WOMENS-HEALTH Messages for February, 1998: Hysterectomy or tubal? (long)

Hysterectomy or tubal? (long)

From: llb (anonymous@obgyn.net)
Fri, 27 Feb 1998 12:35:50 -0600 (CST)

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Reply: Harvey S. Marchbein, M.D.: "Re: Hysterectomy or tubal? (long)"

I'm having a scheduled c-section in a few months, and was planning to have a tubal ligation done at the same time. I'm now trying to decide whether to have the tubal ligation with childbirth as planned, or to wait and have a separate surgery - hysterectomy (w/o BSO) and bladder repair. Here's the history:

Since a vaginal delivery 12 years ago that involved a 3-hour pushing stage, I have suffered from stress urinary incontinence that has gotten worse with gradual weight gain; before this pregnancy, exercises suggested by a physical therapist specializing in pelvic floor strengthening have been minimally effective in treating the SUI.

I'm aware that pelvic floor relaxation can produce all sorts of very nasty symptoms as one ages; i.e., cystoceles, rectoceles, worse SUI, urge incontinence. I'm also aware that for these reasons and others (endometriosis, unexplained pelvic pain, dysmenorrhea, dysparunea, cervical dysplasia), many women end up choosing to have a hysterectomy later in life.

In my mind, here are the pros to having the hysterectomy and bladder repair: - Desire for permanent sterility (which could admittedly be accomplished with tubal ligation) - History of worsening SUI - Likely avoidance of common pelvic floor problems - No more periods!

Here are the cons: - Separate surgery (with associated risks) w/general anesthesia, and separate recovery period - ?

This is a tough decision. Though there is no physiological reason for having a uterus once childbearing is complete, does the uterus have any other holistic function in the body? Am I being too paranoid assuming that my current SUI will get worse with age? Is there anything else I'm not considering? Though I only briefly discussed the option with my female OB, I was quite surprised that she didn't try to dissuade me from hysterectomy...my impression was that she considered it as viable an option, considering my history, as a tubal. Any opinions, medical or otherwise, are very much appreciated.

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