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I rehearsed what I would say to my new OB/GYN all morning. “I’m not leaving here without a care plan” was the mantra I repeated in my head. When it came time to speak to the doctor about my symptoms and timeline, I’m sure I was a bit intense.
What came next surprised me—my doctor listened. I was given options, my questions were answered, and by the end of the appointment, I was beginning the process of scheduling a laparoscopic hysterectomy. I fully intended on having to prove I was worthy after all these years of suffering—but I didn’t have to. I sat in the car and had a good cry before my drive home. I felt so relieved.
For years, having had abnormal cycle lengths, painful periods, painful sex, lower back pain, and pain shooting down my leg that dropped me to the floor sometimes—I questioned what was different this time.
Was it my age? Was it the number of symptoms? Was it the right doctor at the right time in geopolitics?
“Are you sure?”
Friends and clients have lamented about finding a doctor that would do more than order another ultrasound or offer more than a “wait and see” approach. Many women under 40 without kids claim to face more objections from doctors over surgical options than those older and who have children.
Seekers of surgical sterilization—tubal ligation or hysterectomy—are also typically asked what their partners have to say, regardless of relationship type or status. After reading an analysis of the National Survey of Family Growth’s 2015-2019 data by Danvers & Evans, it’s understood that surgeons screen their patients for potential regret and use age as a primary factor. The survey found that after accounting for considerations like education, the reason for the surgery, race, number of children, and age—only age has a “statistically significant association” with regret, especially if the patient was under 30 at the time of surgery. So, if you’re relatively young and seeking surgery, your doctor is most certainly going to ask you questions to make sure you’re sure.
Is surgical sterilization right for you?
Without a doubt, people are making reproductive health decisions based on the actions of their state legislatures. Fifty-eight percent of people capable of giving birth now live in a state that has severe restrictions on abortion access, according to the Guttmacher Institute. It will be a few years before we have data on how Dobbs affects people’s decisions for surgical sterilizations in states with abortion restrictions.
There are plenty of reasons to consider the removal of reproductive organs that aren’t about birth control. Chronic pain can bring people to the point where they just don’t care about having children. They just want the pain to stop.
When periods are normal, the endometrium that builds up inside the uterus is shed when no fertilized egg is implanted after ovulation. When endometriosis is present, that lining is outside the uterus in the gut, often on other organs. Endometriosis affects 2-10% of women, according to Johns Hopkins. It cannot be fully diagnosed without exploratory surgery, and the only treatment is surgical.
A lesser-known condition is an adenomyosis, where the endometrial tissue is inside the muscles of the uterine wall. Imagine the sharpest, most uncomfortable splinter you’ve ever had. Imagine it’s there permanently, and it hurts pretty much daily, but once a month, you feel like you’re being ripped open from the inside (more than normal) as the splinter wiggles around. Your only option is to cut off your thumb to remove the splinter.
Then there are fibroids, polycystic ovarian syndrome, and chronic pelvic inflammatory disease that could be the culprit of chronic pain— all of which can be debilitating.
What happens next “down there”?
Searching the internet for answers is fucking scary sometimes. Thankfully a friend recommended joining Hysterectomy Sisters. This Facebook group is an online community committed to giving factual, timely answers to its 36,000 members. Asking tens of thousands of women how to resolve constipation while on pain meds or how long before you were ready for sex again is bound to get you an answer faster than if you call the nurse line. It’s also a place to post about their thoughts and fears without judgment.
Allow your pelvic floor time to heal. Orgasm creates tension, pulling, and movement around incisions; therefore, you’ve gotta lay off all stimulation until you’re healed. Your post-surgical instructions only address not putting anything inside your vagina. It doesn’t say that we should not participate in any sexual activity, solo or partnered. Still, it should because the insertion of something into our vaginas is not our only route to pleasure.
Laura McKaig, a pelvic floor therapist based in Olathe has plenty of advice for recovery. While many people might think that surgery is the final step in their care plan, McKaig says pelvic floor therapy is necessary after procedures like this.
“Often the instructions ‘listen to your body’ just aren’t enough to know how to get back to the activities you love. That includes your sex life. Sometimes sex can feel weird or different after a hysterectomy. Pelvic [floor therapy] can help your pelvic floor muscles and core regain the movement and strength needed to recover well and enjoy sex again,” says McKaig.
You should visit a pelvic floor therapist if you have any pain remaining after eight weeks post-op (this goes for guys that have had vasectomies, too), if sex feels noticeably different or painful, if you’re holding your breath while lifting an object, if you feel heaviness or dullness in your pelvis or lower back, or if you feel like your genitals have “checked out” from the rest of your body.
You’ll likely need hormone replacement therapy (HRT) if both ovaries are removed. Taking hormones is also a big decision that has both positives and risks. Estrogen is a key chemical in our bodies that affects our skin, bones, heart, and brain. Side effects of surgical menopause include vaginal dryness and hot flashes. HRT is the only way to treat those.
Jill Chadwick, Director of Media Relations with The University of Kansas Health System, says the decision for treatment is a deeply personal one that should be made between a patient and their doctor.
No matter what is happening in our society, you deserve facts about your health. You deserve solutions to your pain. You deserve to be treated like a grown adult who can make informed decisions. Openly discuss your symptoms with your doctor. Be your own advocate for your health. It’s okay to go to a different physician if you don’t feel heard.