WOMENS-HEALTH Messages for September, 1999: Re: Severe cervical dysplasia and hysterectomy

Re: Severe cervical dysplasia and hysterectomy

From: William D. McIntosh, MD (anonymous@obgyn.net)
Wed, 22 Sep 1999 09:17:25 -0500 (CDT)

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In reply to: Lieza: "Severe cervical dysplasia and hysterectomy"

At Tue, 21 Sep 1999, Lieza wrote: >
>I was diagnosed with mild dysplasia back in Feb. and had a Leep done.
>My Gyno also told me I have HPV and that my husband should see a doctor
>for this. My husband never went to see a doctor. He just refused. In
>August, I returned for another pap and this time I was dx. with severe
>dyspasia and endometriosis. My options are another leep or
>hysterectomy. I opted for a hysterectomy and I am scheduled for the
>procedure in two weeks. I am reading information stating if I can put
>off a hysterectomy I should. My question is, would it be wise to try
>another leep and this time totally demand my dear husband to seek
>medical attention and see if the dysplasia diminishes or is the
>hysterectomy a good alternative? I am 28 and confused. I don't want to
>leave my children w/o a mother. This is why I opted for the TVH. At
>the same time I am doing research and if I can save MY uterus and cervix
>by all means I will. I just need a little advice. Also, should I seek
>a second opinion before undergoing this surgery?

I can certainly understand your desire to avoid or delay hysterectomy, but what, if any, treatment your husband receives is completely irrelevant to your situation. The HPV is, and has been, in your body, and nothing whatsoever will eradicate it, including hysterectomy. Your husband also has this virus, but penile cancer is very rare, and easily spotted. He probably should mention this to his doctor, but there is not likely to be anything that needs doing for him. He is not re-infecting you between treatments, you already have the virus, so your situation would not change, whether he falls off the face of the earth, or continues as he has been doing, or sees his doctor.

A LEEP proceedure has a >90% probability of curing your severe dysplasia, can be performed in the office at (relatively) little expense, so this is not an indication for a hysterectomy. Of course, you will need close follow-up for some time to come.

Endometriosis can be an indication for hysterectomy, though it should be considered a last resort, to be used only when less invasive techniques have failed, and the when the patient herself has decided that she cannot live this way any longer. Endometriosis is not life threatening, so the descision for hyst is made soley on the patient's perception of her situation, her symptoms, her childbearing desires, etc.

A second opinion is always a good idea whenever you are uncomfortable with your choices. By the way, a hysterectomy for endometriosis where the ovaries are left in place is usually pointless. The ovaries are the source of the estrogen that is the "fuel" for the endometriosis, while the uterus is usually a relatively innocent bystander. If you are not going to have the ovaries removed as well, you might as well not have the hyst.

-- William D. McIntosh, MD, FACOG 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.

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