1 Females, Fibroids and Mutilation

	Mutilation - Any operation which deprives the body of one of its members, eg an arm leg or organ, is a MUTILATION and such a measure is only 	undertaken when the health of the individual necessitates this and with the permission of the patient and his relatives.
	Medical and Nursing Dictionary and Encyclopedia

A Woman's Place....

Most living organisms are basically hermaphrodites. An animal, such as a human, has a pair of gonads the surface of which is capable of producing eggs while the core produces sperm. Rarely a human hermaphrodite is found with an ovotestis, producing both sperm and eggs. Although not a lot of people know this sex was invented only to introduce genetic variation to a species. Having separate sexes means that not only is genetic material reassorted and reorganised into many different combinations but self fertilisation cannot not occur.
The body shows clear evidence of its hermaphroditic nature. The male penis is the clitoris in the female. The male has a vestigial uterus. Both sexes have mammary glands though only the female suckles its young. All the steroids produced by the ovary, testis, adrenal cortex and placenta share the same basic structure, founded on cholesterol. And the same sex hormones are found in both sexes. Females produce male hormones, androgens, and males produce the female hormones, oestrogen and progesterone. The different sexes show different development of the basic hermaphroditic system and produce differing amounts of the same hormones. 
The genetic material of a human is collected into twenty three pairs of chromosomes. Twenty two pairs are called autosomes and are randomly inherited by males and females. The sex chromosomes of the female are a matched pair of average size chromosomes, called X chromosomes, while the male has two dissimilar chromosomes, one X and a small Y. It is theoretically possible for a female to inherit from her mother the chromosomes - both autosomes and X chromosome - which her mother got from her maternal grandfather and so be entirely composed of genetic material from males and yet be completely female.
There is no genetic material specifically limited to females and the material found only in males, that of the Y chromosome, has been linked with few genetic characteristics. This small chromosome does not confer intelligence, courage, strength, virtue, understanding or wisdom to its holder. What it does do is make the gonad develop into a testes, ensuring that its possessor will be a privileged individual, a responsible adult and not a silly female to be condescended to - or worse treated as insensible property.
In most cases, that is.
There are several gene variations which causes the female secondary sexual system to develop even in the presence of a Y chromosome. The resulting individual is genetically male and has male gonads but his body is physically female. He is usually treated with female hormones to maintain his female appearance and often also treated like a female in not being told just why he doesn't bleed like all the other girls.

There is thus no genetic basis to any claim of male superiority. And no justification for either male machismo or female intuition. And since all individuals produce the same hormones, though in different amounts, it would be difficult to assert a hormonal basis for male excellence. In fact, like unbalanced female hormone levels, excessive androgen production appears to have decidedly anti-social effects.
Nevertheless in most countries and cultures it is the female who finishes up with the sticky end of the lollipop. As Wendy Cooper puts it so concisely in Understanding Osteoporosis, "It was basic female biology that from the start confined women to a constant round of childbearing and caring, giving men their chance to exclude them first from the hunting pack, then from the councils of power, and in that way from access to wealth and influence in their own right."
We are a long time from the hunting pack but the situation today is not significantly different, as the authors of the original American Our Bodies, Ourselves noticed:-
"At school we had learned that though we were expected to do well our real vocation was to be wife and mother. Boys were being trained for the  important work in society. We learned that what our culture labelled as work was not for us, and what we did was not seen as important."
But it was not enough merely to relegate all women to subservient roles. The male was set up as the real human, compared to which all females were imperfect, flawed copies that had to be managed by men. They were not only physically weaker but physically and mentally inferior. And spiritually they didn't exist at all.

....is Under the Heel

The ancient Greek Aristotle declared that spherical hens eggs must develop into cocks since the sphere was the more perfect geometrical shape just as the male was the more perfect human form. Although esteemed as a biologist Aristotle reached this conclusion purely on male chauvinist theory. Two millennia later a pedantic Teuton took the trouble to hatch out numbers of round and oval eggs to establish that the sex of the chick bore no relationship to the shape of its egg.
The ultimate in the negation of women is shown in classic Greek drama where Apollo appears in defense of the mother murdering Orestes, stating that men have only one real parent, the male. The female is only the ground which grows the male seed. It's therefore quite permissable to murder, rape and abuse any and all females, since they are all essentially non-persons of 
the sort that jews became under the Nazis. Centuries later early microscope users drew fanciful pictures of these miniature humans, which they called homunculi, and which they convinced themselves they had seen inside every sperm.
The major religions all discriminate against women. Christianity was not only based on male dominated Judaism but its dogma was crystallised by St Paul the misogynist. Intellectually the christian church admired the classical Greeks, so antipathetic to women that they even preferred males as bedfellows - a woman for breeding, a boy for pleasure was their motto. The well known pederast Aristotle was the most admired of all Greek philosophers, his completely erroneous theory of matter being composed of four elements - fire, earth, air and water - being totally accepted by European thought and still obvious today in astrology. And although the homophobic christian church could not acknowledge Aristotle's sexual inclinations his attitude to women was perfectly acceptable to christian dogma.
Being thus profoundly influenced by a womanhater and a homosexual it is scarcely surprising that most christian sects have a very negative attitude to women. Even at the close of the twentieth century the female is still regarded as inferior by most clerics and, though eminently suited for scrubbing the church steps or raising funds, never fit to hold office within the church itself, or anywhere else for that matter. How could a woman represent Christ, a male? For although a male human was said to be a human being furnished with a pair of testis it seems the christian divinity is a pair of balls with a god attached.
And one churchman jocularly declared that women who wanted to be clerics should be burnt at the stake as witches. The christian church still resides with its trappings - in the Middle Ages.
Counsellors were always men, wise elders and sages; women were silly featherbrains or old crones, the source of all foolishness, superstition and "old wives' tales".

This prejudice against women can be seen in the attitude of most societies to basic female functions. Thus menstruation is almost universally picked on as an unpleasant, disgusting female habit, likely to cause harm to respectable male society.
Menstrual flow was regarded as polluting to men. During menstruation women were forbidden to prepare food and segregated - and still are in many places. Pliny warned that menstruating women make new wine sour, seeds sterile, grass wither, garden plants dry up and fruit fall from the tree. Aristotle said that the very look of a menstruating woman would take the polish from a mirror causing the next person looking in it to become bewitched. Where on earth did they get these "old wives' tales"?
In Hungary the menstruating woman was barred from making preserves, pickles or bread. If her husband had sex with her he would be "unclean" for seven days. And according to the Hebrews and Romans if she conceived at this time the child would be deformed. The rural Maya still believe that menstruating women make wells collapse and in Uganda pots and pans handled by a bleeding woman have to be destroyed.
In some cultures women are punished for bleeding. In ancient Persia women were isolated for four days. If a woman was still menstruating on the fifth day she was savagely beaten and isolated for a further five days. If still bleeding she was again savaged and regarded as being possessed by a devil.
Even today a survey found that 12% of males and 5% of females said that menstruating women should stay away from other people. In Menstrual Disorders Annette and Graham Scambler write that, "Early socialization often conveys that menstruation is the biological "fate" of women rather than an affirmation of womanhood. Given the negative aspects of the concept of menstruation absorbed through late childhood and adolescence it is not surprising that many adult women seem predisposed to associate menstrual change with physical or psychological  distress, social handicap and even illness." And in Female Cycles Werdeger says on menstruation, "Adults consider it unpleasant, messy and downright unclean. This assessment of menstruation is yet another nail in the coffin of female self-respect."
Thus 48% of women are antipathetic towards menstruation and the minority of women who do not regard it as the "Curse" are often thought strange. 
In his book Everywoman:A Gynaecological Guide for Life Dr Llewellyn-Jones suggests that just as repressed minority groups often accept the attitudes of dominant groups towards themselves so many of the repressed female majority have accepted the submissive, female doormat stereotype of their male masters. And along with male attitudes on the proper place of women they accept the dominant male attitude to their reproductive system as something inferior and unreliable which should be amputated at the first sign of malfunction.
Of the three groups of women who Naomi Stokes found to be satisfied with their hysterectomies the first was women who had very severe symptoms, another was women who worshipped the medical profession and the last consisted of women who regarded being female, and bleeding, as a social disadvantage.
This seems to have been the attitude of Elaine, quoted by Nikki Henrigues & Ann Dickson in Women on Hysterectomy as regarding her womb as "more than useless it was a damned nuisance."
Is it significant that Elaine was a doctor's wife?
There are many women so conditioned by society to regard being female as being inferior that they are incapable of regarding the extirpation of their female organs in anything but an advantageous light.

Control by Sexual Amputation

Another favoured method of putting down women is to dump all sin and sexual phobias on them. According to men it is women who, by sexually tempting men, are the cause of all men's troubles. They made Adam eat forbidden fruit or came with a whole Pandora's box of afflictions for men. As they are non-persons they do not actually manufacture these ills. They are merely instruments of powerful, and therefore male, malignant forces. But as they are so likely to be lead astray they must always be ruled by men and punished severely, such as being burnt to death as "witches", if they want to be considered as individuals, like real, male humans.
A particularly nasty way of repressing women is the practice of female circumcision, or female genital mutilation, as it is more correctly called. This was practised in ancient Egyptian times and is widespread today. It is common throughout Africa and most of Asia and also found in Peru, Brazil, E. Mexico and Australia. Almost 100% of Somali women are mutilated, 90% in Ethiopia/Eritrea, Mali, and Sierra Leone, 60% in Kenya, Gambia, and the Ivory Coast and 50% in Senegal, Egypt, Guinea Bissau, and Nigeria. A WHO report estimates the global toll at around 85-114 million. Excuses given for the torture include assuring women's chastity (and thus the male owner's   "honour"), protection from rape, increased sexual pleasure for the husband, improvement of fertility (though its effect is precisely the opposite) and hygiene - as it is believed that a woman with a clitoris is dirty and smells bad. Men believe that female genitals and sexual desires are naturally vile and refuse to marry uncircumcised women. Although it is mentioned neither in the Bible nor the Koran (being a pagan practice) most Muslim peasants believe that female mutilation is required by islamic law. Custom and male social pressure ensure its persistence.
The Foundation for Women's Health Research and Development (FORWARD) writes that the reasons for female genital mutilation "generally derive from the role and status of women in society. In most cases, the purpose of the various practices is to control female sexuality and conserve the monogamic status of women". And although it is supposed to be illegal in Britain as late as 1993 a Harley Street doctor was struck off for agreeing, for ?500, to perform a female mutilation.
Asma El Dareer conducted a survey of the practice and effects of female circumcision, published in her book Woman, Why do You Weep. Although declared illegal in 1945 she found that in northern Sudan over 90% of women were circumcised, usually as children between the ages of 4 to 8 years. The most severe form of mutilation involving the total removal of the clitoris and both the inner and outer labia, called pharonic circumcision, was performed in 80% of cases. Following this amputation the female is left, like a punctured Barbie doll, with no external genitals, merely a very small hole.
Naturally such treatment produces many adverse effects, both short and long term, especially in the primitive and unhygienic conditions in which most girls are damaged. Immediate effects are difficulty in passing urine, urine retention, bleeding, infection, shock and fever. Death is not uncommon. Longer term effects are sexual difficulties, menstrual complications, vulvar abscesses, birth complications, effects on the newborn and urinary tract infections. Genital mutilation increases the risk of sterility and pelvic inflammatory disease, doubles a woman's risk of dying in childbirth and triples the baby's chance of death.
Henriques and Dickson, stating the western view of sex, claim that after hysterectomy "With your clitoris and your vagina intact your sexual response will remain the same. Your capacity to experience orgasm need not be affected at all because your clitoris is untouched."
Female genital mutilation makes sexual intercourse so difficult that the bridegroom may resort to cutting open his bride. Childbirth results in the tearing apart of the sexual area. The pain from these experiences would naturally reduce a woman's capacity for sexual pleasure even if her sensitive sexual areas remained. Since the clitoris is damaged even in the most minor form of female circumcision, and totally destroyed in the more severe types, the Western sexual guru would expect to find the mutilated woman to be immune to sexual pleasure.
And indeed of more than 2,000 women interviewed by Asma El Dareer 50% said they had never experienced sexual pleasure. Sex was merely a duty, and often an unpleasant one at that. Another 23.3% were totally indifferent and the remainder had sometimes found sex pleasurable.
Some of the men interviewed by Ms El Dareer said that they did not want an uncircumcised woman because her sexual appetite would be excessive. One educated man said the clitoris must be excised because it may become over-stimulated and create uncontrolled sexual desire.
Old wives' tales?
Almost all the men who had their wives recircumcised (that is sewn up again after being torn open by childbirth) said that the main reason for it was that it gave them greater pleasure. It is painful for women but the tightness was exciting for men.
Ms El Dareer remarks, "All of which suggests that men seek only their own sexual pleasure." And of course to control women with mutilation.
I found very interesting the fact that 82.6% of women favoured the continuation of the practice and that it was women who did the dirty work of actual mutilation. So conditioned are they by their social customs, and the social and economic necessities of getting a husband-owner for them, that they willingly assist in the mutilation of their small daughters.
In 1992 Milos and Macris wrote of circumcision, "Only by denying the existence of excruciating pain,.... the risks and effects of permanently altering normal genitalia, the right of human beings to sexually intact and functional bodies, and the right to individual religious freedoms can human beings continue this practice."
But they were writing of the far less damaging or extensive mutilation of infant male circumcision.

They say that every cloud has a silver lining and perhaps the suppression of African culture on slave plantations had a positive effect in preventing the genital mutilation of black female slaves. However the industrial nations evolved other methods of docking female organs, from which the modern black woman suffers. Female circumcision was never widely practised in the West but during the nineteenth century surgical techniques were developed using female guinea pigs and the surgical mutilation of women quickly became extremely fashionable.
In Women Under the Knife Anne Dally writes that, "Few people at the time regarded women as people in their own right, few could see them as anything except appendages to men. These beliefs and prejudices, much more powerful than logic or scientific knowledge, were increasingly strengthened not by exploration and discovery, but by pontification and intellectual processes based on emotion... The tendency to pontificate is strongest in those accustomed to authority and the medical profession was becoming accustomed to this."
Women were also regarded as being dominated by their reproductive system and permanently ill because of it. Virchow wrote, "Woman is a pair of ovaries with a human being attached; whereas a man is a human being furnished with a pair of testis", and in the History of Medicine Duin and Suitcliffe acknowledge that to the doctor "a woman's uterus and ovaries were not only involved in the reproduction of the species but they were also the source of much illness."
The physician Thomas Radford defended the then fatal practice of caesarean section by arguing that, "since a woman's main reason for living was her ability to bear children, if the organs involved in this did not function because of disease, then it did not matter so much if she lost her life during an operation to fix them."
So the attitude of nineteenth century medical men towards women in general made operations on female reproductive organs acceptable. And the first operations involving cutting open the belly were all on women who had large growths of the ovary. These growths were sometimes massive and surgery was the only effective treatment but with the septic surgery of the time mortality rates were horrific.

In the mid nineteenth century Dr J Marion Sims developed a surgical technique to close holes, called fistulas, that had developed between the vagina and bladder, usually caused in childbirth, sometimes by misuse of obstetric instruments, by experimenting on female slaves. His successful subject, Anarcha, was operated upon thirty times without anaesthetic. Dr Mendelsohn, author of MALePRACTICE:How Doctors Manipulate Women, comments that, "His obsession with surgery and his lack of compassion for the women who endured the incredible torture he inflicted on them are still reflected in the behaviour of many who practice this speciality today." 
But by the low standards of the time Dr Sims was not particularly cruel for although these operations were so painful that, in his own words, "none but a woman could have borne them" he kept his guinea pigs supplied with "tremendous quantities of opium", which must have helped to keep his subjects relatively painfree and too doped to care. And his motives for developing female restorative surgery were probably of the finest capitalist sort.
At the time black females were valued as breeding stock and damaged stock was worthless.
For the real, underlying reason for surgery was frequently not misogyny but money. As Dr Mary Putnam Jacobi realised in 1895, "I think, finally, it is in the attention paid to women, and especially in their new function as lucrative patients, ...that we find explanation for much of the ill-health among women freshly discovered today."

Having developed their surgical skills by operating on women with life threatening conditions medical men extended the occasions to commit surgery to ever increasingly trivial and fanciful reasons. And as Dally notes, "In most mutilating operations, especially those of the reproductive organs, the patients were women."
In 1838 Colomat had realised that variations in the position of the womb were of no significance and stated "those inclinations that take place in the non-gravid womb require no special treatment." This did not prevent many quacks from performing operations to resuspend a perfectly normal womb that was not in the standard position and 110 variations on womb suspension had been invented by 1925. And many thousands of totally unnecessary and dangerous operations had been performed, providing much income for the surgeons and much unnecessary pain and danger for the unfortunate female patients.
After becoming experienced at removing grossly abnormal ovaries surgeons started extending the reasons for removing ovaries until, by 1872, even perfectly healthy organs were removed. These castrations were performed on women because they were insane, hysterical, unhappy or just plain difficult to control. 
In 1896 Dr David Gilliam made it clear that he believed castration made women obedient and urged more castrations. G J Barker-Benfield, in Horrors, observes that "disorderly women were handed over to the gynecologist for castration and other kinds of radical treatment by husbands or fathers unable to enforce their minimum identity guarantee - the submission of women." Castration for psychological disorders continued as late as 1946. Dr J Studd noted that castrations were performed for the "quaint Victorian defects of nyphomania and menstrual epileptic mania." Naturally imaginary conditions which called for the castration of men would never have been described as "quaint".
In 1882 William Goodell, professor of clinical gynaecology at the university of Pennsylvania, said of the castration of mentally disturbed women "If the operation be not followed by a cure, the surgeon can console himself with the thought that he has brought about a sterility in a woman who might otherwise have given birth to insane progeny".
This shows the start of the deliberate sterilization of women judged by doctors as not fit for breeding by removing part, or all, of their reproductive system. This disturbing tendency of the medical profession to mutilate women in accordance with their own prejudices is still in evidence today. As Dr Mendelsohn tells us, "Patients in charity hospitals are particularly vulnerable to hysterectomy performed for sterilization. In some charity hospitals so many hysterectomies are performed on indigent black patients that they are laughingly referred to as Mississippi appendectomies." And it is a statistical fact that poor Americans are more likely to be hysterectomised, though less likely to suffer caesarean section.
However even the medical profession was not completely insensitive to the appalling facts and a few individuals spoke against the rising tide of surgical destruction.
In 1891 Spencer Wells attacked the castrators, asking would anyone strip off the penis for a stricture, or castrate a man because he has a hydrocoele or was a moral delinquent?
The Pennsylvania State Board of Public Charities concluded that castration was "illegal, experimental in character, brutal and inhumane and not excusable on any reasonable ground." It was estimated that by 1906 over 150,000 women had been castrated.
Yet today castration is more popular than ever, with more than a quarter of a million women being castrated EVERY YEAR in the US alone. The new excuse given for female neutering is cancer prevention. That is perfectly healthy ovaries which it is known are causing no physical, psychological or moral symptoms are cut out just in case they develop cancer.

Another mutilation the Victorians committed on women was removal of the clitoris. Disturbed women who masturbated or who were insubordinate were surgically mutilated. Anne Dally writes that Isaac Baker Brown removed the clitoris of a 20 year old woman because she "was disobedient to her mother's wishes", sent visiting cards to men she liked and spent "much time in serious reading". However this operation was never as popular as castration - probably due to western prudishness which did not like to admit that there were such things as external genitals. I'm sure it was much easier to to talk about removing hidden, internal reproductive organs than to mention those external bits so embarassingly sexual in nature and obviously not concerned in reproduction.
The first hysterectomies were performed in the mid nineteenth century and few patients survived the ordeal, the death rate being 50% between 1881-1885. As the survival rate rose the operators became increasing eager to mutilate on the slightest excuse until in 1969 Ralph C Wright declared, "The uterus has but one function: reproduction. After the last planned pregnancy, the uterus becomes a useless, bleeding, symptom-producing, potentially cancer-bearing organ and therefore should be removed. If, in addition, both ovaries are removed....another common source of inoperable malignancy is eliminated."
I wonder how Mr Wright would have liked his useless cancer-bearing prostate and testes to have been removed and replaced with a testosterone tablet.
Even members of the profession have admitted that as many as 40% of hysterectomies are "questionable" and a study by Cornell University Medical College estimated that 22% of the 789,000 hysterectomies performed in the US in 1975 were unnecessary. That year there were 1,700 deaths due to hysterectomy operations so even by the extremely liberal indications to operate that doctors give themselves 374 women lost the last half of their life span to "save" themselves from the possibility of reproductive cancer and the inconvenience of the last few years of menstrual bleeding.
Why women consent to these mutilations was established in a 1973 study which stated, "What is clear is that in many instances there is little evidence of informed consent by the patient and that these operations have been "sold" to the public by surgeons in a manner not unlike many other deceptive marketing practices."
The fact that gynaecologists find it easy to manipulate women into agreeing to unnecessary hysterectomies is shown by a notorious interview of 1975 when a Baltimore doctor admitted "Some of us aren't making a living, so out comes a uterus each month to pay for the rent."
As early as 1895 William Priestley spoke on overoperating in gynaecology. "It seems to me just now that the tendency is to impart a too large surgical element into the treatment of diseases of women and comparatively to neglect their medical side."
He said that it was absolutely unjustifiable to operate for symptomless fibroids, to open the abdomen for uterine displacements causing only discomfort or to remove ovaries for indefinite nerve pains.
Current "quality assurance" guidelines of the American College of Obstetricians and Gynecologists recommend womb excision for women with
"asymptomatic myomata associated with uterine size equal to or larger than 12 weeks of gestation (or weight of 280g) determined by physical examination".  The reasons given are usually inability to feel the ovaries and increased risk of complications if hysterectomy is done later. Reiter found no increase in complications with larger womb sizes and pointed out that as very few ovarian cancers are discovered by feeling the ovaries at routine examination this was no justification for womb amputation. In fact Barber estimated that the chance of detecting an ovarian growth was only 1 in 10,000 examinations.
Although no objective basis for this mutilation has been provided it has been recommended routinely for symptomless women with wombs greater than 12 weeks size in review articles, standard texts and criteria sets published by the ACOG. Approximately 175,000 of the hysterectomies performed every year in US are because of fibroids. Reiter found that in the operation series he studied one third of hysterectomies for fibroids were symptomless. If this is typical then about 70,000 women a year are mutilated in the US because of symptomless fibroids, and many of them are castrated at the same time.
Priestley had also noticed that gynaecology was "an excellent field for the charlatan, who may pretend to cure complaints or persuade helpless patients to submit to unnecessary operations, all for large fees". And this was well before the twentieth century hysterectomy boom.

Although women are still discriminated against and oppressed in most fields, in medicine male chauvinism can have deadly repercussions. In the words of Dr Mendelsohn, "The chauvinism of a physician or surgeon, however, may condemn the same woman to a lifetime of dependence on drugs or cost her the life or health of her baby, to say nothing of the loss of her breasts, her uterus, her ovaries, and even her life."
For the slackening of legal and social control of women in the western world has been accompanied by increasing medical control of their life and an increasing frequency in excision of their female organs. And in the US the sexual freedom accompanying the introduction of the birth pill was followed by the 1970s hysterectomy boom.
Gynaecology emerged at a time when women were regarded as property and, as far as medicine was concerned, nice lttle earners. Dr Dally relates the story of a young woman, about to be married, who had unspecified symptoms, which her doctor decided were due to diseased ovaries. Although her ovaries were normal the doctor removed them anyway so they never would give her any trouble. He also removed her normal appendix.  He didn't tell his victim that she had been neutered but after the marriage informed her new owner, the husband.
You might think that attitudes had changed. However Whitelaw mentions a malpractice case, brought in California in the 1980's, in which a 21 year old, childless woman was cut open because of suspected appendicitis. The surgeon, the family practitioner, saw pus and decided that she had pelvic infectionary disease. He then gutted her entire reproductive system. There was no abscess formation and no consent for mutilation had been given. The castrated woman, who will have to take oestrogens for the rest of her life, was awarded damages of $250,000. And I think she was grossly underpaid. Could you imagine a 21 year old man having his entire reproductive system removed because a medic thinks he's got an infection?
In Issues of Blood: the Politics of Menstruation Laws says that, "Gynaecologists act primarily as men, and only secondarily as doctors". Strangely enough this applies even when the gynaecologist is biologically female, so thoroughly has male dominated society and medical school done its chauvinist work.


The Effects of Castration

In 1979 a Scandinavian study was published on the effects of castration on women. Of 146 women aged 15-30 who had been castrated between 1910 and 1940 a total of 41 had died by 1971. Of these 22 had died of cardiovascular disease and 4 were suicides. This gives a quite spectacular suicide rate of 10%. However as these would have included the psychological weaklings the remaining castrates would probably die of natural causes, giving an overall suicide rate of only 2.7%. In Britain about 0.7% of all deaths are by suicide, which is much commoner amongst males.
Castration was shown to be associated with an increase in heart disease, nervous disease, fractures and osteoporosis and an increase in cholesterol level, adrenocortical activity and drug use. Traumatic psychological experience due to sterility was also noted.

Along with the adrenal glands, the ovaries are major producers of the sex hormones necessary to continued good health. The levels of sex hormones in the blood are influenced by many factors and as some of the hormones are bound to proteins the amount of active hormone can alter while the total amount remains unchanged. The level of oestrogen in the blood can be lowered by stress or low blood sugar. Increasing the fibre content of the diet increases the amount of protein bound oestrogen. Higher levels of fat in the diet produce higher oestrogen levels. Obese individuals (both male and female) have lower levels of bound oestrogen and higher levels of free, active oestrogen. Alcohol decreases oestrogen while smoking is associated with increases in androgens. Excessive exercise reduces both androgens and oestrogens.
The ovaries produce a hormone which affects blood pressure. They also affect the parathyroid gland, which in turn affects bone metabolism. The production of beta endorphins by the brain is affected by the normal menstrual cycle and abnormal menstrual conditions, like premenstrual depression, are associated with abnormal beta endorphin cycles.
Besides producing oestrogens a woman produces about 300 micrograms of testosterone a day, a third directly from the ovaries and the rest indirectly through a precursor produced in equal amounts by the ovaries and the adrenal glands. In the body tissues, especially fat tissues, testosterone is converted to oestrogen. During the menopause the ovary stops producing fertile eggs and ceases to produce oestrogens. But its testosterone production increases by 25%. When a woman is surgically castrated she is deprived of much of her androgen supply and the testosterone level of a castrated young woman is only half that of a normal postmenopausal woman.

In 1990 Weinstein wrote that the major excuse for castrating, prevention of cancer, was "an illogical reason because most women have a low risk of ovarian cancer. However because it was widely believed that the only function of the ovaries after childbearing was to produce estrogen and progesterone, and that these hormones could be adequately replaced, the ovaries were considered expendable...
It is currently recommended that oophorectomy not be performed unless it is detrimental to the patients health to conserve her ovaries."
Petru et al, 1991, concluded that castration "before the age of 50 years does not seem to be generally indicated in patients with retained 
ovarian function who undergo hysterectomy."
However the proportion of women castrated at hysterectomy rose from 25% in 1965 to 41% in 1984. In the early 80's Dicker notes that 58% of the women who had abdominal hysterectomy had one or both of their tubes or ovaries removed at the same time. And in 1993 Boike et al, reviewing 50 cases each of abdominal hysterectomy, laparoscopic hysterectomy and vaginal hysterectomy, found that 66% of these women had been castrated, 80% of those over 40 being done. As far as I can make out only 7 had any ovarian abnormality and 5 had ovarian cancer in the family. Which means that of the 150 women 87, more than half, had perfectly normal ovaries removed.
Sightler et al "recommend routine prophylactic oophorectomy in all women undergoing hysterectomy after the age of 40. This strategy would have prevented 60 cases of ovarian cancer treated at the University of Miami during the past 14 years."
However in order to save 1 woman from ovarian cancer it has been calculated than 500 women must have their normal ovaries sacrificed and their hormone balance disrupted. They take the risk of losing their sex life and must either take HRT, which not all women find palatable, to restore their oestogen level, risking any associated ill effects this may have, or risk the increased heart failure and osteoporosis associated with lack of oestrogen. US figures for 1980 show that while a total of 21,300 women died from cancers of the womb, womb neck and ovaries combined 485,000 died of heart disease.
Moreover in 1994 Wilcox et al found that while 50% of women aged 35-44 whose wombs were removed by open surgery were also castrated only 7.6% of vaginally mutilated women were castrated. For 55-64 year old women the castration rates were 88.1% with open surgery and 20.8% with vaginal surgery. From this I would say that women are persuaded to have their organs docked by being offered less traumatic vaginal surgery leaving no obvious scars. However as fewer surgeons are willing to hazard the difficult blind grabbing of ovaries they are much less likely to be castrated, even though, of course, they still have the same risk of developing ovarian cancer as women having open surgery.
A 1989 survey of British gynaecologists found that when performing a hysterectomy while 2% would castrate women aged 40-44, 20% would castrate women aged 45-49 and 85% would castrate postmenopausal women. As younger gynaecologists were more likely to castrate it would seem that respect for the female reproductive system is, if anything, decreasing in medical circles.
The Complete Family Health Encyclopedia produced by the British Medical Society in 1990 writes that castration is performed to remove a diseased organ or to reduce sex hormone levels1. The common practice of removing healthy female gonads, called "prophylactic oophorectomy", is not mentioned. And there is no such thing as a "prophylactic orchidectomy" for men.
I cannot understand why men should be so attached to their gonads, especially when they seem to cause terrible pain when damaged. Castrating the male would remove the inconvenience of shaving, prevent testicular cancer and probably reduce the risk of the major killers of heart disease and prostate cancer, as well as reducing the risk of prostate overgrowth. Somehow I doubt very much whether men would regard such a treatment in a very positive light and I would not presume to push castration on them. So why, I wonder, do so many men seem so eager to castrate me.

Castration is often suggested to women who have ovarian cancer in the family. Kerlikowske et al, using cancer incidence data from the National Cancer Institute, found that the lifetime probability of ovarian cancer increases from about 1.6% in a 35 year old woman without a family history of ovarian cancer to about 5% if she has one relative and 7% if she has two relatives with ovarian cancer. They concluded that even among women with a  relative with ovarian cancer the lifetime probability of ovarian cancer was not high enough to recommend castration.
But many women facing hysterectomy with no family history of ovarian cancer will find it strongly suggested, or even done without consultation.
A survey by Piver found that 6 out of 324 women castrated because of family cancer had developed a belly cavity cancer indistinguishable from ovarian cancer. It remains to be seen whether these cancers developed because the ovaries were not present or occur among these families as well as ovarian cancer. However Weber et al have found this ovarian-like cancer in 2 castrated patients who had no family history of ovarian cancer. Castrators say that the risk of this cancer is low but Weber also notes that increasing numbers are being reported, Truong citing 124 cases, and the proportion of castrates is from 9% to 27%. Also From et al reviewed 817 cases of ovarian cancer and identified 74 (9%) in which the cancer was judged not to be primarily ovarian. So it now appears that some cancers diagnosed as ovarian are abdominal anyway and it seems that removing one susceptible organ, the ovary, may not always save you from an ovarian type cancer.
Even when the ovaries have been removed surgeons sometimes leave bits of tissue which produce symptoms, usually pelvic pain which is often dismissed as "not gynaecological" in origin. Surgical removal of these ovarian remnants is often difficult.

In the foreword to Understanding Osteoporosis, Dr Allan Dixon, Chairman of the National Osteoporosis Society noted that a survey of women who were at high risk of developing osteoporosis after being castrated found that 70% had never been treated with HRT. Even for the minority who were treated oestrogen was prescribed on average for only 21 months. Dr Dixon wrote that "Many doctors now feel that failure to give women HRT following a surgical menopause2 is unethical. Some have described it as criminally negligent. If so four out of five of these women were criminally neglected."
However it is in England, where surgeons do not make a direct profit from providing drugs, that women are "criminally neglected". In the US HRT is usually prescribed after castration, or at least it seems to be for financially solvent patients who can pay for the prescriptions.

A final word on cancer prevention by excising female organs from Barbara Garvey, whose family is affected by breast cancer. She said of prophylactic mastectomy (having your breasts removed "just in case") that it was "like having your head chopped off in case you get a headache".
The annual death rate from breast cancer is four times that of ovarian cancer. And Britain's breast cancer rates are among the worst in the world.

Effects of Hysterectomy
 
All surgery is hazardous. Even simple tooth extraction results in a few deaths each year. Although surgery is far safer than in the past every operation is a risk and every unnecessary operation is an unnecessary risk. Dr Mendelsohn expresses it this way, "In 1974 knives were the instruments of 15,000 absolutely senseless deaths in the US. 3,000 of them were used by murderers. In the other 12,000 cases a surgeon held the knife."
In Britain a woman dies each week as a result of having a hysterectomy.
A ten year review of hysterectomy in the US found that the death rate varied from 0.1 to 0.85% and morbidity varied from 0 to 55%. The New York Department of Health found a death rate of 0.35% associated with hysterectomies performed between 1984 and 1986. Dicker reports a death rate of 0.2% for vaginal hysterectomy and 0.1% for abdominal hysterectomy for the years 1978 to 1981. The standard of surgery in the US seems highly variable with hysterectomies being performed by gynaecologists, general surgeons, family practitioners and osteopaths(!). This may be reflected in the differing death and complication rates. The best qualified surgeons are Board certified but Dr Mendelsohn notes that non-Board certified surgeons perform three times more surgery. It has also been noticed that the definition of complications such as fever is variable and while some will record all episodes of raised temperature others count only severe or prolonged fever.
The complications of hysterectomy are numerous and a quarter to a half of all patients will suffer one or more of them. As it involves opening up the vagina, which is naturally full of bacteria and is therefore difficult to sterilize, about a third of patients develop a fever. This may be associated with infections of the wound or the urinary, respiratory or genital tracts. There may be pneumonia or sepsis.
In about 10% of cases a blood transfusion is required because of bleeding during or after the operation. Dicker notes surgical damage was caused in 5% of vaginal hysterectomy patients, with more than 1% having their bladders damaged. Pulmonary embolism, heart attack and anaphylactic shock are rarer and Varma found indications that in some women hysterectomy damaged the nerve supply of the hindgut.
It has been found that 91% of genital fistulas of the lower urinary tract are due to gynaecological procedures, 91% of which are hysterectomies. Most occur in the absence of risk factors, such as adhesions. Gueye notes, "Injuries to the ureter and bladder are common complications in female pelvic surgery. Unfortunately, they remain often unrecognised per operatively." And cause symptoms which may result in more surgery.
Studying 108 hysterectomised Leeds women Rutherford recorded that 7 needed further surgery, 3 immediately after hysterectomy and 4 within the following year. In a large scale study of Canadian women Roos recorded that within two years of surgery 4% of hysterectomy patients finished up back in hospital because of complications.
Surgery can leave you with adhesions, which may stick internal organs together and cause pain. And adhesions may wrap tightly round remaining ovaries, damaging them. This residual ovary syndrome occurs in about 2% of cases. Dr Studd declared that the "chronic disabling, often cyclical pain of the residual ovary syndrome frequently passes undiagnosed3 and when surgery is eventually undertaken it has greater risks of urinary tract injury than those of initial hysterectomy."
His solution is to prevent the possibility of any further trouble after hysterectomy by castrating the woman as well, replacing her reproductive system with a pill. Studd is co-author of a menopause leaflet produced by Organon, who manufacture hormone tablets, and an avid fan of both HRT and female castration. In 1995 he decided that those of his pill popping patients not totally satisfied were suffering from "female testosterone deficiency syndrome" and needed androgen additions to their HRT to sort them out. Dr Studd is a member of the British Menopause Society, Vice Chairman of the National Osteoporosis Society and Chairman of the Menopause and PMS Trust so you can guess what treatment these organisations favour for menopausal problems.
In their promotional literature on the World Wide Web ContiNet, incontinence product providers, record that incontinence may be a postsurgical result of operations such as prostatectomy and hysterectomy.
A study of hysterectomised women conducted by Dinah Gould, a nurse, reported in 1986 that many patients developed symptoms months after discharge from hospital. Over an 11 month period the 85 women developed 303 symptoms, 68 of them at least 4 months after surgery. These included weight change, bowel problems, urinary problems, sleep disturbance, vaginal discharge or bleeding, wound problems, general aches and pains, fatigue, depression and vertigo. Of the 85 women 13 returned to gynaecology clinic.
Out of the 70 questioned about their sex life 20 had problems, which were all conveniently put down to age, and 15 reported a better sex life now they had no bleeding or contraceptive worries. Perhaps these women were not aging as fast as those who had sexual difficulties.

Naomi Stokes quotes Dr D R Reuben as saying in his book How to Get More Out of Sex that "Most hysterectomies, even if the ovaries are not actually removed, bring on a "surgical menopause". Since the ovaries are such delicate structures the cutting and crushing that goes on generally puts them essentially out of business."
It has long been known that ovarian failure follows hysterectomy. Jacobs and Oran in their book Contemporary Gynecology, 1988, wrote that studies assessing ovarian function after hysterectomy had consistently showed that some women suffered premature ovarian failure, ranging from 16.7% (Beavis, Brown & Smith, 1969) to 35.6% (Leverton, 1958).
Siddle found that hysterectomised women had a significantly lower age at ovarian failure, which seemed to be unevenly distributed; some women being apparently unaffected while others, even at quite young ages becoming menopausal within 2 years of the operation. He estimated that 25% of hysterectomy patients suffer premature ovarian failure.
It may be that this failure is due to surgical damaging of the ovarian blood supply but it has also been suggested that a lack of the postaglandins secreted by the womb accelerates ovarian failure or that scar tissue or adhesion formation producing the residual ovary syndrome is responsible.
It would be interesting to know if the frequency of ovarian failure varied with the surgeon or was uniform no matter who did the surgery. I suspect that a major reason for ovarian failure after hysterectomy is, as Dr Reuben said, surgical damage caused by the general "cutting and crushing that goes on", especially with heavy handed hysterectomists and indeed a London surgeon, Miss Pitkin, has been reported as saying that only ovaries damaged by heavy-handed surgeons pack up. If so there must be many heavy-handed medics around as even vitamin peddlers Life Plus Vitamins can write that many women "have had hysterectomies and immediately have had to learn to deal with major hormonal changes".
Interestingly Siddle's second suggestion with regard to the management of the hysterectomy patient was to avoid placing clamps near the ovary during the operation!
Laparoscopic hysterectomies, which should be associated with less "cutting and crushing", should also be less likely to cause ovarian failure, though as far as I'm aware there is, as yet, no data available on ovarian failure age after laparoscopic surgery.

The effects of ovarian failure are numerous and insidious. They include increased risks of osteoporosis, osteoarthritis and cardiovascular disease, along with menopausal symptoms such as flushes, sweating, vaginal dryness, insomnia, palpitations, shortness of breath, pain on urinating, migraine, pins and needles, dizziness and urine leakage. In a study involving nearly 1,000 hysterectomised women Oldenhave et al found that all these menopausal symptoms were more frequently found in hysterectomised women. The increased incidence of menopausal symptoms after hysterectomy has also been noted by Siddle, Barlow and Roos. "Old wives' tales" about unpleasant effects after hysterectomy probably originated with the not-so-old wives suffering menopausal symptoms caused by ovarian damage after their operation.
Siddle urges medics "not to dismiss women as neurotic if they return soon after hysterectomy complaining of oestrogen deficient symptoms". Which implies that women are regarded as neurotic when they are not thoroughly grateful for their mutilations. And could you imagine anyone suggesting that doctors not regard a group of men as neurotic?

A major effect of premature ovarian failure is osteoporosis, known as brittle bones, where the bones lose minerals and break more easily. Women are 10 times more likely to suffer brittle bones than men. Both male and female hormones protect against the disease and after the menopause along with the loss of oestrogen women lose minerals from their bones. The highest rates of bone loss occurs in the initial stages of oestrogen decline, one study showing that within 2 years after castration women who did not take HRT lost 20% of their spinal bone mass.
Of the 1,000 members of the National Osteoporosis Society who replied to a survey 23% had been hysterectomised or castrated - over half of them before the age of 47- and 61% already suffered from osteoporosis.
It would be interesting to know what the proportion of surgical mutilation was among those who had developed osteoporosis. Hysterectomy is currently running at 20% in Britain but while osteoporosis typically develops in the 60's or later, the peak age for hysterectomy is about 40. That is the average present day hysterectomised osteoporotic would have been operated on twenty or more years ago, when hysterectomy rates were lower in Britain. It would be very interesting to know what the relative incidence of castration and hysterectomy is in todays osteoporotics compared with their contemporaries with intact bones. However Oldenhave writes that in the Dutch municipality of Ede the total percentage of hysterectomised women aged 40 to 60 had tripled from 6.2% in 1967 to 18.6% in 1987. If the same figures apply to British women I expect the osteoporotic woman to be up to 3 times more likely to have had reproductively mutilating surgery than a healthy female contemporary.

Another effect of ovarian damage maybe due to falling androgen levels. The normally aging ovary increases its testosterone production. When the ovary is surgically removed its hormone output stops abruptly. HRT may replace lost oestrogen, it does not replace lost testosterone - and testosterone stimulates sexual desire in the female. It has been noted that sexual dissatisfaction is more frequent after castration than after hysterectomy alone. And in 1988 Sherwin and Gelfand found that women who were given both oestrogen and testosterone reported higher rates of sexual desire, sexual arousal and numbers of fantasies than those who were either given only oestrogen or who were untreated. Moreover these effects were strongest during the period just after drug treatment, when testosterone levels were at their highest. 
Of the 500 women interviewed by Naomi Stokes, 477 did not care as much for sex after the surgery and 399 had lost their sexual appetite entirely. Most of these were castrated as well as hysterectomised. It is quite unnerving to read in Mrs Stokes book of this being referred to as being "cleaned out", as if a woman's reproductive system was something filthy of which a gynaecologist "cleansed" her.
If the ovarian failure associated with hysterectomy is due to surgical damage, rather than an earlier natural shutdown due to the absence of the womb, then these women may have reduced testosterone levels similar to that of castrates, and some of the negative sexual effects after hysterectomy may be due to lack of testosterone.
In Hysterectomy - The Positive Recovery Plan at the time of her interview Carole was still suffering from sexual difficulties. As she put it, "Everything was OK after the operation, it was okay for a year but slowly it got worse and worse, until there's nothing there. Nothing at all. I can't  feel anything. I can't understand what's happening because it didn't happen straightaway.
My GP said sometimes when you have big operations it does happen. It upsets your hormones....
Mr W said "There's nothing technically wrong with you".
I feel completely dead. I feel horrible about it."
Although Carole's ovaries were not removed I wonder if Carole's problem was due to falling androgen levels following unnatural ovarian failure. And with lack of androgen, failing libido. She had been operated on because of pain yet 18 months after surgery the pain returned. Trying to present her mutilation in a positive light the authors found that Carole now did not worry so much about what people thought. As Rhett Butler might have put it she no longer gave a damn. And this was presented as a boost to her self-esteem worthy of losing sexual pleasure, and suffering mutilation, for.

In its publications for the masses the medical profession assures women that hysterectomy will not alter the length of the vagina. However in an effort to establish the best method of repairing womb and vaginal prolapses Given et al measured actual vaginal length in a number of women. Premenstrual women with wombs were found to have an average vaginal length of 9.2 cm, postmenopausally it was 8.5 cms. Premenopausal hysterectomised women had a vagina length of 8.5 cms, decreasing to 8.2 cms after the menopause.
This shows that hysterectomy DOES decrease length, no matter what hysterectomy apologists say, though considering the normal wide biological variation of women I doubt whether this slight shortening has much effect on women's lives at all.
Which does not mean that hysterectomy may not have profound physical effects. The female sexual response seems to be very variable and although the clitoris is very sensitive and triggers the sexual response in most women, some find other sensations just as important. Indeed if there were no other sexually sensitive areas then the genitally mutilated woman would always be totally sexually dead. The womb neck of a menstrual woman has many sensory nerve endings and many women are sensitive to the pressure on the neck of the womb produced by the thrusting of the penis. Also during an orgasm the uterus rises up in the belly cavity, fills with blood, almost doubling in size, and contracts rhythmically. Total hysterectomy amputates these sensations.
It seems that clitoral or vaginal stimulation fires the pudendenal nerve, while vaginal or cervical stimulation fires the pelvic nerve. In 1981 Perry & Whipple found that women on valium lost sensitivity of the pudendal but not pelvic nerve. Hysterectomy damages the pelvic nerve and women who were sensitive to pelvic nerve stimulation find sex less thrilling. The New York State Department of Health found that "Many women report that orgasm feels different without the muscles of the uterus. Some women are bothered by this; others hardly notice".
Dr Cutler says that retaining the cervix makes orgasm loss, painful sex and frequent urination all less likely. Subtotal hysterectomy is followed by fewer urinary tract infections, there is less blood loss at operation, the structure of the vagina is not changed and there is no cutting or stitches in the upper vagina to become infected or produce painful sex. These vaginal vault granulations, which may need cauterising, are a common complication of total hysterectomy. Mucous produced by the womb neck during sex also helps to keep the vagina lubricated.
Some Scandinavian studies suggested that women who kept their womb neck had a better sex life after hysterectomy than those who lost the entire womb. This conclusion has been challenged but a 1992 paper found that the womb neck was retained in 21% of a Swedish series of hysterectomies and younger women were more likely to keep it. For Danes also the womb neck was retained in 20% of hysterectomies done between 1988 and 1990.
In the US the womb neck, the cervix, is removed in 95% of hysterectomies. The excision of the womb neck is usually justified as "cancer prophylaxis" although doctors are always telling women that having regular smear tests will protect them from cervical cancer and although prostate cancer kills 4 times more men than cancer of the cervix kills women there is, of course, no such thing as a "prophylactic prostatectomy". Hysterectomy - The Positive Recovery Plan states that a subtotal hysterectomy is not only the easiest from the surgeons's point of view but the one from which patients recover the fastest. Garrey's Gynaecology Illustrated agrees that leaving the womb neck is both an easier and also a safer operation.
However the BMA's Complete Family Health Encyclopedia, published in 1990, states that subtotal hysterectomy, leaving the womb neck, is now "obsolete".
It is interesting that techniques have been developed which remove the womb while preserving the shell of the womb neck. Vietz and Ahn write that in this way "pelvic floor support is maintained and transvaginal sexual sensation is less likely to be impaired".
In Cervical Smear Test: What Every Woman Should Know doctors Singer and Szarewski report that after treatment for abnormal smears a study found that women experienced loss of interest in sex, hostility towards their partners, lack of sexual enjoyment and often reported pain during sex. This was all attributed to the woman's bad attitude to having part of their womb neck destroyed yet they noted that this change in attitude came not with the diagnosis of cell change and the need for treatment but after the physical treatment itself. In spite of this evidence of bad effects from even limited damage to the womb neck the doctors later declare that hysterectomy should make very little or no difference to a woman, including her sex life. They also declare that the womb has no other function but to act as a box used to package a baby and further declaim that after the menopause ovaries are no longer of any use and ovarian hormones "can easily be replaced by synthetic ones, with no noticeable change in effect."
Masterson observed that "Even minor surgeries, which should have no conceivable effect on sexual desire or function, have the potential for resulting in serious sexual dysfunction". Even so he would have no hesitation in castrating women over 40 or in removing the womb because of the minor inconvenience of stress incontinence. Such is the consideration accorded to female sexual function by professional medics!
The womb produces prostaglandins, which it is suggested help to maintain the ovaries. It is thought that sexually active women may have their ovarian function supported by the prostaglandins in semen. It also appears that regular sex is often associated with regular menstrual cycles and that sporadic sex activity may disrupt ovarian hormone production.
In normal menstrual women and women on HRT the womb also produces endorphins. These are the opium like substances which produce the runners "high". Endorphin levels fall after castration and it has been suggested that the disruption of the ovarian/womb connection may be the cause of depression after hysterectomy. It may be that the frequent exercise programs in which some women indulge help them to cope after hysterectomy by producing endorphins to keep them happy.
Prostacyclin, a hormone which helps to prevent heart disease by dilating blood vessels and preventing blood platelets from sticking together, is also produced by the womb.

A letter received by Dr Mendelsohn tells one woman's story, "I had a complete hysterectomy4 when I was in my thirties. If I had it to do over again, I would never have one. I went to several doctors before I consented to the surgery, and they all agreed the surgery had to be done and that hormones would take care of any subsequent problems I might have. The surgery not only wrecked my sex life, but also ruined my nerve. We had a good sex life before surgery but now it gets worse each year. It's a bitter pill to swallow when you know you're a failure, and your husband tells you that you're a poor sex partner."
In a newspaper interview the founder of the Hysterectomy Educational Resources and Services said that before hysterectomy "sex had been, on a scale of one to ten, a ten plus." After the operation "there was no sexual desire or feeling. There was a deadening of sensation, from the waist to the mid-thigh".
A final account comes from The New Our Bodies, Ourselves, "I had a hysterectomy two years ago at the age of forty five. I went from being fully aroused and fully orgasmic to having a complete loss of libido, sexual enjoyment and orgasms immediately after the surgery. I went to doctors, all of whom denied even having seen a woman with this problem before and told me it was psychological. Before surgery my husband and I were having intercourse approximately three to five times a week, simply because we have an open and loving relationship.
Now I find that I have to work at becoming at all interested in intercourse. And I no longer have the orgasm that comes from pressure on the cervix, though I still have a feeble orgasm from clitoral stimulation."
Nora Coffey says that many of the women who call HERS tell her that they've talked to their gynaecologist about their loss of sexual desire only to be rebuffed with a comment like "I've never heard anything like that before". She says, "When I get thirty calls from women who've been hysterectomized by the same doctor and he tells each and every one the same thing, I know that he knows darn well what he's doing to those women,".

Of course for the 10% of women who never experience an orgasm a hysterectomy will make no difference to their non-existent sex life, except perhaps ensure that it will remain exactly that.

Fibroids and Bleeding

The two conditions which are the occasion of 75% of all hysterectomies are fibroids and heavy menstrual bleeding, called menorrhagia.

A fibroid is a lump which can develop in the gut or the skin, or even rarely in the lungs, but which is most frequently found in the female reproductive system. It is a ball of muscle tissue which may grow in spurts but is usually slow growing. A womb growth rate of up to three pregnancy weeks a year is considered normal. They are related to oestrogen levels, being rarely developed in children and menopausal women. With the hormonal surges of pregnancy they may grow rapidly but usually shrink afterwards so that they often finish up the same size as before pregnancy.
In the womb fibroids may develop within the womb wall, just under the womb lining or close to the outside surface. There may be literally hundreds or only one. They may be barely visible or weigh several pounds. They may cause considerable symptoms and pain or be entirely symptomless.
About 10% of fibroids are found under the womb lining and these are the most likely to produce severe bleeding. This type of fibroid can be removed vaginally by an experienced gynaecologist. They may become stalked and project into the womb, where they can be torn or cut off with scissors. Those merely projecting into the womb cavity can be sliced down with a laser or a special cutting tool called a resectoscope. Quite large fibroids can be removed this way and Donnez, in Belgium, has removed fibroids by shrinking them with Zoladex, lasering them as much as possible and then repeating the process.
Fibroids on the outside of the womb may also become stalked when they can be easily snipped off. They are the least likely to cause symptoms.
Where the fibroid is inside the womb wall the womb must be cut into to remove it. About 70% of fibroids are of this type.
The surgical removal of fibroids is called a myomectomy and was first recorded in 1845. More than half a century ago it was possible to remove 40 fibroids, weighing a total of 21 pounds and over 200 have been removed from one woman. Gynaecological textbooks all agree that in nearly every case the fibroids alone can be removed. But they also all agree that hysterectomy is "better". Most assert that death and complication rates are higher with myomectomy and both Quixley and Dewhurst have called convelescence after myomectomy "stormy". Yet one medical author, Kistner, states that mortality and morbidity after myomectomy are minimal if care is taken to prevent infection and bleeding, a claim which could scarcely be made for hysterectomy if you accept Dicker's 42.8% complication rate.
Benagiano described myomectomy as a "simple procedure" and Dr Golfarb writes that myomectomy is no more difficult than hysterectomy for an experienced surgeon. And Jeffcoate's Principles and Practice of Clinical Gynaecology says that although myomectomy is said to be more dangerous than hysterectomy this is not true for present day surgery. It would seem that those who actually do a lot of myomectomies do not find them difficult while those who do not insist that myomectomy is difficult.
There are other contradictions among the textbooks. Danforth and Scott say that fibroid removal is associated with adhesions while Chatfield insists that the chance of adhesions forming is minimal. Monaghan favours the use of Bonney's clamp, which he says gently blocks the blood supply, while Chatfield dislikes clamping, which he thinks sometimes damages the blood vessels. And while Monaghan insists that every tiny fibroid should be removed, Chatfield favours the removal of significant fibroids only.
As fibroids are surrounded by a sort of capsule their actual removal is quite simple and described as being like shelling peas. However the cavity they leave behind needs to be stitched together to prevent it filling with blood, producing a haematoma. Whether the womb can be easily restored to its normal shape or not depends upon how many fibroids have to be removed and where they are situated. If there are very many scattered fibroids it may be difficult to remove them without making many cuts in the womb surface, causing much damage to the womb walls. As a gynaecologist regards the womb as being there only to bear children he will have no hestitation in amputating it if a myomectomy will not completely restore its form.
Besides any technical difficulty in restoring womb shape the major hazards of myomectomy are bleeding and adhesion formation. Bleeding can be reduced by the use of GnRH-agonists, which produce a shrinking of both the womb and fibroids. Fibroids may shrink entirely, Perl recording the complete disappearance of a fibroid the size of a grapefruit, but the effect is very variable and a 40% shrinkage is about average.
In 1993 LaMorte et al wrote a paper on complications after myomectomy. They noted that there was little actually recorded on the subject. Conception rates after the operation are often the only observations made. Because the medical attitude is that the womb exists only to carry babies myomectomy is only done as an aid to fertility since any woman not requiring babies has no right, in the view of the vast majority of the medical profession, to keep her reproductive system.
La Morte et al concluded that morbidity after myomectomy was at an acceptably low rate and studies of myomectomy patients by Fayez and Dempsey, Smith and Uhlir and Nezhat et al all showed much lower rates of morbidity than after hysterectomy. None of them used GnRH-agonists and in 7 years of reconstructive surgery Fayez and Dempsey not only operated on the tubes of 336 women and performed 148 myomectomies but also discharged all patients from hospital within 24 hours of surgery. There were no postoperative complications, no blood transfusions and no rehospitalization. Swiftly removing patients from the unhealthy hospital environment seems to have helped to reduce the risk of developing complications, though as those were otherwise healthy women being treated for infertility they were probably less likely to develop complications anyway. Of the 32 myomectomy patients who later had laparoscopy 9% were found to have adhesions, an amazing low figure since Diamond et al found adhesions in most patients after pelvic surgery. Adhesions form after hysterectomy and caesarean section and their minimization is helped by strict blood control, the use of Ringer's lactate to wash away fibrin produced from cut tissues and by not contaminating the body with talc from surgical gloves.
As the bacteria laden vagina is not entered the incidence of fever after myomectomy is lower and according to Dewhurst the raised temperatures that do develop in myomectomy patients are usually due not to infection but to the oozing of blood into the fibroid shell or the body cavity. Vaginal vault granulations, a common complication of hysterectomy, cannot occur after myomectomy.
Damage to the bladder most commonly occurs when the womb is cut away from it. As this does not happen during conservative surgery bladder damage should be only rarely associated with myomectomy, though once again I have seen no information on this point.
The long term effects of hysterectomy such as premature ovarian failure with its increased risks of osteoporosis and heart disease, sexual dysfunction and psychological trauma would not be expected after myomectomy but there have been no studies to assess these factors and it may be that any pelvic surgery, including caesarean section and sterilization, has the potential, especially when performed by barely competents, to damage ovarian function. There is some evidence that even simple sterilization may sometimes result in ovarian failure and sterilized women have been reported to have a doubled risk of being hospitalised because of menstrual disease, increasing to a 6 fold risk for those sterilized between the ages of 20-24 years.
Complications developing after myomectomy are different from those from hysterectomy, and their incidence and severity depends upon how many fibroids have been removed, how large they were, how easy they were to remove, and how skilled the surgeon was. The operation may be extremely difficult or even easier than a routine hysterectomy.
On balance it would seem that your chance of developing complications after surgery depends not upon which operation you have but upon how difficult your particular surgery is and how competent your surgeon is.
If there are few fibroids, they are fairly close to the womb surface and they are not too big they can be removed by laparoscopic, or keyhole surgery. Instruments are inserted through small cuts in the belly and their use controlled by a tiny camera. Laparoscopy is generally regarded as suitable for removing no more than 4 fibroids of no more than 10 cm in diameter, though Nezhat et al have laparoscopically removed fibroids up to 15 cms in size. It is less traumatic than open surgery and the patient has no large scar. In England a charity, the Women's Endoscopic Foundation, Cleveland, can arrange for this surgery to be done.

Overall 13% of women of reproductive age complain of excessive bleeding. In half the women hysterectomised for heavy bleeding no physical cause for excessive blood loss is found. In the vast majority of cases no attempt is even made to scientifically assess menstrual loss.
As the Scamblers note a woman who thinks she has excessive bleeding will probably be diagnosed as menorrhagic, generally without an attempt to measure the extent of blood loss. If no organic causes are found for the bleeding it might be assumed to be psychosomatic. However any treatment will almost certainly be physical rather than psychological.
Dr Llewellyn-Jones notes that womb enlargement, often with associated heavy bleeding, may be due to hormonal imbalance, possibly caused by emotional factors. As the doctor observes hysterectomy may stop the bleeding but will do nothing for emotional problems. He concludes that it is important to "try hormones first to see if they will relieve the symptoms" but never suggests any psychological or social treatment for the "emotional problems" - merely drug treatment to attempt to reset the hormonal balance.
Margaret Rees, research gynaecologist at the John Radcliffe Hospital, Oxford, measured the blood losses of a number of women referred for hysterectomy to end heavy periods and found that only 40% had blood losses greater than 80 mls, the upper limit of the normal range. That is 6 out of 10 woman were not losing so much blood that they needed their wombs removing. If these figures are representative more than half of the women hysterectomised for heavy bleeding are not, in fact, by medically accepted standards, suffering from excessive blood loss. They are being mutilated to control a complaint which they don't even have. Not very scientific!
In 1990 Rees measured the blood losses of 17 women aged 30-45 and found that all had normal blood loss with a range of 15-60 mls. 14 women accepted that their bleeding was not excessive, 2 had mefenamic acid treatment and one fool still insisted on being fixed. 
Coulter et al found that of 145 women referred to outpatients with heavy bleeding 42% had no medical treatment for their condition before being referred. Of women referred to outpatients for menstrual problems as many as 43% had first mentioned symptoms to the GP less than one month before the referral and nearly half of these did not appear to have symptoms severe enough to require immediate referral.
And while the gynaecologist prescribed drug treatment for 41% of the women under 35, those over 40 were prescribed drugs in only 22% of cases, even though being nearer the menopause these women would need treatment for a shorter time. 

Wendy Cooper writes, "Hysterectomy is rarely within your control; if recommended by a gynaecologist, it is usually unavoidable. Unfortunately it's again something recognised as an induction factor in early menopause. Where there is real medical justification for removing the womb, of course there is no question of trying to avoid this surgery... Nevertheless, it's worth making quite sure that your gynaecologist has no other option in dealing with your problem."
Later she repeats this, saying "it's still worth making quite sure your hysterectomy really is necessary, as the records show that within two years of this surgery being carried out the ovaries begin to fail even in quite young women in one case in four."
After listing the adverse effects associated with hysterectomy Oldenhave et al suggest, "Further prospective studies on hormonal changes after hysterectomy are needed. In the meantime premature climacteric hormonal changes should be taken into account as possible adverse effects of hysterectomy with ovarian conservation. Where menstrual problems might indicate a hysterectomy, women should be encouraged to cooperate with the physician to find the most successful therapy other than hysterectomy such as drug therapy, myomectomy or - in case the patient declines future pregnancy - endometrial resection."
However, as I found by bitter experience, the medical professsion as a whole is extremely relucant to perform myomectomies on any woman over 35. Professor Weingold says myomectomy is possible in almost all patients. So almost a third of all hysterectomies could be replaced by myomectomies. 
It seems highly unlikely that they ever will be.

Hysterectomy

About three quarters of hysterectomies are performed on women between the age of 30-49. National hysterectomy rates vary from 11 per year per 10,000 women to over 60. The countries with the lowest rates, Norway and Sweden, also have the highest life expectancy and the lowest infant mortality. In the US it has been found that the rate varied fivefold both across the country and, in Massachusetts, across small population areas. The rates also varied with the type of health insurance cover. An uninsured woman has only half the chance of being hysterectomised that an insured woman has. Since a prepaid plan does not give doctors more money for more surgery women with this type of insurance are 4 times more likely to keep their wombs than if they have fee-for-service plans. The highest educated women are less likely to lose their wombs.
The more gynaecologists and beds a country has the more operations are performed. And where a woman can be sold a hysterectomy "like many other deceptive marketing practices" the hysterectomy rate soars.
Women were sold hysterectomy as a more effective means of sterilization than cutting the tubes. Between 1968 and 1970 the number of hysterectomies performed for sterilization at the Los Angeles County University of Southern California Medical Center increased 742%. When it became obvious that hysterectomy was much more dangerous, and had many more complications, than tube tying official bodies recommended that it not be done purely for birth control.
However gynaecologists are very good at creative diagnosis. Of the 500 women interviewed by Mrs Stokes 234 of them had the operation for birth control reasons, although they said the doctor put other reasons on the medical forms. Because the indications for hysterectomy are so liberal any small fibroid was "justification" for mutilation. In fact unscrupulous gynaecologists are quite likely to play on a woman's fear of cancer by calling the fibroid a "tumour". Diana Scully noticed this in her study of medical practices, "When the pathology involved a fibroid, "the tumor" was presented in such a way that the woman would initially become alarmed. Later, when the resident assured her that fibroids weren't cancerous, the psychological impact had already been made. Many women were frightened into surgery by the word "tumor", which is closely associated with cancer and death in our health-conscious society."
The account in the WHRRIC "fibroids" leaflet is even worse with a woman being deliberately threatened by her doctor with the very rare possibility of cancerous change in her fibroids.
Heavy bleeding is always a good excuse. Pelvic pain also requires no pathological justification. Many of the wombs excised show no sign of any physical abnormality.
Even cancer or precancerous conditions, the diagnosis in 5-10% of all operations, do not always require amputation. Dennerstein, Wood and Burrows wrote that, "a doctor was perplexed by a woman who had extensive cancer of the womb lining (non-invasive) and who had completed her family but wished to retain her uterus for sexual and menstrual reasons and elected to have local removal of the lining rather than hysterectomy." This shows that extensive extirpation of the reproductive system is not always medically necessary and that doctors are amazed when they find a non-breeding female who does accept the standard medical and social view of her female organs as disposable trash.
Cervical intraepithelial neoplasm (CIN) is an early cell abnormality which may lead to invasive cancer if not treated. Vessey et al wrote that hysterectomy is not a common treatment for CIN yet this was the diagnosis for half of those hysterectomised for cancer and precancer in the Oxford Family Planning study. Younger women have the abnormal cells frozen or lasered. Older women, especially if they have any other reproductive flaws, are treated to the final solution.
In 1992 Spuhler and de Grandi wrote that they preferred to avoid hysterectomy for womb neck abnormalities. They noted that cancer could be present in the vagina as well as the womb neck. After hysterectomy cancer cells could be hidden in vaginal scarring and as smear tests are rarely done on hysterectomised women vaginal cancer may not be detected.
Vaginal cancer is rare but increasing, and women hysterectomised even for non cancerous conditions are more likely to develop it than intact women.
As Ms Scully noted, women are often persuaded to have unnecessary operations so that apprentice surgeons would get experience at performing them. Dr Gifford Jones also warns of this practice in his book What Every Woman Needs to Know about Hysterectomy.
And Dr Mendelsohn points out that a hysterectomy brings the surgeon a fee three times fatter than that for a simple sterilization.

When medical activities are scutinised the rates fall. Ganbone reports that hysterectomy frequency fell by 24% after a criteria-based quality assurance process for hysterectomy was instituted at a large teaching hospital. There was a significant decrease in the rate for chronic pelvic pain, recurrent bleeding, and preinvasive disorders of the uterus. In Switzerland Domenighetti reported a 33% decrease in the number of hysterectomies performed in the Ticina district after a publicity campaign about this surgery.
The gynaecologist is not a physician but a surgeon. Medical treatment for female complaints, noted in 1895 as being neglected, appears now almost non-existent in conventional medicine.

I read of these facts about females, fibroids and mutilation after the spring of 1992, when I went to my GP with "female trouble".


1 usually done to prevent stimulation of an existing hormone dependent cancer, such as prostate cancer
2 Castration
3 Why I wonder?
4 a "complete hysterectomy" in the USA usually means both hysterectomy and castration.