They call themselves Urogynecologists, women's doctors who do not deal with pregnancies or infertility or hysterectomies, only what they refer to as "pelvic floor disorders" including urinary incontinence. So you'd like to think they'd be upfront about the fact that hysterectomy is one of the major reasons why 40% of all U.S. women find themselves leaking urine by the time they hit the age of 60. (Interesting coincidence: that's the same percentage of women who undergo a hysterectomy by the time they are 60.)
In fact, a very large and long study of Swedish women found that a woman's chance of incontinence at least doubled after a hysterectomy.
This group of doctors has even put a price tag on what it costs women to deal with incontinence: an average of $15 a week for pads, laundry and dry cleaning. If you multiply that by the 17 million women--a low estimate--who have this embarrassing problem, and then by 52 weeks, you find out that incontinence is costing American women at least $13 billion a year. This calculation does not include the cost of the various prescription medications now being promoted by drug companies to relieve incontinence.
Yet, you can search the website of the American Urogynecologic Society (AUG) or their new information website, Voices for PFD, and you won't find a mention of hysterectomy. The closest you get is this statement with its vague reference to surgery: "Sometimes, very clear-cut events such as pregnancy, vaginal delivery, surgery, radiation or accidental injury can lead to these kinds of problems..." Notice that all of these causes of incontinence are essentially unavoidable--except surgery for hysterectomy, which is avoidable with other treatments in 70 to 90% of cases.
But wait, these doctors have a solution to incontinence, once you've got it: More surgery! Last year, the AUG released results of a study showing that two years after women had surgery to try to cure stress urinary incontinence, their cost per week had dropped to $4 from $15 while their episodes of incontinence dropped from 23 per week to 3. Hooray.
The final irony is that just a few days ago, the AUG released its own study of information about incontinence on various web sites and found them "inadequate." Two physician reviewers evaluated more than 50 websites and found them "not comprehensive, relevant or accurate."
I tried to reach Dr. Steven Minaglia, a Hawaii-based physician whose team reviewed the websites, but he had left for a trip to China. Perhaps when he gets back he can ask them to review why AUG's own website doesn't bother to tell women about the connection between hysterectomy and incontinence.
Perhaps he could start by having them review the Swedish study.
Showing posts with label women's health. Show all posts
Showing posts with label women's health. Show all posts
Wednesday, September 21, 2011
Friday, November 19, 2010
Encouraging News About UAE, An Alternative to Hysterectomy
Recently published research on Uterine Artery Embolization has shown that it is a good alternative to hysterectomy for women suffering heavy menstrual bleeding or pain from uterine fibroid--benign--tumors.
A 5-year follow-up study of women who agreed to be randomly picked for either a hysterectomy or Uterine Artery Embolization (UAE) showed that 7 of 10 women who underwent the organ-sparing procedure had relief of their symptoms that was good enough to have been able to avoid further surgery after five years.
This is important news because 40% of all hysterectomies--275,000 of them--are done each year because of symptoms caused by fibroids. According to best estimates, another 250,000 women a year undergo myomectomies, in which the fibroids are cut out of the uterus but the uterus is spared. Both surgeries usually involve a stay in the hospital and, depending on the technique used for the hysterectomy, recovery periods of up to six weeks. With UAE, women report returning to normal activity, including sex, within two weeks.
In addition, a UAE poses much less risk to a woman's ovaries if she is under 45. Dr. Bruce McLucas, a Los Angeles gynecologist who performed the first UAE in the United States in the early 90s, said in an interview that the incidence of ovarian failure "in my hands is 3%" in women in that age group and about 5% when done by other surgeons. McLucas recently performed his thousandth UAE. However, ovarian failure occurs in about half of all women older than 45 who undergo UAE.
About half of all women who undergo hysterectomies end up without their ovaries--often healthy ovaries-- because gynecologists continue to scare them into consenting to their removal (or yank them out even with no consent) with talk of ovarian cancer. They minimize the adverse impact on women's health that will result from the loss of their ovaries. Most gynecologists still view the low risk of developing ovarian cancer as outweighing the much greater risks of developing heart disease, osteoporosis, loss of sexual pleasure, etc. from castration (the proper word for amputation of women's sex/reproductive organs.)
McLucas, who practices at the Ronald Reagan UCLA Medical Center and is Clinical Professor in the medical school there, is now engaged in a campaign to publicize the benefits of the procedure. He will be appearing December 1 on the TV show, The Doctors.
I've long wondered why so many women in their early 40s experience such heavy bleeding. McLucas explained that, "In the years running up to the menopause, we have a domination of estrogen in the menstrual cycle," and estrogen fuels the growth of fibroids, which are present in 40% of women over 40. Many women, however, do not experience heavy bleeding or pain from them; only 10 to 20% of women who have fibroids need treatment.
But those who do must deal with monthly hemorrhaging that can last two weeks and require frequent changing of even the most absorbent tampons. Many become anemic.
"The first major myth about fibroids is that waiting for menopause is necessarily a good option," said McLucas. He explained that because fatty tissue produces a substance that mimics estrogen, fibroids in some women will not shrink after menopause. And, if a woman is taking replacement hormones, the fibroids also tend to grow. Waiting for menopause therefore, may or may not be a good idea depending on the individual woman.
So what is UAE? It's an outpatient procedure done under local anesthetic in which a small cut is made in the upper thigh and then in the femoral artery. From there, guided by X-rays, the surgeon plugs the uterine artery with inert particles.
Starved of blood, the fibroids usually--but not always--shrivel to about half their size, calcify and cause no further problems.
But doesn't the uterus then die as well?
Fortunately, the uterus is fed blood by the ovarian artery as well, and will "resupply the uterus within an hour of surgery," according to Dr. McLucas.
He has also published research showing that among women who still wanted to have children after the procedure, about 1/3 had successful pregnancies.
I had a hysterectomy in my early 40s because of heavy menstrual bleeding, and after viewing this new research, I would have tried a UAE if it had been available to me. Maybe it would not have worked, as is the case with a friend of mine, but given the information I now have, it would have been worth a try to keep my uterus.
Even now, many years later, women who want to try this alternative will very likely need to look beyond their usual gynecologist. McLucas thinks he is the only gynecologist doing UAE in the United States. But interventional radiologists--the same doctors who insert cardiac stents--do them, and so do, oddly enough, some cardiologists.
Ideally, women should find a gynecologist who can refer them to a radiologist who will perform the procedure. After that, the gynecologist will oversee their recovery.
Dr. McLucas predicts that within 10 years there will be at least one gynecologist in each major city who performs UAEs. Until then, women are still on their own in their efforts to keep their precious organs. A good starting place for information is the Fibroid Treatment Collective website, which features Dr. McLucas.
A 5-year follow-up study of women who agreed to be randomly picked for either a hysterectomy or Uterine Artery Embolization (UAE) showed that 7 of 10 women who underwent the organ-sparing procedure had relief of their symptoms that was good enough to have been able to avoid further surgery after five years.
This is important news because 40% of all hysterectomies--275,000 of them--are done each year because of symptoms caused by fibroids. According to best estimates, another 250,000 women a year undergo myomectomies, in which the fibroids are cut out of the uterus but the uterus is spared. Both surgeries usually involve a stay in the hospital and, depending on the technique used for the hysterectomy, recovery periods of up to six weeks. With UAE, women report returning to normal activity, including sex, within two weeks.
In addition, a UAE poses much less risk to a woman's ovaries if she is under 45. Dr. Bruce McLucas, a Los Angeles gynecologist who performed the first UAE in the United States in the early 90s, said in an interview that the incidence of ovarian failure "in my hands is 3%" in women in that age group and about 5% when done by other surgeons. McLucas recently performed his thousandth UAE. However, ovarian failure occurs in about half of all women older than 45 who undergo UAE.
About half of all women who undergo hysterectomies end up without their ovaries--often healthy ovaries-- because gynecologists continue to scare them into consenting to their removal (or yank them out even with no consent) with talk of ovarian cancer. They minimize the adverse impact on women's health that will result from the loss of their ovaries. Most gynecologists still view the low risk of developing ovarian cancer as outweighing the much greater risks of developing heart disease, osteoporosis, loss of sexual pleasure, etc. from castration (the proper word for amputation of women's sex/reproductive organs.)
McLucas, who practices at the Ronald Reagan UCLA Medical Center and is Clinical Professor in the medical school there, is now engaged in a campaign to publicize the benefits of the procedure. He will be appearing December 1 on the TV show, The Doctors.
I've long wondered why so many women in their early 40s experience such heavy bleeding. McLucas explained that, "In the years running up to the menopause, we have a domination of estrogen in the menstrual cycle," and estrogen fuels the growth of fibroids, which are present in 40% of women over 40. Many women, however, do not experience heavy bleeding or pain from them; only 10 to 20% of women who have fibroids need treatment.
But those who do must deal with monthly hemorrhaging that can last two weeks and require frequent changing of even the most absorbent tampons. Many become anemic.
"The first major myth about fibroids is that waiting for menopause is necessarily a good option," said McLucas. He explained that because fatty tissue produces a substance that mimics estrogen, fibroids in some women will not shrink after menopause. And, if a woman is taking replacement hormones, the fibroids also tend to grow. Waiting for menopause therefore, may or may not be a good idea depending on the individual woman.
So what is UAE? It's an outpatient procedure done under local anesthetic in which a small cut is made in the upper thigh and then in the femoral artery. From there, guided by X-rays, the surgeon plugs the uterine artery with inert particles.
Starved of blood, the fibroids usually--but not always--shrivel to about half their size, calcify and cause no further problems.
But doesn't the uterus then die as well?
Fortunately, the uterus is fed blood by the ovarian artery as well, and will "resupply the uterus within an hour of surgery," according to Dr. McLucas.
He has also published research showing that among women who still wanted to have children after the procedure, about 1/3 had successful pregnancies.
I had a hysterectomy in my early 40s because of heavy menstrual bleeding, and after viewing this new research, I would have tried a UAE if it had been available to me. Maybe it would not have worked, as is the case with a friend of mine, but given the information I now have, it would have been worth a try to keep my uterus.
Even now, many years later, women who want to try this alternative will very likely need to look beyond their usual gynecologist. McLucas thinks he is the only gynecologist doing UAE in the United States. But interventional radiologists--the same doctors who insert cardiac stents--do them, and so do, oddly enough, some cardiologists.
Ideally, women should find a gynecologist who can refer them to a radiologist who will perform the procedure. After that, the gynecologist will oversee their recovery.
Dr. McLucas predicts that within 10 years there will be at least one gynecologist in each major city who performs UAEs. Until then, women are still on their own in their efforts to keep their precious organs. A good starting place for information is the Fibroid Treatment Collective website, which features Dr. McLucas.
Tuesday, November 2, 2010
An "Essential" Guide to Hysterectomy That Isn't
The title, Women's Hysterectomy Stories: The Essential Guide," gave me great expectations. Here, available on line for $17, was an e-book that I thought might help to enlighten women about the perils to their long-term health and sexuality from hysterectomies.
So, I sprung for the $17. And was sorry that I did.
This book, written by Ruth Steeves and promoted on her website, Hysterectomyresources.com, is only for you if you've already made up your mind that you really need a hysterectomy. It will advise you about making arrangements in advance of your surgery for child care, and meals, and what to expect in the hospital, and once you get home.
But just like HysterSisters, which is promoting the daVinci robotic system for the surgery, this book and Steeves' website see the epidemic of hysterectomies through rose-colored glasses. The goal is to eliminate your anxiety about having a hysterectomy. The furthest they go in bucking the medical establishment is to encourage women to get a second opinion.
HysterSisters has actually launched a "Give Me a Second" campaign whose purpose is "to strengthen the doctor-patient relationship, to improve women's quality of care through awareness of minimally invasive surgical procedures (italics mine) and to increase confidence in their healthcare decisions."
Once again, it's all about finding a doctor who will use laparoscopy or robots for a less traumatic hysterectomy. Not to avoid one altogether and survive with your organs intact.
The problem with the generic advice to get a second opinion is that too many gynecologists disregard all the evidence about the serious after-effects of hysterectomy and removal of the ovaries and won't volunteer any information about them. These are not side-effects--like an infection due to the surgery--but long-term adverse impacts on health and sexual pleasure.
Without a uterus, a woman can not experience what some refer to as a full-body orgasm in which the uterus pulses rthymically. That is not an opinion. It's an incontrovertible fact, but the gynecologist who will warn you about that is a rare individual. You also won't hear about your increased risk of future bladder and back problems, or about your much higher risk of heart attack if your ovaries are removed. There's no controversy at all about these after-effects of hysterectomy. The evidence has been reported in medical journal articles repeatedly over the last several decades.
Yet, to justify the supposed joy of hysterectomy, The Essential Guide tells one anonymous woman's tale of painful periods ever since she had her first, and her gloriously wonderful life after hysterectomy.
Other than that one, there are only three other stories included as MP3 downloads or PDFs. One of the women had uterine cancer (an absolutely valid and unavoidable reason for a hysterectomy); another had to be on blood thinners for another condition and this had serious effects on her periods (how common is that one? and who knows what alternatives she had?); and the third said she had "passed out" every time she got her period. Again, thankfully, not a common experience. All end up as testimonials for Steeves' book.
That said, yes indeed, women should get second opinions. And third and fourth, if need be, until they find a doctor whose practice is focused on avoiding hysterectomies, not doing them. Some medical centers now have specific hysterectomy alternatives centers. Search for them. But first, arm yourself for these discussions by learning about the anatomy of our reproductive organs and the essential role they play in our health and pleasure for as long as we are alive.
To get that information, I once again recommend the HERS Foundation website where you can watch a plain vanilla explanation, with diagrams but not any sort of bloody video, of the functions of your uterus and organs. You'll be grateful for investing 10 minutes of your time to save your future health and pleasure.
So, I sprung for the $17. And was sorry that I did.
This book, written by Ruth Steeves and promoted on her website, Hysterectomyresources.com, is only for you if you've already made up your mind that you really need a hysterectomy. It will advise you about making arrangements in advance of your surgery for child care, and meals, and what to expect in the hospital, and once you get home.
But just like HysterSisters, which is promoting the daVinci robotic system for the surgery, this book and Steeves' website see the epidemic of hysterectomies through rose-colored glasses. The goal is to eliminate your anxiety about having a hysterectomy. The furthest they go in bucking the medical establishment is to encourage women to get a second opinion.
HysterSisters has actually launched a "Give Me a Second" campaign whose purpose is "to strengthen the doctor-patient relationship, to improve women's quality of care through awareness of minimally invasive surgical procedures (italics mine) and to increase confidence in their healthcare decisions."
Once again, it's all about finding a doctor who will use laparoscopy or robots for a less traumatic hysterectomy. Not to avoid one altogether and survive with your organs intact.
The problem with the generic advice to get a second opinion is that too many gynecologists disregard all the evidence about the serious after-effects of hysterectomy and removal of the ovaries and won't volunteer any information about them. These are not side-effects--like an infection due to the surgery--but long-term adverse impacts on health and sexual pleasure.
Without a uterus, a woman can not experience what some refer to as a full-body orgasm in which the uterus pulses rthymically. That is not an opinion. It's an incontrovertible fact, but the gynecologist who will warn you about that is a rare individual. You also won't hear about your increased risk of future bladder and back problems, or about your much higher risk of heart attack if your ovaries are removed. There's no controversy at all about these after-effects of hysterectomy. The evidence has been reported in medical journal articles repeatedly over the last several decades.
Yet, to justify the supposed joy of hysterectomy, The Essential Guide tells one anonymous woman's tale of painful periods ever since she had her first, and her gloriously wonderful life after hysterectomy.
Other than that one, there are only three other stories included as MP3 downloads or PDFs. One of the women had uterine cancer (an absolutely valid and unavoidable reason for a hysterectomy); another had to be on blood thinners for another condition and this had serious effects on her periods (how common is that one? and who knows what alternatives she had?); and the third said she had "passed out" every time she got her period. Again, thankfully, not a common experience. All end up as testimonials for Steeves' book.
That said, yes indeed, women should get second opinions. And third and fourth, if need be, until they find a doctor whose practice is focused on avoiding hysterectomies, not doing them. Some medical centers now have specific hysterectomy alternatives centers. Search for them. But first, arm yourself for these discussions by learning about the anatomy of our reproductive organs and the essential role they play in our health and pleasure for as long as we are alive.
To get that information, I once again recommend the HERS Foundation website where you can watch a plain vanilla explanation, with diagrams but not any sort of bloody video, of the functions of your uterus and organs. You'll be grateful for investing 10 minutes of your time to save your future health and pleasure.
Tuesday, September 7, 2010
In Honor of Ovarian Cancer Month: Hold On To Your Ovaries!
Shame on The New York Times for printing a one-sided article touting the benefits of female castration as a way of preventing ovarian cancer. The article reported on a study of women who had inherited the BRCA1 or BRCA2 mutations that increase the risk for breast and ovarian cancer. Of the women who kept their ovaries, 6 percent developed ovarian cancer, compared with 1 percent of those who gave permission to remove their ovaries.
Ovarian cancer is deadly serious: 15,000 women a year die from it, and the Ovarian Cancer Alliance has marked September for observance of Ovarian Cancer Awareness Month. Fear of ovarian cancer is the major reason why about 300,000 women a year permit doctors to remove their ovaries, usually at the same time as a hysterectomy. However, only a small percentage of those women have the BRCA mutations; they face a lifetime risk of only 1.39% of developing ovarian cancer (or 1 in 72), while the risk of breast cancer over her lifetime is 12.15% (or 1 in 8), according to the National Cancer Institute. So using fear of ovarian cancer to convince a woman who does not have the mutations to have a hysterectomy, is clearly unwarranted.
Now the question is, how warranted is such a recommendation for women who do have the mutation? Well, if all we were talking about was removing some non-essential or at least less-essential body part--even a breast--then trading a 5% risk for a 1% risk of a deadly cancer, for which there is no good treatment, might indeed be a sensible option.
But no woman should make that choice until she understands all that she will be sacrificing along with her ovaries, and the added health risks that accompany this drastic decision.
As I've blogged about before, losing your ovaries is literally castration and brings on not only a sudden, intense menopause, with severe hot flashes, mood swings, loss of energy, etc., but also drastically raises the odds that a women will suffer other serious problems as a result. A study published in the journal The Lancet in October, 2006, found that women castrated before the age of 45 double their risk of death from heart attack. Some previous studies put the increased risk of heart disease at 5.5 times, regardless of age at time of operation.
And then there are the increased risks for osteoporosis and bone fractures and Parkinson's disease and other forms of dementia.
As for women who have enjoyed sex--well, they can say good-bye to their former selves. Our ovaries continue to function long after menopause, still producing some estrogen and other hormones. Without them, welcome to the world of dry. Libido--gone or dramatically reduced. Ability to feel and enjoy--women can't even remember what it felt like. Impact on your relationships--depends on how understanding and tolerant is your partner.
The Ovarian Cancer National Alliance is pushing for an increase in funding for research for a test that would detect ovarian cancer at an early stage, and for a cure. Amen to that.
But the next time The New York Times or anyone else publishes an article about ovarian cancer prevention through castration, they ought to be sure to tell women about the increased risks and poor quality of life that they will be endure as a result.
Ovarian cancer is deadly serious: 15,000 women a year die from it, and the Ovarian Cancer Alliance has marked September for observance of Ovarian Cancer Awareness Month. Fear of ovarian cancer is the major reason why about 300,000 women a year permit doctors to remove their ovaries, usually at the same time as a hysterectomy. However, only a small percentage of those women have the BRCA mutations; they face a lifetime risk of only 1.39% of developing ovarian cancer (or 1 in 72), while the risk of breast cancer over her lifetime is 12.15% (or 1 in 8), according to the National Cancer Institute. So using fear of ovarian cancer to convince a woman who does not have the mutations to have a hysterectomy, is clearly unwarranted.
Now the question is, how warranted is such a recommendation for women who do have the mutation? Well, if all we were talking about was removing some non-essential or at least less-essential body part--even a breast--then trading a 5% risk for a 1% risk of a deadly cancer, for which there is no good treatment, might indeed be a sensible option.
But no woman should make that choice until she understands all that she will be sacrificing along with her ovaries, and the added health risks that accompany this drastic decision.
As I've blogged about before, losing your ovaries is literally castration and brings on not only a sudden, intense menopause, with severe hot flashes, mood swings, loss of energy, etc., but also drastically raises the odds that a women will suffer other serious problems as a result. A study published in the journal The Lancet in October, 2006, found that women castrated before the age of 45 double their risk of death from heart attack. Some previous studies put the increased risk of heart disease at 5.5 times, regardless of age at time of operation.
And then there are the increased risks for osteoporosis and bone fractures and Parkinson's disease and other forms of dementia.
As for women who have enjoyed sex--well, they can say good-bye to their former selves. Our ovaries continue to function long after menopause, still producing some estrogen and other hormones. Without them, welcome to the world of dry. Libido--gone or dramatically reduced. Ability to feel and enjoy--women can't even remember what it felt like. Impact on your relationships--depends on how understanding and tolerant is your partner.
The Ovarian Cancer National Alliance is pushing for an increase in funding for research for a test that would detect ovarian cancer at an early stage, and for a cure. Amen to that.
But the next time The New York Times or anyone else publishes an article about ovarian cancer prevention through castration, they ought to be sure to tell women about the increased risks and poor quality of life that they will be endure as a result.
Wednesday, July 28, 2010
Feeling Un-Sexy in America
The market is huge and tantalizing: in the midst of a culture drenched in sex, one in three American women say they have about as much interest in sex as Monday Night Football.
That's why the recent rejection by the Food and Drug Administration of flibanserin, the latest drug intended to boost female libido, was such a disappointment to the pharmaceutical industry intent on hitting the jackpot with a female Viagra.
Trials of the drug showed it did too little to warrant approval, and that finding, in turn, sparked the latest debate on why it's so much harder to find a sex drug for women than men. After the usual chatter about sexual desire being so much more dependent on women's emotions then men's came the theories that essentially blame women's drive for equality.
For example, after chalking up some of the apathy to a resurgence of 19th century "bourgeois propriety, " Camille Paglia, writing in a New York Times op-ed, blamed Super Moms who've turned men into "cogs in a domestic machine commanded by women." She also slapped at workplaces where women are finally enjoying some modicum of equality with men as leading to a suppression of physicality and then to boredom with each other.
The sad part of this commentary is that is is so ill informed by facts. Take a look at the recent medical literature on women's sexuality, as I have recently in researching a book on the subject, and you find the authors still quoting 1960s work by Masters & Johnson. Our culture glorifies sex but when it comes to doing actual research on the subject we're stuck in old-fashioned prudery.
The best evidence, however, points to far-different culprits than those plucked out of the air by Paglia: the 600,000 hysterectomies a year performed on women plus women's use of birth control pills and medications like Prozac.
By the time a woman in America reaches the age of 60, the chances are one in three that she will have had a hysterectomy. Afterward, it is common for women to report loss of sexual desire, less sexual activity, decreased genital sensation and difficulty achieving orgasm. This is a reality that the surgeons don't want women to know, and that hysterectomized women most often keep to themselves out of shame and fear.
Why does hysterectomy adversely affect sexuality? Part of the answer is that about 300,000 of the women who undergo hysterectomies also lose their ovaries at the same time. Perhaps half the others also suffer a loss of ovarian function as a result of damage from the surgery done to remove their uterus. That means about 450,000 women will lose ovarian function this year, and every year.
When ovaries are removed or cease functioning, that is castration. Castration is an ugly word, but when you cut out someone's reproductive/sex organs, it is the proper medical word. Shrinking from it just allows doctors to continue to recommend the removal of healthy organs as no big deal, and in fact a benefit to women, a way of reducing their chances of ovarian cancer. Not calling it castration helps conceal the fact that without her ovaries, a woman loses not only estrogen--the main concern of men because it enables vaginal lubrication--but also most of her testosterone, often called the "hormone of desire."
For men, the equivalent would be recommending routine removal of healthy testicles to prevent testicular or prostate cancer. Of course, I've never heard of a man willingly giving up healthy testicles unless he's deliberately changing gender. I once knew a man who consented to surgical castration because he had prostate cancer. Afterward, he told me how indifferent he had become to things like sexy movie scenes that before had turned him on.
Women I've interviewed who have been castrated say there is no artificial cocktail of replacement hormones that comes close to making them feel like their old selves. And believe me, they've tried to find one. Before the surgery, they had ample desire. Afterward, zip. This change had nothing to do with their emotional state, only the very drastic loss of the hormones produced by their sex organs.
When it comes to the birth control pill, the manufacturers have long been coy about the effect on women's sex lives, listing as a side effect "sexual changes." Translation: less desire. Loss of desire is also a side effect of anti-depressants including Prozac.
Now, I'm not saying that over-worked women don't have less interest in sex than women who get enough sleep, or that deeply entrenched negative attitudes toward women's sexuality don't still exist. Of course they do. And women suffering from serious depression may have a need for medication that outweighs any worry about the impact on their sex lives.
But it's certainly anti-woman to suggest, as Paglia did, that the culprit is women's desire for equality in the workplace. Or that our excellent organization skills, which make it possible for us to bring in a critical paycheck while raising children and keeping a home, should be criticized as de-masculinizing our partners.
Women are being castrated by the hundreds of thousands every year. That's a fact, and that's where the focus and the outrage should be because there are organ-sparing alternatives as much as 90 percent of the time.
That's why the recent rejection by the Food and Drug Administration of flibanserin, the latest drug intended to boost female libido, was such a disappointment to the pharmaceutical industry intent on hitting the jackpot with a female Viagra.
Trials of the drug showed it did too little to warrant approval, and that finding, in turn, sparked the latest debate on why it's so much harder to find a sex drug for women than men. After the usual chatter about sexual desire being so much more dependent on women's emotions then men's came the theories that essentially blame women's drive for equality.
For example, after chalking up some of the apathy to a resurgence of 19th century "bourgeois propriety, " Camille Paglia, writing in a New York Times op-ed, blamed Super Moms who've turned men into "cogs in a domestic machine commanded by women." She also slapped at workplaces where women are finally enjoying some modicum of equality with men as leading to a suppression of physicality and then to boredom with each other.
The sad part of this commentary is that is is so ill informed by facts. Take a look at the recent medical literature on women's sexuality, as I have recently in researching a book on the subject, and you find the authors still quoting 1960s work by Masters & Johnson. Our culture glorifies sex but when it comes to doing actual research on the subject we're stuck in old-fashioned prudery.
The best evidence, however, points to far-different culprits than those plucked out of the air by Paglia: the 600,000 hysterectomies a year performed on women plus women's use of birth control pills and medications like Prozac.
By the time a woman in America reaches the age of 60, the chances are one in three that she will have had a hysterectomy. Afterward, it is common for women to report loss of sexual desire, less sexual activity, decreased genital sensation and difficulty achieving orgasm. This is a reality that the surgeons don't want women to know, and that hysterectomized women most often keep to themselves out of shame and fear.
Why does hysterectomy adversely affect sexuality? Part of the answer is that about 300,000 of the women who undergo hysterectomies also lose their ovaries at the same time. Perhaps half the others also suffer a loss of ovarian function as a result of damage from the surgery done to remove their uterus. That means about 450,000 women will lose ovarian function this year, and every year.
When ovaries are removed or cease functioning, that is castration. Castration is an ugly word, but when you cut out someone's reproductive/sex organs, it is the proper medical word. Shrinking from it just allows doctors to continue to recommend the removal of healthy organs as no big deal, and in fact a benefit to women, a way of reducing their chances of ovarian cancer. Not calling it castration helps conceal the fact that without her ovaries, a woman loses not only estrogen--the main concern of men because it enables vaginal lubrication--but also most of her testosterone, often called the "hormone of desire."
For men, the equivalent would be recommending routine removal of healthy testicles to prevent testicular or prostate cancer. Of course, I've never heard of a man willingly giving up healthy testicles unless he's deliberately changing gender. I once knew a man who consented to surgical castration because he had prostate cancer. Afterward, he told me how indifferent he had become to things like sexy movie scenes that before had turned him on.
Women I've interviewed who have been castrated say there is no artificial cocktail of replacement hormones that comes close to making them feel like their old selves. And believe me, they've tried to find one. Before the surgery, they had ample desire. Afterward, zip. This change had nothing to do with their emotional state, only the very drastic loss of the hormones produced by their sex organs.
When it comes to the birth control pill, the manufacturers have long been coy about the effect on women's sex lives, listing as a side effect "sexual changes." Translation: less desire. Loss of desire is also a side effect of anti-depressants including Prozac.
Now, I'm not saying that over-worked women don't have less interest in sex than women who get enough sleep, or that deeply entrenched negative attitudes toward women's sexuality don't still exist. Of course they do. And women suffering from serious depression may have a need for medication that outweighs any worry about the impact on their sex lives.
But it's certainly anti-woman to suggest, as Paglia did, that the culprit is women's desire for equality in the workplace. Or that our excellent organization skills, which make it possible for us to bring in a critical paycheck while raising children and keeping a home, should be criticized as de-masculinizing our partners.
Women are being castrated by the hundreds of thousands every year. That's a fact, and that's where the focus and the outrage should be because there are organ-sparing alternatives as much as 90 percent of the time.
Friday, June 4, 2010
Gynocologist's Professional Org Ignores Heart Attack Risk
The professional organization that sets the standards of care followed by gynecologists has just released a new patient education booklet on hysterectomy. While this new version from the American College of Obstetricians and Gynecologists is something of an improvement (I'll get to that later), it leaves out completely the most serious risk facing women who are hysterectomized and/or lose their ovaries: heart attack.
I brought that very subject up with my cardiologist recently (yes, I have heart problems), and this is what he said:
"If they're taking out their ovaries, they're giving these women heart attacks. And you can quote me." Dr. Pavel Romano, Huntington, New York.
The "they," of course, is gynecologists. It's brave of Dr. Romano to put his name on a quote like this, but he's really not going out on a limb on the science. As I blogged about recently, solid research has now established that losing your ovaries greatly increases a woman's risk of heart attack; losing your uterus alone also increases that risk, but not by as much.
So I carefully read ACOG's new patient education booklet, expecting to find mention of this risk. Remember, heart attack is the leading cause of death of American women.
And is that risk mentioned? No, it is not.
I asked the spokesperson for ACOG just who is responsible for the contents of the pamphlet, and she ascribed it to "ACOG Fellows" who base the content on the College's Practice Bulletins and Committee opinions.
I've asked to interview one or more of these Fellows, but in the meantime I've now had the pleasure of reading ACOGs "Guidelines for Women's Health Care," published in 2007. Nowhere in that very long description of how doctors should respond to women's various gynecological problems is any mention of the increased heart attack risk brought about by hysterectomy and oopherectomy.
Absent any other explanation, this seems to be a case of a medical truth that's inconvenient for business. Acknowledging the heart attack risk might force the gynos to confront their tendency to just yank out a woman's organs, and that would leave many of them unable to earn their usual fees. It takes a lot more skill than many gynecologists have, and a lot more time, for apparently no bigger reimbursement from Medicaid, for example, to remove only a woman's fibroids instead of her entire uterus. Fibroids are the most common reason for hysterctomizing a woman, and they are never a good reason for a hysterectomy, much less removal of ovaries. Apparently, learning to do the more difficulty surgery is a problem for many gynecologists, who prefer instead the quicker, more lucrative and simpler job of just cutting out entire organs.
As I said earlier, there is some new information in the pamphlet that is helpful to women deciding whether to consent to a hysterectomy. The pamphlet now admits that the menopausal symptoms caused by ovary removal "may be more intense" (oh, yeah, make that will be horrendous) than if a woman went through menopause naturally. And that there is an increased risk of bone fracture due to osteoporosis.
But most of the pamphlet is still devoted to explaining the different ways surgeons can cut out a woman's organs and the details of how a woman is prepped for surgery.
A woman reading this pamphlet would still come away with only a partial understanding of the functions of her organs and of the consequences of surgery that may very well shorten her life.
It's an outrage that complete information is still absent from this booklet, and no woman agreeing to the surgery based on it is giving truly informed consent.
I brought that very subject up with my cardiologist recently (yes, I have heart problems), and this is what he said:
"If they're taking out their ovaries, they're giving these women heart attacks. And you can quote me." Dr. Pavel Romano, Huntington, New York.
The "they," of course, is gynecologists. It's brave of Dr. Romano to put his name on a quote like this, but he's really not going out on a limb on the science. As I blogged about recently, solid research has now established that losing your ovaries greatly increases a woman's risk of heart attack; losing your uterus alone also increases that risk, but not by as much.
So I carefully read ACOG's new patient education booklet, expecting to find mention of this risk. Remember, heart attack is the leading cause of death of American women.
And is that risk mentioned? No, it is not.
I asked the spokesperson for ACOG just who is responsible for the contents of the pamphlet, and she ascribed it to "ACOG Fellows" who base the content on the College's Practice Bulletins and Committee opinions.
I've asked to interview one or more of these Fellows, but in the meantime I've now had the pleasure of reading ACOGs "Guidelines for Women's Health Care," published in 2007. Nowhere in that very long description of how doctors should respond to women's various gynecological problems is any mention of the increased heart attack risk brought about by hysterectomy and oopherectomy.
Absent any other explanation, this seems to be a case of a medical truth that's inconvenient for business. Acknowledging the heart attack risk might force the gynos to confront their tendency to just yank out a woman's organs, and that would leave many of them unable to earn their usual fees. It takes a lot more skill than many gynecologists have, and a lot more time, for apparently no bigger reimbursement from Medicaid, for example, to remove only a woman's fibroids instead of her entire uterus. Fibroids are the most common reason for hysterctomizing a woman, and they are never a good reason for a hysterectomy, much less removal of ovaries. Apparently, learning to do the more difficulty surgery is a problem for many gynecologists, who prefer instead the quicker, more lucrative and simpler job of just cutting out entire organs.
As I said earlier, there is some new information in the pamphlet that is helpful to women deciding whether to consent to a hysterectomy. The pamphlet now admits that the menopausal symptoms caused by ovary removal "may be more intense" (oh, yeah, make that will be horrendous) than if a woman went through menopause naturally. And that there is an increased risk of bone fracture due to osteoporosis.
But most of the pamphlet is still devoted to explaining the different ways surgeons can cut out a woman's organs and the details of how a woman is prepped for surgery.
A woman reading this pamphlet would still come away with only a partial understanding of the functions of her organs and of the consequences of surgery that may very well shorten her life.
It's an outrage that complete information is still absent from this booklet, and no woman agreeing to the surgery based on it is giving truly informed consent.
Tuesday, April 27, 2010
The HERS Conference: Dr. Levine Delivers the Truth
The HERS conference last Saturday delivered a mountain of information in an atmosphere charged with sadness. Much of the audience was in tears listening to women tell about how they had become victims of doctors who continue to ignore the facts about avoidable hysterectomies.
In this first report on the conference, I'm focusing on Dr. Mitchell Levine, a remarkable, Boston-based gynecologist whom we would clone if we could. Here's my report:
Dr. Mitchell Levine, who teaches at the Tufts and Harvard Schools of Medicine, doesn't look much different from other tanned and fit 57-year old male doctors. But when he talks about women and their fate as victims of hysterectomy and removal of their ovaries, his tone because so respectful, even reverential, that it is unexpected, almost shocking.
"It's too sacred, it's too complex, to just take things out," he is saying as he sweeps a laser pointer over a full-color diagram of a woman's internal organs. But, he continues, taking a uterus out is so easy to do: "Clamp, clamp, clamp, clamp. Done." He demonstrates with four quick clenches of his hands.
Levine is speaking at the 28th conference of the HERS Foundation in a Manhattan hotel. He's telling the truth about the consequences of this surgery and why he believes that "at least" 90 percent of the 600,000 done each year could be avoided with other treatments, some as simple and cost-free as waiting.
It's a huge contrast to the paternalistic advice most women get: Your uterus is just a cradle. Done having children? Then you don't need it any more. But you'll still have the playpen! Wink. Wink.
And: You'll love life after your hysterectomy. No more periods!
And: If I end up taking out your ovaries, just think, no more risk of ovarian cancer!
"It's part of their training," Dr. Levine explains to me. "That these (the ovaries) are ticking time bombs. Instead, you end up shortening (a woman's) life because you've increased her risk of heart disease." Yes, that's right, a woman 40 to 44 whose ovaries are removed or which stop functioning as a result of a hysterectomy (that happens in better than one in 10 cases) faces twice the risk of heart disease as a woman with intact ovaries. This added risk more than outweighs the possibility of ovarian cancer, according to medical studies.
"Can you imagine if a man went to a doctor for a benign condition and the doctor said, 'I can fix that by cutting your nuts off?'" Levine asked with a laugh.
"He'd turn right around and walk away."
Indeed. Men would never voluntarily give up their virility, their joy in sex, to cure a non-life-threatening problem. They have no confusion about the fact that their organs are sex organs, not just baby-makers. Yet, women's organs have been labeled by the medical profession as "reproductive" instead of sexual, and the medical professions is more interested in us as baby factories than as sexual beings. So they talk us into castration for non-life-threatening fibroids and bleeding that can be managed in other ways. And we enjoy sex less as a result, some of us losing most if not all of our libido and some or most of our ability to feel sexual stimulation.
The situation has become more perilous for women as new surgical techniques make it possible to do hysterectomies on an outpatient basis.
Levine goes into detail about this. There's the traditional way, via a long abdominal incision; and then there are the newer ways, via the vagina or laparoscopically through small, abdominal incisions. For the small percentage of women who truly need their organs removed, these techniques are better, shortening recovery time from the surgery.
But regardless of how the surgery is done, there are the same consequences for women who could have avoided it. No matter how it's done, says Levine, removing the uterus "is still cutting the ligaments and the blood supply" to not just the uterus but to other organs as well.
As a result, 10 to 15 percent of women who have only their uterus removed lose the function of their ovaries anyway, apparently because of the loss of blood supply. This plunges them, whether they are 25 or 45, into an immediate and crushing menopause.
Furthermore, the ligaments that are cut are critical to the support of the bladder and bowel. When the uterus is removed, it leaves an empty space, and lacking their previous support, the other organs can sag and lean on each other. Urinary and bowel problems become much more likely.
The most common reason for hysterectomy is fibroids. But when Dr. Levine sees women with fibroids, hysterectomy is the last thing on his mind.
"For example, if a routine exam shows a fibroid, but the woman has no symptoms, I reassure her and say, 'See me in a year.'
"Or, if she's bleeding a lot but it's manageable, I just tell her to take some iron and wait" if she is near menopause. Estrogen, he explained, makes fibroids grow, and because estrogen levels drop at menopause, fibroids will then shrink.
If the bleeding is severe and menopause too far off, Dr. Levine may do surgery to remove them, leaving the uterus and ovaries intact.
Women at the conference asked what Dr. Levine would do if a woman had multiple fibroids--30 or even 50--or if some of them were very large. He answered that it didn't matter. He could still remove them, explaining that they are usually in a sort of capsule, like a hard boiled egg, and pop out when the capsule is cut.
But here's the kicker: Even though it takes longer to cut out fibroids and stitch the uterus back together than to do a hysterectomy--clamp, clamp, clamp, clamp--Dr. Levine gets paid less money to do the conserving surgery than to hollow out a woman's insides.
As U.S. Rep. Carolyn Maloney said at the conference, "Where is the outrage?"
In this first report on the conference, I'm focusing on Dr. Mitchell Levine, a remarkable, Boston-based gynecologist whom we would clone if we could. Here's my report:
Dr. Mitchell Levine, who teaches at the Tufts and Harvard Schools of Medicine, doesn't look much different from other tanned and fit 57-year old male doctors. But when he talks about women and their fate as victims of hysterectomy and removal of their ovaries, his tone because so respectful, even reverential, that it is unexpected, almost shocking.
"It's too sacred, it's too complex, to just take things out," he is saying as he sweeps a laser pointer over a full-color diagram of a woman's internal organs. But, he continues, taking a uterus out is so easy to do: "Clamp, clamp, clamp, clamp. Done." He demonstrates with four quick clenches of his hands.
Levine is speaking at the 28th conference of the HERS Foundation in a Manhattan hotel. He's telling the truth about the consequences of this surgery and why he believes that "at least" 90 percent of the 600,000 done each year could be avoided with other treatments, some as simple and cost-free as waiting.
It's a huge contrast to the paternalistic advice most women get: Your uterus is just a cradle. Done having children? Then you don't need it any more. But you'll still have the playpen! Wink. Wink.
And: You'll love life after your hysterectomy. No more periods!
And: If I end up taking out your ovaries, just think, no more risk of ovarian cancer!
"It's part of their training," Dr. Levine explains to me. "That these (the ovaries) are ticking time bombs. Instead, you end up shortening (a woman's) life because you've increased her risk of heart disease." Yes, that's right, a woman 40 to 44 whose ovaries are removed or which stop functioning as a result of a hysterectomy (that happens in better than one in 10 cases) faces twice the risk of heart disease as a woman with intact ovaries. This added risk more than outweighs the possibility of ovarian cancer, according to medical studies.
"Can you imagine if a man went to a doctor for a benign condition and the doctor said, 'I can fix that by cutting your nuts off?'" Levine asked with a laugh.
"He'd turn right around and walk away."
Indeed. Men would never voluntarily give up their virility, their joy in sex, to cure a non-life-threatening problem. They have no confusion about the fact that their organs are sex organs, not just baby-makers. Yet, women's organs have been labeled by the medical profession as "reproductive" instead of sexual, and the medical professions is more interested in us as baby factories than as sexual beings. So they talk us into castration for non-life-threatening fibroids and bleeding that can be managed in other ways. And we enjoy sex less as a result, some of us losing most if not all of our libido and some or most of our ability to feel sexual stimulation.
The situation has become more perilous for women as new surgical techniques make it possible to do hysterectomies on an outpatient basis.
Levine goes into detail about this. There's the traditional way, via a long abdominal incision; and then there are the newer ways, via the vagina or laparoscopically through small, abdominal incisions. For the small percentage of women who truly need their organs removed, these techniques are better, shortening recovery time from the surgery.
But regardless of how the surgery is done, there are the same consequences for women who could have avoided it. No matter how it's done, says Levine, removing the uterus "is still cutting the ligaments and the blood supply" to not just the uterus but to other organs as well.
As a result, 10 to 15 percent of women who have only their uterus removed lose the function of their ovaries anyway, apparently because of the loss of blood supply. This plunges them, whether they are 25 or 45, into an immediate and crushing menopause.
Furthermore, the ligaments that are cut are critical to the support of the bladder and bowel. When the uterus is removed, it leaves an empty space, and lacking their previous support, the other organs can sag and lean on each other. Urinary and bowel problems become much more likely.
The most common reason for hysterectomy is fibroids. But when Dr. Levine sees women with fibroids, hysterectomy is the last thing on his mind.
"For example, if a routine exam shows a fibroid, but the woman has no symptoms, I reassure her and say, 'See me in a year.'
"Or, if she's bleeding a lot but it's manageable, I just tell her to take some iron and wait" if she is near menopause. Estrogen, he explained, makes fibroids grow, and because estrogen levels drop at menopause, fibroids will then shrink.
If the bleeding is severe and menopause too far off, Dr. Levine may do surgery to remove them, leaving the uterus and ovaries intact.
Women at the conference asked what Dr. Levine would do if a woman had multiple fibroids--30 or even 50--or if some of them were very large. He answered that it didn't matter. He could still remove them, explaining that they are usually in a sort of capsule, like a hard boiled egg, and pop out when the capsule is cut.
But here's the kicker: Even though it takes longer to cut out fibroids and stitch the uterus back together than to do a hysterectomy--clamp, clamp, clamp, clamp--Dr. Levine gets paid less money to do the conserving surgery than to hollow out a woman's insides.
As U.S. Rep. Carolyn Maloney said at the conference, "Where is the outrage?"
Monday, April 19, 2010
Evidence Ignored by Doctors Removing Women's Ovaries
I have been deeply affected by the comments of women in response to my last blog about hysterectomy. Their lives have been devastated by--what should I call them? Ignorant? Arrogant? Unethical? Unprofessional? All of these?--doctors who continue to remove healthy ovaries from women in the face of evidence that they are causing irreparable harm to their patients.
Spurred by these comments, and by my need to prepare to attend the HERS Hysterectomy Conference this coming Saturday, I did some research and found a smoking gun right on the website of the American College of Obstetricians and Gynecologists. It's an August, 2005 article (scroll down the search page to the 7th article) that appeared in the journal Obstetrics & Gynecology. Apparently, it's not required reading for the practicing physicians who continue to castrate women.
Called "Ovarian Conservation at the Time of Hysterectomy for Benign Disease," it takes a comprehensive look at the risks and benefits of removing a woman's ovaries at the same time that she has a hysterectomy for non-cancerous problems like fibroids and heavy bleeding. As far as I can tell at this point, it appears to be one of the latest investigations of the issue, which, despite its importance to women, has not been the subject of much research at all.
Here are some of the conclusions:
I certainly have no satisfactory answer to that.
But some, apparently, believe that the overriding benefit is to reduce a woman's chance of getting ovarian cancer. But this study notes that removal of the uterus alone lowers the risk of ovarian cancer by 40% below the level of women who retain their uterus.
So, let's see: since men have a risk of testicular cancer, should doctors be removing their testicles just in case? Or treating them with female hormones to reduce the risk of prostate cancer?
We women know that would never happen. Men prize their virility and do everything to keep it. Women prize their sexuality, too, but consent to hysterectomy and oopherectomy too often without realizing what they will be giving up. Thus the need for the HERS Foundation video and consent only after seeing it.
So, is it ignorance of the facts that keeps doctors castrating women? Or what? Theories--and certainly facts--welcome.
Spurred by these comments, and by my need to prepare to attend the HERS Hysterectomy Conference this coming Saturday, I did some research and found a smoking gun right on the website of the American College of Obstetricians and Gynecologists. It's an August, 2005 article (scroll down the search page to the 7th article) that appeared in the journal Obstetrics & Gynecology. Apparently, it's not required reading for the practicing physicians who continue to castrate women.
Called "Ovarian Conservation at the Time of Hysterectomy for Benign Disease," it takes a comprehensive look at the risks and benefits of removing a woman's ovaries at the same time that she has a hysterectomy for non-cancerous problems like fibroids and heavy bleeding. As far as I can tell at this point, it appears to be one of the latest investigations of the issue, which, despite its importance to women, has not been the subject of much research at all.
Here are some of the conclusions:
- At no age is there any clear benefit to women from removal of the ovaries (oophorectomy).
- "For women younger than 65 at the time of surgery, oophorectomy increases the risk of dying from coronary heart disease."
- Evidence from the Nurses' Health Study says that the risk of heart attack was doubled if the women in question were between 40 and 44 years old; and up 40% if the women were older than 50.
- After losing their ovaries, women have higher bad cholesterol levels, higher blood pressure and more hardening of the arteries.
- Women who were past menopause when they had an oophorectomy ended up with 54% more bone fractures due to osteporosis than women with intact ovaries.
- The fractures often were of the hip, and having a hip fracture between ages 60 and 64 meant dying early--a loss of 11 years of life!
- It also means that many of those women could never leave their homes again on their own. One study found that before breaking a hip, 28 percent of the women were housebound; after the fracture, 46 percent were housebound.
I certainly have no satisfactory answer to that.
But some, apparently, believe that the overriding benefit is to reduce a woman's chance of getting ovarian cancer. But this study notes that removal of the uterus alone lowers the risk of ovarian cancer by 40% below the level of women who retain their uterus.
So, let's see: since men have a risk of testicular cancer, should doctors be removing their testicles just in case? Or treating them with female hormones to reduce the risk of prostate cancer?
We women know that would never happen. Men prize their virility and do everything to keep it. Women prize their sexuality, too, but consent to hysterectomy and oopherectomy too often without realizing what they will be giving up. Thus the need for the HERS Foundation video and consent only after seeing it.
So, is it ignorance of the facts that keeps doctors castrating women? Or what? Theories--and certainly facts--welcome.
Tuesday, April 13, 2010
Tell the Truth About Hysterectomy!
Do women really get the whole truth about hysterectomy before consenting to this all-too common procedure? I know I didn't.
Nora Coffey, head of the HERS foundation, has been convinced for years that women do not realize that they will certainly lose some sexual feeling; will likely have problems with their bladders and bowels; that they may suffer back pain and see their waists enlarge as their internal organs and bones shift in place because where their uterus used to be is now an empty space. In the years since I underwent a hysterectomy in my mid-40s, I have suffered all of these symptoms, and my doctor never mentioned a single one. (It was a woman, by the way.)
On Friday, April 24, the foundation will hold its 28th Hysterectomy Conference at the Hilton New York Hotel in Manhattan to focus attention on an effort to require that women learn about all the possible consequences of hysterectomy before consenting to the procedure. The conference will feature an Indiana state legislator who is the first to introduce legislation requiring such disclosure.
And, the keynote address will be given by U.S. Congresswoman Carolyn Maloney of New York who will reportedly raise the issue of unnecessary hysterectomies in the House-Senate Joint Economic Committee, which she chairs. Experts estimate the cost of unnecessary hysterectomies at $17 billion a year.
I'll be covering the meeting for womensenews, a non-profit that specializes in news of particular interest to women.
But in this case, I certainly think that men would like to know about a medical procedure that will most definitely affect their sex lives along with their female partners!
The HERS foundation is advocating that women be required to view an 11-minute video it produced before consenting to hystserectomy. The video shows in a very matter-of-fact manner, using only color diagrams and voice-over-text, the story of female anatomy that somehow got left out of all our high school health classes.
"Women who watch that get it: they understand this is very serious surgery," says Coffey, who believes requiring the video is the only way to bring down the number of women who lose their uterus every year. As I've blogged about before, an astounding one out of every three American women have had surgery to remove their uterus by the time they are 60, and of those, 75% also lose their ovaries, the equivalent of male castration.
There is precedent for requiring the showing of videos: Utah, for example, requires women who are seeking an abortion to see one. Drug companies are required to put informative inserts into packages of medication, for example in birth control pills, thanks to the historic efforts of women's advocates including Barbara Seaman.
Losing your uterus is not like losing a tooth. Lose a tooth, and you can still chew with the others or get a false one to take its place. Each woman get's only one uterus, and it's so much an integral part of our bodies that you don't even realize you'll miss it until it's gone. And then, it's too late.
Nora Coffey, head of the HERS foundation, has been convinced for years that women do not realize that they will certainly lose some sexual feeling; will likely have problems with their bladders and bowels; that they may suffer back pain and see their waists enlarge as their internal organs and bones shift in place because where their uterus used to be is now an empty space. In the years since I underwent a hysterectomy in my mid-40s, I have suffered all of these symptoms, and my doctor never mentioned a single one. (It was a woman, by the way.)
On Friday, April 24, the foundation will hold its 28th Hysterectomy Conference at the Hilton New York Hotel in Manhattan to focus attention on an effort to require that women learn about all the possible consequences of hysterectomy before consenting to the procedure. The conference will feature an Indiana state legislator who is the first to introduce legislation requiring such disclosure.
And, the keynote address will be given by U.S. Congresswoman Carolyn Maloney of New York who will reportedly raise the issue of unnecessary hysterectomies in the House-Senate Joint Economic Committee, which she chairs. Experts estimate the cost of unnecessary hysterectomies at $17 billion a year.
I'll be covering the meeting for womensenews, a non-profit that specializes in news of particular interest to women.
But in this case, I certainly think that men would like to know about a medical procedure that will most definitely affect their sex lives along with their female partners!
The HERS foundation is advocating that women be required to view an 11-minute video it produced before consenting to hystserectomy. The video shows in a very matter-of-fact manner, using only color diagrams and voice-over-text, the story of female anatomy that somehow got left out of all our high school health classes.
"Women who watch that get it: they understand this is very serious surgery," says Coffey, who believes requiring the video is the only way to bring down the number of women who lose their uterus every year. As I've blogged about before, an astounding one out of every three American women have had surgery to remove their uterus by the time they are 60, and of those, 75% also lose their ovaries, the equivalent of male castration.
There is precedent for requiring the showing of videos: Utah, for example, requires women who are seeking an abortion to see one. Drug companies are required to put informative inserts into packages of medication, for example in birth control pills, thanks to the historic efforts of women's advocates including Barbara Seaman.
Losing your uterus is not like losing a tooth. Lose a tooth, and you can still chew with the others or get a false one to take its place. Each woman get's only one uterus, and it's so much an integral part of our bodies that you don't even realize you'll miss it until it's gone. And then, it's too late.
Thursday, November 19, 2009
The Risks of Mammography for Under-50 Women
Need another reason to be happy about not getting mammogram from age 40 on?
Skipping them will reduce your risk of breast cancer by reducing your exposure to radiation. Here's the explanation for how that happens, from the Cancer Prevention Coalition:
If that's not enough to give you pause, look a little further at the Coalition's web site and you'll see that compressing a breast in which cancer is already growing can actually cause cancerous cells to spread.
There are all sorts of other issues with mammography, like poor quality control and the mystery of why the risk factors for breast cancer apply to white women but don't work well to predict the disease in black women.
These are the kinds of questions we should be making noise about instead of rejecting sound scientific advice about when--and whether--to have mammograms.
Skipping them will reduce your risk of breast cancer by reducing your exposure to radiation. Here's the explanation for how that happens, from the Cancer Prevention Coalition:
Thus, premenopausal women undergoing annual screening over a ten-year period are exposed to a total of about 10 rads for each breast. As emphasized some three decades ago, the premenopausal breast is highly sensitive to radiation, each rad of exposure increasing breast cancer risk by 1 percent, resulting in a cumulative 10 percent increased risk over ten years of premenopausal screening, usually from ages 40 to 50 (4); risks are even greater for "baseline" screening at younger ages, for which there is no evidence of any future relevance.
If that's not enough to give you pause, look a little further at the Coalition's web site and you'll see that compressing a breast in which cancer is already growing can actually cause cancerous cells to spread.
There are all sorts of other issues with mammography, like poor quality control and the mystery of why the risk factors for breast cancer apply to white women but don't work well to predict the disease in black women.
These are the kinds of questions we should be making noise about instead of rejecting sound scientific advice about when--and whether--to have mammograms.
The Good News about Mammograms That No One Wants to Hear
Here's the bottom line, folks. The uproar over the "new" recommendation that women under 50 should not get regular mammograms is all about money not women's health.
In fact, since 1971 the science has been clear that women under 50 get no benefit from regular mammograms. That is, they die just as often from breast cancer as women who haven't gotten regular mammograms. But despite getting no benefit, all too many undergo unnecessary biopsies that leave scars both physical and mental.
That was the very clear message that just came from the expert panel that finally had the guts to tell the unvarnished truth to the public. You'd think this new clarification about the lack of benefits from an unnecessary test would be greeted with cheers.
Instead, it's been treated like an assault on women motivated by a dastardly effort--by those "death panel" advocates in the Obama Administration--to cut health care costs.
So rabid has the mammography industry become about protecting its profits that it has literally become "un-American" to tell the truth about mammography.
OK. You need proof. So let's talk.
First, why should you believe me? Because I've been writing about various aspects of women's health for 30 plus years, and I spent a year as an editor at MAMM, the women's magazine whose sole topic is women's cancers. I have a shelf-full of books about women's health including one that every woman should have: The Secret History of the War on Cancer, by Devra Lee Davis, the Director of the Center for Environmental Oncology at the University of Pittsburgh Cancer Institute. (Look here for more about her.)
Second, even though someone is not a doctor, some facts about human breasts are easy for all of us to understand and go a long way to explaining the situation.
For instance, you might ask, what are they actually looking for on the X-ray film from a mammogram? Dr. Davis explains that they are looking for tiny white dots or other white shapes. This white "stuff," if you'll excuse the lack of scientific language, is calcium that can be left behind by cancerous cells as they grow. The breasts of women who have stopped menstruating and who are generally over 50, are fatty, and the fat shows up as black, a great background against which to see the white dots.
But the breasts of women under 50 are not fatty; they are dense, and are "riddled with lots of white spots, making it really hard to make out any tumor within," Davis writes in her book. So radiologists can only use their best guess to diagnose a particular white spot as suspicious, and most of the time--that's most of the time--they are wrong.
How wrong? In any given year, 70 of every 1,000 women under age 50 who have a mammogram will be told something suspicious has been found, meaning that over the decade between the age of 40 and 50, 700 women out of 1,000 will be told to undergo a biopsy.
Now a biopsy is no small thing. A friend of mine who underwent two of them--no cancer was found--described "excruciating pain." She was left with significant scars. And the mental anguish as women wait for the biopsy and then the result is similarly painful. Davis calls it "terror."
So if there's no benefit in terms of extending life, and all this downside of pain and anxiety--plus the expense--women under 50 should be cheering, not filled with new anxiety because of the recent announcement.
I find it shameful that most of the media coverage about the recommendations has sounded almost hysterical. You can just see the hand-wringing. The moaning about what women should do now? How will they cope? Etc. Etc.
Let's get over it, ladies. This is a step forward, not back. The advice is clear: if you're under 50, you will get no benefit from regular mammograms unless you are in a high-risk category. Over 50, you'll only have to get one every other year. That means less radiation, fewer trips to the imaging center, less humiliation as you have your boobs squished between two plates, fewer unnecessary biopsies, less mental anguish.
And is it a bad thing if we save some money besides?
In fact, since 1971 the science has been clear that women under 50 get no benefit from regular mammograms. That is, they die just as often from breast cancer as women who haven't gotten regular mammograms. But despite getting no benefit, all too many undergo unnecessary biopsies that leave scars both physical and mental.
That was the very clear message that just came from the expert panel that finally had the guts to tell the unvarnished truth to the public. You'd think this new clarification about the lack of benefits from an unnecessary test would be greeted with cheers.
Instead, it's been treated like an assault on women motivated by a dastardly effort--by those "death panel" advocates in the Obama Administration--to cut health care costs.
So rabid has the mammography industry become about protecting its profits that it has literally become "un-American" to tell the truth about mammography.
OK. You need proof. So let's talk.
First, why should you believe me? Because I've been writing about various aspects of women's health for 30 plus years, and I spent a year as an editor at MAMM, the women's magazine whose sole topic is women's cancers. I have a shelf-full of books about women's health including one that every woman should have: The Secret History of the War on Cancer, by Devra Lee Davis, the Director of the Center for Environmental Oncology at the University of Pittsburgh Cancer Institute. (Look here for more about her.)
Second, even though someone is not a doctor, some facts about human breasts are easy for all of us to understand and go a long way to explaining the situation.
For instance, you might ask, what are they actually looking for on the X-ray film from a mammogram? Dr. Davis explains that they are looking for tiny white dots or other white shapes. This white "stuff," if you'll excuse the lack of scientific language, is calcium that can be left behind by cancerous cells as they grow. The breasts of women who have stopped menstruating and who are generally over 50, are fatty, and the fat shows up as black, a great background against which to see the white dots.
But the breasts of women under 50 are not fatty; they are dense, and are "riddled with lots of white spots, making it really hard to make out any tumor within," Davis writes in her book. So radiologists can only use their best guess to diagnose a particular white spot as suspicious, and most of the time--that's most of the time--they are wrong.
How wrong? In any given year, 70 of every 1,000 women under age 50 who have a mammogram will be told something suspicious has been found, meaning that over the decade between the age of 40 and 50, 700 women out of 1,000 will be told to undergo a biopsy.
Now a biopsy is no small thing. A friend of mine who underwent two of them--no cancer was found--described "excruciating pain." She was left with significant scars. And the mental anguish as women wait for the biopsy and then the result is similarly painful. Davis calls it "terror."
So if there's no benefit in terms of extending life, and all this downside of pain and anxiety--plus the expense--women under 50 should be cheering, not filled with new anxiety because of the recent announcement.
I find it shameful that most of the media coverage about the recommendations has sounded almost hysterical. You can just see the hand-wringing. The moaning about what women should do now? How will they cope? Etc. Etc.
Let's get over it, ladies. This is a step forward, not back. The advice is clear: if you're under 50, you will get no benefit from regular mammograms unless you are in a high-risk category. Over 50, you'll only have to get one every other year. That means less radiation, fewer trips to the imaging center, less humiliation as you have your boobs squished between two plates, fewer unnecessary biopsies, less mental anguish.
And is it a bad thing if we save some money besides?
Wednesday, August 19, 2009
The Truth--and Myths--About Home Births
When I told my women friends that my older son's first baby--and my first grandchild--would be born at home, most of them looked shocked. They immediately voiced fears, saying that they thought it was much safer to have the baby in a hospital because things can go wrong, and in that case, an operating room would be immediately accessible.
It didn't change their minds when I told them that this was a low-risk pregnancy, that my son's girlfriend had been healthy throughout, and that everything showed that the baby--a boy--was doing well. Nor were their minds changed when I said she would have a birth assistant (a certified doula) to help her through the labor, and then a highly experienced midwife to deliver him.
Well, he was born a week ago today, and came into the world with eyes open wide, pink and healthy and calm.
I know exactly how he looked because I saw him within moments of his birth. All four of his grandparents, his uncle and aunt, were there at home waiting. We suffered along with Nicole as we listened to her cry and yell during the last throes of childbirth. But once we heard his cry, we ran upstairs, applauded, cried, hugged and poured champagne. I'll never forget that morning.
Baby Henry began nursing like a champ immediately, and has been calm and content ever since. When he wakes up to nurse, his eyelids flutter and he frowns as if all that light is still a shock to him.
And then I remember the hospital nurseries with fluorescent lights glaring, 24 hours a day. No wonder the nurseries are usually ringing with the howls of the newborns!
So the outcome for my grandson was perfect. The midwives--a second one came at the end to help--called it a beautiful birth. They should know. For one of them it was the 251st. birth she had attended.
The birth assistant, by the way, was with Nicole throughout her labor, coaching her on changing positions, massaging her, using aroma therapy, accupressure, a birth chair, etc. to help her.
But what of my friends' fears? Justified or not?
Not.
Here's the evidence, culled from the best and most recent study of home births. It comes from a study of 7,600 births in the U.S. and Canada, published in the British Medical Journal in 2005, that were planned to occur at home with certified midwives attending. All of the births studied were low-risk, meaning that the mothers were healthy, with no chronic health problems, and that all pre-birth exams showed the babies in good health as well. The outcomes of the home births were compared to low-risk births that occurred in hospitals.
The bonus, of course, in this era of soaring health costs, is that a home birth is far less expensive than one that takes place in a hospital.
Meanwhile, the American College of Obstetricians and Gynecologists continues to oppose home births while infant and maternal mortality rates for the U.S. continue to be far worse than those in other western countries where medical interventions, like cesaereans, occur far less often.
Which leads me to believe that opposition to home births is rooted in the desire of the medical establishment to protect their income stream, and not out of concern about the safety of women and babies.
Yet, American women are so frightened of childbirth at home that less than 1% choose to stay out of the hospital. A pity. For them, their families and babies.##
It didn't change their minds when I told them that this was a low-risk pregnancy, that my son's girlfriend had been healthy throughout, and that everything showed that the baby--a boy--was doing well. Nor were their minds changed when I said she would have a birth assistant (a certified doula) to help her through the labor, and then a highly experienced midwife to deliver him.
Well, he was born a week ago today, and came into the world with eyes open wide, pink and healthy and calm.
I know exactly how he looked because I saw him within moments of his birth. All four of his grandparents, his uncle and aunt, were there at home waiting. We suffered along with Nicole as we listened to her cry and yell during the last throes of childbirth. But once we heard his cry, we ran upstairs, applauded, cried, hugged and poured champagne. I'll never forget that morning.
Baby Henry began nursing like a champ immediately, and has been calm and content ever since. When he wakes up to nurse, his eyelids flutter and he frowns as if all that light is still a shock to him.
And then I remember the hospital nurseries with fluorescent lights glaring, 24 hours a day. No wonder the nurseries are usually ringing with the howls of the newborns!
So the outcome for my grandson was perfect. The midwives--a second one came at the end to help--called it a beautiful birth. They should know. For one of them it was the 251st. birth she had attended.
The birth assistant, by the way, was with Nicole throughout her labor, coaching her on changing positions, massaging her, using aroma therapy, accupressure, a birth chair, etc. to help her.
But what of my friends' fears? Justified or not?
Not.
Here's the evidence, culled from the best and most recent study of home births. It comes from a study of 7,600 births in the U.S. and Canada, published in the British Medical Journal in 2005, that were planned to occur at home with certified midwives attending. All of the births studied were low-risk, meaning that the mothers were healthy, with no chronic health problems, and that all pre-birth exams showed the babies in good health as well. The outcomes of the home births were compared to low-risk births that occurred in hospitals.
- Infant mortality was 1.7 per 1,000 births, a rate as low as occurs in hospitals with low-risk births.
- Medical interventions occurred at less than half the rate as in hospitals. For example, only 2.1% of the women at home suffered an episiotomy, compared to 33%--yes, one in three--in the hospital. Only 3.7% of the women at home ended up delivering by caesarean section, compared to 19% in the hospital.
- None of the mothers died. Some of the women--12%--were transferred to a hospital when problems developed. If a woman is within 20 minutes of a hospital, she is likely to be under care in an operating room as quickly as a woman who labors in the hospital. That's because it takes some time to mobilize the equipment and staff needed, and that mobilization can get started just as quickly with a phone call from home.
The bonus, of course, in this era of soaring health costs, is that a home birth is far less expensive than one that takes place in a hospital.
Meanwhile, the American College of Obstetricians and Gynecologists continues to oppose home births while infant and maternal mortality rates for the U.S. continue to be far worse than those in other western countries where medical interventions, like cesaereans, occur far less often.
Which leads me to believe that opposition to home births is rooted in the desire of the medical establishment to protect their income stream, and not out of concern about the safety of women and babies.
Yet, American women are so frightened of childbirth at home that less than 1% choose to stay out of the hospital. A pity. For them, their families and babies.##
Thursday, May 8, 2008
1 in 3 American Women Castrated
Castration is an ugly word, but it's the right word to use when talking about the 600,000 American women who have their uteruses removed every year! And of them, 438,000 simultaneously have their ovaries cut out also. One out of three American women over 60 lives on without her uterus or ovaries, and is never the same for their loss.
Never the same sexually: a woman who always had uterine contractions during orgasm can't have them ever again after a hysterectomy. Furthermore, even if her ovaries are not removed, sexual sensation is diminished because of the severing of nerves and lowered flow of blood to the vagina, labia and clitoris. If a woman consents to removal of her ovaries also, she is thrown into an immediate and crushing menopause.
As someone who underwent uterine removal in her 40s, I am speaking from personal experience, but to get a sense of how bad it is for women take a look at both the website of the HERS Foundation and its associated blog and comments. The foundation's mission is to stop this continuing assault on women by the medical profession. In their comments on the blog, young women, one only 16, others in their 30's and older describe not only devastated sex lives, but loss of energy, depression, memory loss, bone and joint pain.
Nora Coffey, president of the HERS Foundation, is campaigning for a law that would require that women receive complete information about hysterectomy before they consent. They aren't getting that now, with so-called patient education information limited primarily to talking about the uterus's function as a baby incubator. (You don't need it anymore, dear, do you? goes the spiel.) HERS has developed an 11-minute video that makes clear the uterus's other functions as a sexual organ and a muscle that supplies support to the bladder and bowel. The video should be required viewing before a woman gives her consent. In fact, there's a petition to sign to make that happen.
In no other country do so many women undergo hysterectomies, and the procedure is less necessary today than ever because there are now alternatives for treating bleeding from fibroids, for example, the single largest reason for hysterectomy. It's a scandal of which America's oby-gyns should be ashamed.
Never the same sexually: a woman who always had uterine contractions during orgasm can't have them ever again after a hysterectomy. Furthermore, even if her ovaries are not removed, sexual sensation is diminished because of the severing of nerves and lowered flow of blood to the vagina, labia and clitoris. If a woman consents to removal of her ovaries also, she is thrown into an immediate and crushing menopause.
As someone who underwent uterine removal in her 40s, I am speaking from personal experience, but to get a sense of how bad it is for women take a look at both the website of the HERS Foundation and its associated blog and comments. The foundation's mission is to stop this continuing assault on women by the medical profession. In their comments on the blog, young women, one only 16, others in their 30's and older describe not only devastated sex lives, but loss of energy, depression, memory loss, bone and joint pain.
Nora Coffey, president of the HERS Foundation, is campaigning for a law that would require that women receive complete information about hysterectomy before they consent. They aren't getting that now, with so-called patient education information limited primarily to talking about the uterus's function as a baby incubator. (You don't need it anymore, dear, do you? goes the spiel.) HERS has developed an 11-minute video that makes clear the uterus's other functions as a sexual organ and a muscle that supplies support to the bladder and bowel. The video should be required viewing before a woman gives her consent. In fact, there's a petition to sign to make that happen.
In no other country do so many women undergo hysterectomies, and the procedure is less necessary today than ever because there are now alternatives for treating bleeding from fibroids, for example, the single largest reason for hysterectomy. It's a scandal of which America's oby-gyns should be ashamed.
Friday, March 7, 2008
Barbara Seaman: Warrior for Women's Health
Hundreds of people crowded Riverside Memorial Chapel in Manhattan last night to memorialize feminist activist and crusader Barbara Seaman, who died Feb. 27 of lung cancer. Her Washington Post obituary admirably lays out the highlights of her career as the mother of the women's health movement and as a clear and urgent voice warning women of the dangers first of birth control pills and later hormone replacement therapy.
How right she was became apparent when researchers halted the Women's Health Initiative after finding that HRT actually raised the risk of heart disease and breast cancer. Widespread use of HRT, in fact, by the women of Long Island could explain the high incidence of the disease there, a theory I laid out in an op-ed for Newsday.
But the dozens of speakers last night made plain that Barbara practiced generosity on an unmatched scale, using a vast network of friends in all places as an intricate web that supported and encouraged all of us.
I saw Barbara at a party last fall celebrating the publishing of Devra Lee Davis's book, The Secret History of the War on Cancer. She did for me that night what I now understand was her way with everyone: not just introducing me to people she thought I should meet, but blowing a horn for me that I would never have had the nerve to do myself. I learned at her memorial service that this is what she did for everyone she knew, not just setting up a new connection but pumping up each person's confidence with a recitation of their achievements (how she remembered it all, I cannot say) and admonitions to follow through and make things happen.
I didn't know it was the last time I would see her. She looked well. She told few people about her illness and did not subject herself to chemotherapy or radiation, choosing instead to live out her remaining days in relatively good health until the last few weeks.
In her eulogy last night, novelist Erica Jong described Barbara as her mentor and the mentor for so many other women writers and activists. Barbara had been particularly attentive to young women in her later years, and Jong said she took that as a lesson.
"Mentoring is the next stage of feminism," said Jong.
Perhaps that's just another way of saying that what we give returns to us a hundred-fold.
I miss Barbara. But the appreciation she expresssed for me will always stay with me, a goad to live up to her image of my very best self.
How right she was became apparent when researchers halted the Women's Health Initiative after finding that HRT actually raised the risk of heart disease and breast cancer. Widespread use of HRT, in fact, by the women of Long Island could explain the high incidence of the disease there, a theory I laid out in an op-ed for Newsday.
But the dozens of speakers last night made plain that Barbara practiced generosity on an unmatched scale, using a vast network of friends in all places as an intricate web that supported and encouraged all of us.
I saw Barbara at a party last fall celebrating the publishing of Devra Lee Davis's book, The Secret History of the War on Cancer. She did for me that night what I now understand was her way with everyone: not just introducing me to people she thought I should meet, but blowing a horn for me that I would never have had the nerve to do myself. I learned at her memorial service that this is what she did for everyone she knew, not just setting up a new connection but pumping up each person's confidence with a recitation of their achievements (how she remembered it all, I cannot say) and admonitions to follow through and make things happen.
I didn't know it was the last time I would see her. She looked well. She told few people about her illness and did not subject herself to chemotherapy or radiation, choosing instead to live out her remaining days in relatively good health until the last few weeks.
In her eulogy last night, novelist Erica Jong described Barbara as her mentor and the mentor for so many other women writers and activists. Barbara had been particularly attentive to young women in her later years, and Jong said she took that as a lesson.
"Mentoring is the next stage of feminism," said Jong.
Perhaps that's just another way of saying that what we give returns to us a hundred-fold.
I miss Barbara. But the appreciation she expresssed for me will always stay with me, a goad to live up to her image of my very best self.
Subscribe to:
Posts (Atom)
Posts
