Why Does the US Favor Total Abdominal Hysterectomy?

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Betty Dodson

Dear Betty,

Various surveys show that 30 to 40 percent of women have some sexual deterioration from a hysterectomy and the doctors don't tell them.  The government says that 40 percent of them are not needed. Since you are coming out against circumcision, FGM and labia surgery, I would think you would work on this also.

It would be especially noticed on Youtube.  Here it shows the effect of routinely removing the cervix in the operation:

27% have a bad effect from that, yet the cancer risk is tiny. Sometimes the vagina winds up too short or there is pain. As you might expect, the cervix and ovaries are removed much less in Germany.  Here the cervix is removed 93% and the ovaries over 70% of the time. The safest sexually is to simply remove the growth if that is the problem or just the uterus without the cervix.

Here is a discussion of the various problems that occur:

Towards the middle here it reviews why ovaries should not be removed.

Doctors routinely have consent forms that allow them to do as they see fit and they don't value the ovaries and cervix a whole lot. To avoid their removal, a woman could require that the form say they will not be removed unless cancer is proven or no more than a minor part of an ovary can be removed.

It would help a huge amount if these links were put in some prominent place.


Dear D,

You are so right. I dealt with hysterectomy issues in my old website, but not as much since we've launched D&R. So many of my questions now deal with the younger population of teens and twenties who are victims of the Bush years with abstinence only standing in for sex education. However, even before that time our sex ed in grade schools, high schools, colleges and universities was and still remains inadequate when it comes to including information about how to create sexual pleasure for women!

I am still happily intact with all my sexual parts. Now in my early 80's, I'm having great orgasms with masturbation. Carlin is in her prime about to turn 40 and she is very active sexually. So the subject of hysterectomy doesn't show up frequently in my Q&A section. I quote from your links below:

"Current practice in the United States strongly favors total abdominal hysterectomy (TAH) over supracervical hysterectomy (SCH) for benign gynecologic disease. Potential advantages of SCH over TAH include decreased operative morbidity and reduced risk of urinary and sexual dysfunction [5-10]. Patient concerns about sexual functioning after hysterectomy may also play a role in the decision to undergo a supracervical hysterectomy versus total abdominal hysterectomy."

Today, I believe most women and doctors know to leave ovaries or at least one ovary intact. However leaving the cervix in place is not well understood especially as it relates to a woman's sexual arousal and orgasm.

I'm speaking first person now as it's based on my experience. When I become VERY aroused which can take up to 30 minutes or more of clitoral stimulation, my uterus lifts up (balloons) which creates more vaginal depth. In this state, I'm comfortable with an 8" penis or my Obsidian dildo going deep past my cervix into what I call "the cul de sac" which I believe is also known as the "D" (deep) spot. Perhaps this is what we call a "vaginal" orgasm that women claim feels "deeper and more profound than just a clitoral orgasm.

Since I am also stimulating my clitoris with a vibrator at the same time, I suspect this has yet to be studied by science that is still primarily controlled by men in the past. This is changing as more women enter into these professions.

These so-called spots or areas are all part of the internal clitoris that sends signals through the spine to the pleasure center in our brains. One exception is the vagus nerve that transmits information from the cervix, uterus and vagina and bypasses the spinal cord but still reaches the brains pleasure center.

hypogastric nerve – transmits information from the uterus and cervix in women and the prostate in men.

pelvic nerve – transmits information to the vagina and cervix in women, and the rectum, for both sexes.

pudendal nerve – transmits information from the clitoris in women and the scrotum and penis in men.

vagus nerve – transmits information from the cervix, uterus and vagina and bypasses the spinal cord.

Since I am dyslexic and have a reading comprehensive disability, I don't pretend to understand the science of our brains and nerves. For instance the idea that female orgasm is always accompanied by pelvic contractions is not always the case for me. While I have at times been aware of this sensation, it is not consistent. But I do know that my cervix is involved in what I call the "Meltdown Orgasm" which I described as absolutely the best, but so rare indeed. To be downright truthful, I've maybe had two so far this year from extended masturbation while edging. . .getting close and backing off many times before I allow my orgasm to explode! I'm convinced my cervix is involved in this profound experience.

This is a long winded effort to explain why I believe the cervix is part of female sexual response. For those women who no longer have one, you are still orgasmic. Remember, the Big O is rare enough that we can live happily without one. However, given the choice, most women we would prefer to keep the cervix. So all doctors have to do is bone up on the technique to do this just a bit more complex surgery. The result will be that women will heal more quickly and those of us who really prefer those deep orgasms and cervical contractions can still enjoy them. That's not asking too much of the medical professionals!

Thanks D for bringing this up.

Dr. Betty

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