WOMENS-HEALTH Messages for February, 1999: Re: Ovarian Cyst: Laparoscopy vs. conventional surgery

Re: Ovarian Cyst: Laparoscopy vs. conventional surgery

From: William D. McIntosh, MD (anonymous@obgyn.net)
Sun, 28 Feb 1999 11:04:18 -0600 (CST)

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In reply to: Chuck: "Re: Ovarian Cyst: Laparoscopy vs. conventional surgery"

At Sat, 27 Feb 1999, Chuck wrote: >
>Dr. McIntosh--
>
>Thank you for the helpful information regarding ovarian cyst removal.
>One more question: As I mentioned before, my wife already had her left
>ovary removed. If the doctor finds it impossible to save her right one
>when removing this cyst, is there any reason not to remove her uterus at
>the same time? It appears to be a widely accepted practice to remove the
>uterus once the ovaries go, but is this for any particular reason, other
>than to avoid unnecessary periods (assuming she would go on ERT)? Is
>there any possible benefit to leaving the uterus fully intact or at
>least partially intact (perhaps leaving the cervix)?
>
>Again, thanks.
>

Well, you do like to ask the tough ones. Classically, before the advent of good antibiotics and so on, you did the minimal surgery possible, in this case leaving the uterus. If the patient had residual problems with that, well at least she was alive.

Traditionally, the past 30-40 years, the focus changed. Surgery was dramatically safer, so doing more extended proceedures could be undertaken without a significant increase in risk. Since the uterus without ovaries is regarded as a vestigal organ, removal of the uterus has been generally done at any proceedure in which that last ovary is removed unless there was a good reason not to.

This idea is being rethought, and some people want the uterus, or perhaps just the cervix left in place. Like all of medicine, this is a balancing act. On one hand, some believe that the uterus, or at least the cervix can play a role in sexual gratification. There is little or no objective evidence for this view, but many hold it. On the other hand, a residual uterus significantly complicates hormone replacement therapy, an especially important concern in a woman such as our wife about to be made menopausal surgically at an early age (I am assuming that). Abnormal or irregular uterine bleeding are very possible, and any conditions that affect the uterus such as fibroids, adenomyosis, prolapse and so on can occur as well. This won't happen more commmonly than if she never had any surgery, perhaps even less, but if it is still in there, then it is subject to the diseases that the uterus is subject to.

A compromise would be to leave the cervix only. This still leaves a small chance for bleeding, and of course appropriate pap smear followup, but would probably preserve the sexual function, if any. I must confess, in my patient population, generally women who have a hysterectomy for a uterine problem have a sigificant improvement in their sexual enjoyment, and women who have a hysterectomy for a nonuterine problem, such as your wife, have a small reduction in their sexual enjoyment, though with time and understanding, this can usually be overcome.

-- William D. McIntosh, MD Clarksville, TN

This is for educational purposes only. It is not intended to replace consultation and examination by your physician or other health care provider.

Next message: Chris: "Ovarian cysts"
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In reply to: Chuck: "Re: Ovarian Cyst: Laparoscopy vs. conventional surgery"

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