WOMENS-HEALTH Messages for March, 1997: Re: Uterine Prolapse

Re: Uterine Prolapse

From: R.Daniel Braun, MD (anonymous@obgyn.net)
Wed, 26 Mar 1997 19:19:32 -0600 (CST)

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At Wed, 26 Mar 1997, Janet wrote: >
>I Have a prolapsed uterus to the point where my cervix is sometimes
>protruding about an inch outside of me . I also have a cystocele and a
>rectocele.(They occured before the prolapse) I really do not want a
>hysterectomy. I live on Long Island and I am having trouble finding a
>doctor that will do a uterine suspension.Does anyone know of any doctor
>that specializes in this? I am 42 years old and have not gone through
>menopause yet. I have read that a hysterectomy cuts off some of the
>blood supply to the ovaries and causes a woman to go into menopause
>sooner than she normally would. I also have heard the uterus affects
>sexual response, affects the support of other organs and releases
>chemicals in the body that contribute to your overall feeling of well
>being(endorphins). I am sorry that this is so long, but if there is
>anyone out there that can help me please write. Oh, also at what point
>should I give up on doing Kegels. They seem like they don't do a darn
>thing.
>
>--
>Janet
>

I would certainly give up on the Kegel's now if you have been doing them longer than 3 months and have no relief at all. If they have helped some, then I would recommend continuation. In general, a uterine suspension won't really help with the prolapse. It might make it so that the uterus is not quite falling out, but it probably won't help much with the pressure sensations and falling out sensation and heaviness etc. that you also have. The only thing that will help many ladies (not all will be helped by it and not all will require it to help) is a hysterectomy and depending on the findings, a sacrospinous fixation of the vagina. This is sutureing the upper part of the vagina to a ligament in the pelvis called the sacro-spinous ligament. If, I have a patient with severe prolapse who does not want a hysterectomy, I will sometimes have them try using a pessary. This is a device that goes into the vagina and helps hold things in. It is placed every day and removed every night (sometimes only once a week) It does prevent intercourse when it is in. In general, any surgery less than a hysterectomy will not give adequate relief to justify the risk of surgery. A vaginal hysterectomy and suspension can leave the ovaries in place. They should function just as well after removal of the uterus as before. On the other hand I offer removal of the ovaries to any woman age 40 or above who is having a hysterectomy. This is because of the risk of development of ovarian cancer. Oophorectomy(removal of the ovaries) would mean that you would need to start taking hormonal replacement therapy now instead of whenever your own ovaries stopped working somewhere between 45 and 55 years of age. There are reports of some women who have a change in sex response after hysterectomy, but the majority report no change. If it was good, it usually stays that way. If it was bad, it usually stays that way. I find in general that most of the stories about hysterectomy prevent women who need them from having them. My wife is an excellent example. She had severe pain for about 12 years, from adenomyosis. Her gynecologist and I both told her she should have it done but she was afraid to. When she did have it done, she woke up in the recovery room and said "Gee I don't hurt." These were her first words with a fresh major surgery. Her only regrets now 15 years later is that she didn't have it done much sooner. I'm sorry to have rambled on this way for so long. I hope this helps you. Remember though, YOUR Gynecologist is the one who knows YOUR findings and needs much better than I do. If you are concerned about his or her recommendations, seek a second opinion in person not over the net.

--
R.Daniel Braun, MD  FACOG
Clinical Professor of Obstetrics and Gynecology
Indiana University School of Medicine
Indianapolis, IN
                                      "Heisenberg might have slept here."
                                                                                         Unknown

Next message: Douglas: "Re: cervical cancer follow up"
Previous message: anonymous@obgyn.net: "Re: Paxil & Pregnancy"
In reply to: Janet: "Uterine Prolapse"
Next in thread: Harvey S. Marchbein, M.D.: "Re: Uterine Prolapse"

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