Surgery to remove uterus treats fibroids and endometriosis
If you or someone you know has been told to have a hysterectomy, one of the first things to do is to go to the internet on Google to type the word. You will find more than 400 thousand references in Portuguese and four million in English. Ready: If you hoped for something that would help, you'll probably have a little trouble understanding the real meaning of this term and the scope of the surgery. If you ask friends or relatives, you may hear absurdities, further increasing the doubts and, consequently, insecurity.
Organ is fixed at the time of the cervix making a projection to the vagina - Photo: Getty Images
To understand the hysterectomy, first let's talk a little about this incredible yet misunderstood organ, the uterus, which helped to perpetuate our species in the world. Just to have an idea, it has the ability to grow more than a thousand times during pregnancy. It weighs around 90 grams and fits inside about 5 ml of liquid, and at the end of gestation comes to weigh more than 1 kg, with the capacity to store more than five liters. It is fixed at the time of the cervix by protruding into the vagina (see figure). All this developmental capacity and some genetic alteration of their cells (which may be of a familial or racial character) is the cause of the onset of fibrous tumors of the fibromuscular tissue of the uterine wall. More than 50% of women of reproductive age have fibroids, but only 20% of them will need some form of treatment. Endometrial polyps (uterine cavity), as common as fibroids, follow this same theory and are also causes of abundant uterine bleeding.
The uterus is located between the bladder and the intestine, and therefore surgeries can lead the risk of injury to these structures, especially when there are diseases such as fibroids, endometriosis, cancer and adhesions that distort the anatomy of the pelvis. It is estimated that one to two deaths per 1,000 surgeries occur.
Hysterectomies are surgeries for removal of the uterus. After appendectomy (removal of the appendix), it is the second most performed surgery in the world. It is estimated that in Brazil about 20 to 30% of women will undergo this operation until the sixth decade of life, approximately 200 thousand cases per year, the South region with the least number (PROADESS until 2010), probably by the patients and doctors have other treatment options and lower incidence of cervical cancer. In the US, this number is around 600,000 per year. Medical indications can be for a number of reasons, and benign diseases account for 90% of them, such as fibroids, prolapses, abnormal bleeding and endometriosis. However, pre-malignant and malignant (cancer) lesions may also be responsible for the indication of hysterectomy.
There are numerous other treatment options for benign diseases allowing the preservation of the organ
Regarding the access route for withdrawal of the organ, can be made via the abdominal cavity with minimally invasive techniques - laparoscopy and robotic surgery - open with incisions similar to cesarean sections or vaginally without scarring in the abdomen. The surgery can be total, with or without removal of the ovaries and fallopian tubes, or subtotal, preserving the cervix. The studies do not show any difference for the patients who preserved the cervix regarding the static (fixation) of the vagina, alteration in the urination, or difference during sexual intercourse. The preference, however, is to remove it to avoid bleeding or risk of cancer, especially in the population that has no possibility of adequate screening and when there is a surgical possibility.The decision to have a hysterectomy, type and access route should be discussed at length with the surgeon, always observing the existing disease, risks, benefits and experience of the doctor. Other surgeries may be necessary associated with hysterectomies such as: correction of urinary incontinence, rectal prolapses, correction of fistulas, etc.
There are numerous other treatment options for benign diseases, allowing the preservation of the organ, especially in patients who still want get pregnant. Before the decision, it is necessary to evaluate alternatives like:
- Myomectomies, which consist in the removal of fibroids; Embolization, which is the occlusion of the arteries that irrigate the fibroids, generally with excellent results; Hysteroscopy, where a camera device enters through the cervix into the uterine cavity, allowing the removal of fibroids, polyps and endometrium; Treating hormone disorders with the use of hormones or medicated IUDs in cases of endometrial hyperplasia, which is the growth of tissue surrounding the uterine cavity; Use of analogues, which are medicines that block the ovaries, keeping the patient in a state of? Menopause? for a period until definitive treatment (surgery, for example); Hormones to keep the patient without menstruating for a longer time without leading to a menopause.
The connotation and symbolism of the uterus regarding femininity, motherhood, is very strong. Although not visible and expressing itself in the form of monthly bleeding due to cyclical hormonal variations, the uterus can be a storehouse of dreams, expectations and also unresolved emotional problems. It is enough to remember that in the past it was thought that it was the cause of hysteria, at a time when all pathologies from convulsions, psychoses, neuroses had the same diagnosis. There are still many beliefs today about the withdrawal of the uterus without fundamentals such as: to lose weight, to lose the libido, to lose the pleasure in the relationship, to lose the essence of a woman, that men will not be interested anymore. Not only the suffering of the woman who goes through the surgery, there is also the psychic violence, veiled, often more painful than the scars. That's why you need to be well-informed and emotionally empowered before surgery. So, if possible, look for other opinions!
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