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

Re: Hysterectomy or tubal? (long)

From: Harvey S. Marchbein, M.D. (anonymous@obgyn.net)
Fri, 27 Feb 1998 15:48:49 -0600 (CST)

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In reply to: llb: "Hysterectomy or tubal? (long)"

At Fri, 27 Feb 1998, llb wrote: >
>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
>- ?

First, let me congratulate you on a well thought out presentation and logical decision making concepts.

>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?

In many it will give support to the pelvis but not, apparently, in you.

>Am I being too paranoid assuming
>that my current SUI will get worse with age?

Statistically, you are correct but it is different for everyone.

>Is there anything else I'm
>not considering?

You have a wonderful grasp of the facts. the dicision is the hard part.

>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.

Good luck in your deliberation.

--
Harvey S. Marchbein, M.D. FACOG
OBGYN.net U.S. Representative, New York
Great Neck, New York
http://www.obgyn.net/states/bios/marchbein.htm
http://www.obgyn.net/women/advisors/harveym.htm

**Note:  Opinions expressed here are for educational purposes only
and, as such, do not constitute a physician-patient relationship.
This information is not intended to supplant the need for you to
consult with your physician prior to choosing therapeutic options
and/or interventions.

**Private emails cannot be entertained due to time constraints,
consequently no private emails will receive a response.

**Thank you for your understanding ;-)

Next message: Harvey S. Marchbein, M.D.: "Re: Question about oral contraceptives"
Previous message: Harvey S. Marchbein, M.D.: "Re: calcium/magnesium/vit.e overdose (and endo)"
In reply to: llb: "Hysterectomy or tubal? (long)"

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