Over Half of Doctors Fail to Fully Explain Hysterectomy Options

A new report reveals that more than 60 percent of doctors rarely or never discuss the differences between total and subtotal hysterectomies with their patients. The study, published in the August issue of the journal Obstetrics and Gynecology, relied on a survey of doctors in the Washington, DC area. In total hysterectomies, the entire uterus and cervix is removed through a major abdominal incision; in subtotal hysterectomies, the cervix remains intact and the uterus is usually removed through the vagina, according to Gannett News Service.

Most of the gynecologists surveyed prefer total hysterectomy, and the most common reason was to eliminate the subsequent chance of cervical cancer, according to Reuters Health. However, those in favor of subtotal hysterectomies for women with no clear risk of cervical cancer argue that keeping the cervix may help preserve urinary, bowel, and sexual activity, Gannett reports. Dr. Steve Goldstein, a professor of obstetrics and gynecology at New York University, told Gannett, “What makes this survey so especially disturbing is not just that these doctors were making a choice for their patients without consulting them, but that they chose a surgical option that I believe most women would never choose for themselves, if they were told the truth about their options.” Subtotal hysterectomies also have a faster recovery rate and less risk of postoperative complications, Gannett reports.

Nearly 50 percent of doctors said they routinely performed total hysterectomies even when women had benign uterine diseases like uterine fibroids. Thirty to 70 percent of all women are estimated to have uterine fibroids-particularly women in their 30s and 40s and African American women. A study published in Obstetrics and Gynecology in February showed mifepristone’s promise as a non-surgical way to shrink fibroids. Mifepristone, also known as RU 486 or the “abortion pill,” was shown to shrink uterus sizes 50 percent after six months of treatment. While further studies are needed, they are hopeful that the shrinking of fibroids with mifepristone will 1) help protect against infertility 2) allow some women to avoid a hysterectomy and 3) reduce complications should surgery still be required.

The Feminist Majority Foundation has been leading a campaign to increase clinical trials and research into the potential uses of mifepristone not only to treat fibroids, but also endometriosis, breast cancer, uterine cancer, ovarian cancer, and other serious illnesses. However, efforts by anti-abortion extremists, including a recent petition to the Food and Drug Administration asking for a review of FDA approval for the drug, have severely limited access for women in the US to a potentially lifesaving drug.

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Obstetrics and Gynecology 8/2003; Gannett News Service 8/13/03; Reuters Health 8/11/03; Feminist Majority Foundation

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