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gya wmv gya roberts gya takes over gyakuten jazz gyakuten doujinshi gya roberts global gxxd81 princess diaries 3 The
Purpose of This Web
Site
For a FREE
consultation with Dr. Toaff, Click Here
gyakushuu gxxd avi star wars the roleplaying game gyakuten kenji gxxd 70 were all to blame gxxd68 javi mula come on gyakusyuu4 You
have been told
by your physician
that you must
have a hysterectomy.
Do you know
the reasons
why? Do you
know that there
are alternatives
to hysterectomy?
Do you know
if you are a
good candidate
for another
treatment option?
gyakushuu 4 gyagu manga biyori 2 gxxd 84 gxxd 68 gyakkyou burai kaiji hakairoku hen tankard best case gya roberts boobs Chances
are that if
you did not
specifically
ask, you were
not informed
about an alternative
to hysterectomy.
And, if you
did inquire,
you may have
received an
unsatisfactory
response. You
may have been
told that "hysterectomy
is the best
and most reasonable
solution in
your situation",
or that having
completed your
family, you "don't
need your uterus
and ovaries
any more".
Understandably,
your reaction
to this may
have been shock,
disbelief or
anger and you
simply couldn't
accept this.
You were wondering
if there were
any alternatives
to hysterectomy?
In
this site you
will find answers
to your questions
regarding other
options besides
hysterectomy.
While not all
women are candidates
for treatments
other than hysterectomy,
most women do
have choices.
All women should
be fully informed
about their
condition and
their options
before undertaking
definitive treatment.
gxxd 83 gxxd 80 gyakujoku gxxd 98 gxxd 96 gya roberts micky Why
Would a Woman Resist
Hysterectomy?
In
the United States
550,000 hysterectomies
are performed
each year. In
the vast majority
of these cases
the indications
for surgery
are benign,
non life-threatening
conditions.
Only 10% of
hysterectomies
are performed
for cancer.
The common rationale for advising
hysterectomy and oophorectomy
(removal of the uterus and
the ovaries) is as follows:
the role of the uterus is that
of an "incubator," to
carry babies into this world.
Once the incubator role is
over, be it because of a woman's
age or her lack of desire for
more children, the uterus is
a nuisance. The uterus may
bleed, cause pain, prolapse,
and/or develop cancer. At this
point, hysterectomy would be
considered an advantage to
a woman's well being and longevity.
Regarding the ovaries, it is
commonly felt that after age
40, ovarian function (hormone
production) is approaching
its end, and since the ovaries
can develop cancer it is only
logical to remove the ovaries
as well during hysterectomy.
The resulting absence of ovarian
estrogen, it is proposed, can
be easily overcome with estrogen
replacement therapy.
Is this attitude supported
by scientific evidence and
recent research? An increasing
number of women, as well as
many physicians, believe strongly
that it is not. The uterus
has many roles, not just that
of an incubator. Consequently,
hysterectomy may be followed
by negative consequences, which
may significantly impact the
quality of a woman's life.
First, let us consider the
old rationale that hysterectomy
and oophorectomy can prolong
a woman's life by preventing
uterine and/or ovarian cancer.
The lifetime probability that
a 50 year-old woman will die
of uterine cancer (including
cervical cancer) is 0.5%, for
ovarian cancer this probability
is 0.8%. (Interestingly the
risk of ovarian cancer after
hysterectomy is 40% lower than
expected compared to the general
population). In contrast, the
same woman's risk of dying
of cardiovascular (heart and
blood vessels) disease is 50%.
It has been shown that hysterectomy
(even without oophorectomy)
during a woman's reproductive
years increases the risk (triple
the risk according to some
studies) of heart attack during
the remaining reproductive
years. If the ovaries are removed
as well, the risk of developing
heart disease and osteoporosis
is further increased. The risk
of coronary heart disease decreases
by 6% for each year oophorectomy
is delayed after menopause.
It
has been shown that
after hysterectomy,
even without oophorectomy,
women tend to enter
menopause earlier,
by as much as four
years on the average
according to one
study. During menopause
there is a sharp
increase in the risk
of coronary heart
disease. We may conclude
then that hysterectomy
and oophorectomy
are not likely to
prolong average life
span, rather they
may actually shorten
it, due to an increase
in heart and vascular
disease.
Estrogen
produced by the ovaries
reduces the risk
of osteoporosis and
possibly the risk
of heart disease.
Estrogen may also
help to maintain
cognitive and sexual
function. Theoretically
then, hormone replacement
therapy after hysterectomy
and oophorectomy
could counter the
negative effects
of estrogen deficiency.
However, a recent
study (Women's
Health Initiative) reports
a slight increase
in the risk of heart
disease, thromboembolic
disease, and breast
cancer in women on
combined estrogen-progesterone
(Prempro) replacement
therapy. This has
led medical authorities
to recommend restriction
of hormone replacement
therapy to be used
only for short-term
relief of vasomotor
symptoms or vaginal
dryness. Even prior
to this latest study
it had been shown
that only about 50%
of women for whom
hormone replacement
therapy was prescribed
were still taking
the medication after
12 months. Overall,
only 10% of menopausal
women in the U.S.
are taking hormone
replacement therapy
and this percentage
is dropping rapidly.
Given these facts,
there is a compelling
argument for avoiding
unnecessary hysterectomy
whenever possible.
It is clear that
optimal health is
maintained by uterine
and ovarian preservation,
except when cancer
is already present
or there is a family
predilection for
cancer.
Recent
studies show
that the symptoms
of surgical
menopause (sudden
onset of menopause
after removal
of the ovaries)
are more severe
and prolonged
compared to
symptoms during
natural menopause
(when ovarian
function gradually
diminishes).
The aging ovaries
continue to
produce certain
amounts of estrogen
for at least
ten years after
the start of
menopause and
of androgens
until at least
age 80. The
androgens are
converted to
estrogens by
the fatty tissue
and muscle to
estrogens. Women
who had their
ovaries removed
after menopause
had 54% more
osteoporotic
fractures than
women with intact
ovaries. Androgen
deficiency affects
bone loss, libido,
muscular and
fat distribution,
the sense of
well being,
energy, and
appetite. Preservation
of the ovarian
production of
estrogen and
androgen, albeit
reduced compared
to the reproductive
years, may contribute
significantly
to a woman's
health. This
is another rationale
for preserving
the genital
organs even
after menses
have ceased.
In
a recent long
term observational study,
hysterectomy
was shown to
double the risk
of fracture
in perimenopausal
women. Hysterectomy
also increased
the risk of
osteoporotic
fractures by
20% regardless
of whether the
ovaries were
removed or preserved.
Swedish researchers published
a very large population
study that showed that
women undergoing hysterectomy
are twice as likely to
require subsequent surgery
for Stress urinary incontinence,
the risk being higher
within the first five
years. The need
for organ prolapse surgery
increases 50% women with
a previous total abdominal
hysterectomy, doubles
among women with a previous
subtotal hysterectomy
and quadruples with a
previous vaginal hysterectomy.
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recent
study reports
that women
who underwent
oophorectomy
had an
increased
risk of
developing
dementia
and cognitive
impairment,
especially
if surgery
occurred
before
age 38.
The risk
of dementia
and cognitive
impairment
increased
70% in
women who
underwent
bilateral
oophorectomy
before
age 46
and 260%
in women
who had
unilateral
oophorectomy
before
age 38.
It is also
significant
that surgical
menopause
is abrupt
and can
cause intensified
symptoms.
The health
risks associated
with bilateral
salpingo
oophreectomy
appear
to outweigh
any health
benefits
it might
confer.
gya r gxxd 87 gxxd 69 gyakushuu cg melissa monet wmv avi gya xlg gxxd96 Other
long-term adverse
effects of hysterectomy
have been reported.
Some studies, although
not all, report that
new urinary symptoms
such as frequency,
urgency, and incontinence
occur in 30% of woman
after hysterectomy.
This may be the inevitable
result of bladder
denervation (surgically
cutting off the nerve
supply to the bladder)
during hysterectomy.
Also, slow propulsion
constipation develops
in about a third
of women after hysterectomy,
even without the
presence of rectocele.
Frequently, hysterectomy
leads to sagging
of some internal
genital organs such
as the anterior vaginal
wall (dropped bladder
or cystocele) and
posterior vaginal
wall (rectocele).
These conditions
may cause symptoms
such as difficulties
in urination, stress
urinary incontinence
or constipation,
difficulty in penetration
during intercourse,
and vaginal infection.
These conditions
may be severe enough
to require surgical
correction.
Emotional health may also be
affected by hysterectomy. The
uterus has great psychological
significance for some women,
more so in certain cultures.
Although many women have no
emotional difficulties after
surgery, hysterectomy may be
followed by problems such as
depression, anxiety, and sexual
dysfunction. The issue of sexual
function after hysterectomy
is complex. Some women feel
that by losing their uterus
they have lost their womanhood.
They may feel that their partner
no longer desires them leading
to loss of libido. One physical
consequence which may result
from hysterectomy, and may
directly affect sexual function,
is shortening of the vagina
resulting in pain during deep
penetration. The most important
effect of hysterectomy on sexual
function may be on orgasm.
For some women, "deep" orgasm
involves rhythmic uterine contractions.
Following hysterectomy this
important component is lacking
and such women complain of
a dramatic decline in the quality
of their orgasm. For women
whose orgasmic pleasure does
not depend on uterine contractions,
hysterectomy may not lead to
a decline in the quality of
their sexual response. In fact,
many women report that hysterectomy
led to an improved sexual life,
especially when hysterectomy
eliminated major medical problems
such as bleeding, pain, and/or
prolapse of the uterus. In
other women, fear of an unwanted
pregnancy always had a negative
effect on sexual function and
elimination of this fear by
hysterectomy has enhanced pleasure.
Finally, many women are strongly
opposed, in principle, to the
removal of any organ, genital
or otherwise, unless absolutely
necessary.
In this discussion the drawbacks
of hysterectomy have been summarized.
As women have informed themselves
regarding these issues many
have resisted hysterectomy
until they are convinced that
it is absolutely necessary
for their well-being. After
30+ years in the practice of
obstetrics and gynecology it
remains my firm belief that
a woman has the right to decide
the fate of her own organs.
She should not be made to feel
inadequate or disturbed for
questioning the necessity of
hysterectomy. In fact, I believe
that it is the obligation of
the physician to present to
each woman all of her treatment
options in detail, giving her
the pros and cons of each option.
I believe a physician should
do so honestly, even if that
particular physician is not
capable of providing some of
the treatment options. If the
patient elects not to have
an hysterectomy, it is the
obligation of the physician
to support her in her decision,
even when it means referral
to another expert.
gxxd38 gya bbw gyakkyou burai kaiji gxxd94 gyakuten ippatsuman gxxd97 "......use
of hysterectomy will decrease
as time advances...truly
visionary and responsible gynecologists
will be committed to the
development of new methods
for dealing with certain
functional diseases of
the uterus which will
provide greater comfort
and safety for the patient."
R.
Landesman, MD
(From: Obstetrics and Gynecology
1969:34,625)
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©
COPYRIGHT 1996-2010 ALL RIGHTS RESERVED
MICHAEL E. TOAFF,
MD, MSc
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