|
Hysterectomy (“hyst.”) is
one of the most common
operations undergone by
women. Uterine Artery
Embolization (“UAE”) is
finding increasing
popularity as an alternative
to hysterectomy for therapy
of benign tumors of the
uterus and abnormal uterine
bleeding in women who, for a
variety of reasons, wish to
retain their uterus.
Leaping past the issue of
whether either procedure is
necessary for you (that
could generate a whole
separate article!), women
are frequently ill-prepared
for the consequences of
their procedure. Surgical
gynecologists and
interventive radiologists
are not necessarily in the
habit of performing
extensive workups or making
time available for
counseling on the potential
sexual fallout from either
procedure. “You’re
bleeding...well, cut it out”
(or occlude the blood
vessel) and, if your ovaries
have been removed, “give you
estrogens...” One visit.
Case closed.
Well...there is a lot more
to it than that. What
follows will be in two
parts: What to ask (and
demand) from your doctor
(gynecologist or
radiologist) prior to
surgery and, what to expect
and how to deal with it.
WHAT TO ASK
1. “What is my problem as
you see it?” [Is this really
your problem as you see it?]
2. “Why do you feel I need a
hyst (or UAE); what will it
accomplish? [Is this what
you wish to accomplish?]
3. “What are other
avenues--surgical,
radiological, nonsurgical,
hormonal, etc., for
accomplishing what I wish?
What are the pros and cons
of each?” [Do any of these
alternatives seem to warrant
further exploration?]
4. How long will I be in the
hospital or outpatient
facility? What about pain?
When can I return to general
activities? Sex? Work? What
are the risks?” [Is this
acceptable to you?]
5. “With this procedure,
will I require hormonal
therapy afterward? If yes:
What do you have in mind?”
[Make sure that you fully
understand this before the
procedure. If ovaries are to
be removed, make sure, in
addition to estrogen, that
testosterone is provided].
6. “In what ways might this
procedure effect me
sexually?”
7. “If you are having a UAE,
be sure to make your
radiologist aware that you
expect him to be careful and
selective, occluding the
uterine arteries distal to
(“after”) the blood vessels
that supply other parts of
the pelvis exit from the
uterine artery.
Schedule an appointment
solely for the purpose of
discussing these matters. If
your interventive
radiologist or gynecologist
is not able, or doesn’t
adequately answer your
questions--find another
practitioner!
WHAT TO EXPECT AND HOW TO
DEAL WITH IT
With either UAE or hyst
(whichever the approach:
abdominal, vaginal,
laparoscopic or
supracervical) you are
having a surgical procedure
involving a very vulnerable
area. Be prepared for this.
Discuss it with yourself,
your partner, your physician
and your therapist if
applicable. How do you feel
about it? What about your
ovaries? Will it be best to
leave them in and let them
function (of dysfunction) as
the case may be? Or to
remove them, substituting
estrogen and testosterone
and possibly
progesterone--which could
either be a hassle or
immensely beneficial,
depending on how those
ovaries are presently
functioning (more about this
later).
1. Loss of your uterus
(hysterectomy): Be prepared
to experience this as a
loss. A part of you--the
organ where your children
grew (or perhaps where you
wanted them to grow if you
are involuntarily childless)
is being removed. On the
other hand, if there is
bleeding, pain, etc.--this
may be a huge relief.
2. Loss of ovaries: Same as
above. If your ovaries are
synonymous with your
femininity--think it over
seriously and discuss with a
therapist or your
gynecologist if the issue is
unresolved. A good rule of
thumb: If you are
psychologically attached to
your ovaries and they help
define your femininity,
leave them in! If, at any
age, there are serious
disturbances stemming from
hormonal dysfunction (e.g.
severe PMS, menstrual
migraine, etc.) consider
taking them out and going on
HT. On average, your ovaries
run out of eggs and hormones
+/- age 45-55, so if you are
over 45, you may consider
removal and
estrogen/testosterone which
will usually guarantee a
smooth transition and
eliminate peri-menopausal/menopausal
symptoms entirely (you won’t
go through menopausal
changes, as you are already
“transitioned” to hormone
therapy). Later, after you
are stabilized, you can work
on a slow hormonal
taper-down if you wish.
3. UAE: Why does a heart
attack hurt? Because muscle
is being deprived of blood
and oxygen and is dying. The
same with the uterine muscle
in UAE. It can hurt like H
for several days. Be
prepared with pain meds and
NSAIDs. Additionally,
understand if the
embolization is not as
“selective” as hoped, you
may have significantly
diminished sensation in
vaginal, vulvar and clitoral
areas.
4. Sexual functioning: Not
infrequently, for factors
related to the reason you
are having your procedure in
the first place, you and
your partner may have grown
sexually distant. Then, for
a period of time (4-6 weeks;
significantly less with UAE
and supracervical lap hyst),
you won’t be able to enjoy
intercourse. Initially you
will be fatigued; you will
be hurting--both hyst and
UAE are a little like
getting run over by a truck.
Discuss this with your
partner. Openly acknowledge
the situation if you have
grown sexually distant. Do
you and he wish to be
closer? Discuss this. It is
not at all unusual for
midlife women and women with
uterine maladies to have a
significant diminution in
desire for a variety of
reasons (hormonal changes,
poor sleep quality and
fatigue, pain, bleeding,
etc.). Get your hormones
balanced with estrogen and
testosterone replacement if
your ovaries have been
removed, and possibly the
same (perhaps even adding
progesterone) if you still
have ovaries but are
perimenopausal. This and the
resolution of the medical
problem will help, but don’t
necessarily expect the
desire to come all back. It
frequently doesn’t. You can
still work your way back to
enjoyable and fulfilling
sexual relations.
Some ideas:
a) Even though you may not
be able to have intercourse,
you and your partner can
still engage in single or
mutual self-pleasuring,
fantasy, oral sex, touching,
kissing, etc.
b) SCHEDULE “DATES”! This
really takes the pressure
off both of you. Schedule
“intimate time” at least
once (hopefully twice a
week) in bed, at a time when
you can be private and when
both of you are fresh. This
is a time for intimacy, for
sharing, for re-
establishment. A time for
communication, for new
directions, for erotica and
fantasy and perhaps arousal.
And, who knows “desire” may
follow...
Remember: What determines
post-procedure sexual
functioning is pre-procedure
functioning and preparation.
The more prepared you are,
the more you have thought
about it and discussed it
with your family, doctor and
counselor, the better you
will do afterward. An
excellent reference for
women about to undergo UAE
or hysterectomy is “A
Gynecologist’s Second
Opinion” by William H.
Parker, M.D. (Plume Books,
2003 edition).
Michael Goodman, M.D., FACOG
“Caring For Women”
Perimenopausal Medicine;
Health and Vitality
Enhancement
Davis California
Website:
http://www.caringforwomyn.com
Dr. Goodman is the author of
the recently released book
“The Midlife Bible, A
Woman’s Survival Guide”,
published in 2004 by Robert
D. Reed Publishers. 2
|
