absence or less of education are inextricably related to constitute the risk elements for pre-menopausal hysterectomy. Hypertension is regarded as a plausible biological factor of menorrhagia and a cause for hysterectomy. (Settnes; Jorgensen, 1998)

Not withstanding the clinical indications, the rate of hysterectomy varies in accordance with the personal or demographic characteristics of women. The studies, however, depicts inconsistency on the influence of the race, education, and socio-economic status of the patient on hysterectomy. Some of the studies reveal that the African-American women with less education and with no children are more likely to have hysterectomy. The studies conducted by Kjerluff, Guzinski, Langenberg reveal that the average age-adjusted rate of hysterectomy was more in respect of African-American women in comparison to that of white women. Actually, the average age at hysterectomy was considered younger in African-American women in all the diagnostic cases. (Geller; Burns; Brailer, 1996)

The racial differences are also evident in case of certain diagnoses. About 65.4% of the cases relating to hysterectomy are tend to be found among that of the African-American women who appear to suffer mostly from uterine fibroids but in case of white women the rate is only 25.5%. The white women mostly diagnosed for endometriosis, cancer, uterine prolapse or menstrual disorders. However, the studies conducted by Wilcox, Koonin, Pokras and others conducted during the year 1994 reveals that the rate of total hysterectomy in the case of African-American women were quite similar to those in the case for white women. The reports which are being generated by Health Care Financing Administration — HCFA during 1993 indicates that about 54% of hysterectomies case relates to whites other than that of the blacks. (Geller; Burns; Brailer, 1996)

Irrespective of the fact that hysterectomy constitutes the most general surgery for women that is not associated with pregnancy. But sufficient attention is not being paid to the way in matters relating to the exposure of women to surgery varies in accordance with their social features and also attitudinal/behavior characteristics. The study conducted by Chung-won Lee, Michael B. Toney, and Edna H. Berry by retrieving data from the National Longitudinal Surveys of Mature Women, found out the relationship between socio-economic status and hysterectomy and also the influence of attitudinal/behavioral features on hysterectomy. The study by means of the Cox proportional hazard evaluation could reveal that the response of women to the exposure to hysterectomy considerably varies in accordance with their social and attitudinal standings. Social attributes considered statistically to be the prime risk elements of hysterectomy incorporate the education, employment and marital status of women. The empirically important risk factors among the attitudinal and behavioral factors are considered to be the focal point of control of women and number of children. (Non-clinical risk factors of hysterectomy)

To conclude, hysterectomy is a surgery that removes the uterus of women. The fallopian tubes, ovaries, and cervix are also removed in some extreme cases. This is considered as a solution for a number of diseases and conditions. This is a life saving device resorted to commonly in case of the cancerous uterus or ovaries or hemorrhage of the uterus. However, wide choices are there as alternatives for hysterectomy and it depend upon the patient to choose the appropriate one. This is method undertaken with an objective of improving the quality of life, to relieve pain and heavy bleeding or other chronic conditions and discomfort.

References

Depression in Women” Retrieved at http://www.cchs.net/health/health-info/docs/2300/2364.asp?index=9308. Accessed 5 November, 2005

Hysterectomy” New York State: Department of Health. Retrieved at http://www.health.state.ny.us/nysdoh/consumer/women/hyster.htm. Accessed 4 November, 2005

Lee, Chung-won; Toney, Michael B; Berry, Edna H. “Non-clinical risk factors of hysterectomy” The 130th Annual Meeting of APHA. Retrieved at http://apha.confex.com/apha/130am/techprogram/paper_47155.htm. Accessed 5 November, 2005

Osborn, M. F; Gath. DH (August, 1990) “Psychological and physical determinants of premenstrual symptoms before and after hysterectomy. Psychological Medicine. Vol: 20; No: 3; pp: 565-572

Roeske, N.C. (September 1978) “Quality of life and factors affecting the response to hysterectomy” Journal of Family Practice. Vol: 7; No: 3; pp: 483-488.

Settnes, A; Jorgensen, T. (1998) “Hypertension and hysterectomy in Danish women”

Obstetrics & Gynecology. Vol: 92; Vol: 3; pp: 274-280

Settnes, A; Jorgensen, T; Lange A.P. (May, 1997) “Hysterectomy in a Danish population:

Weight-related factors, psychological factors and life style variables” Ugeskr Laeger. Vol: 26; No: 159(22) pp: 3408-3412

Geller, S. E; Burns, L. R; Brailer, D.J. (February, 1996) “The impact of non-clinical factors on practice variations: The case of hysterectomies” (February, 1996) Vol: 30; No: 6. Health Services Research. Vol: 30; No: 6; pp: 729-750

To Have and Have Not: Perspectives on Hysterectomy and Oopherectomy” Retrieved at http://www.temple.edu/tempress/chapters_1400/1587_ch1.pdf. Accessed 5 November, 2005

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