Some women prefer an abdominal/pelvic surgical intervention (a myomectomy) that removes the fibroids and muscle tissue, but spares the uterus. However, 15-30% of women who have a myomectomy eventually require further surgery because fibroids can recur. A myomectomy requires a search for a very competent surgeon because greater skill is required in the procedure. Even if a woman is not concerned about protecting her fertility, a myomectomy should still be considered as an alternative to a hysterectomy. A hysterectomy appears to be too great a sacrifice for a condition that is considered to be benign 99.9% of the time. However, 30% of hysterectomies performed are to remove fibroids.
It is thought that much of an individual's sexual response is psychic in origin. Therefore, if a woman considers that her internal feminization is a part of her sexual mystique, then the absence of her uterus could prove to be her undoing: 25% of women who have a hysterectomy report increased difficulty becoming sexually aroused and then having a disappointing orgasm, if it occurs. The uterus contracts on the impulses of the orgasm, making the sensation deeper and more satisfying. The uterus also responds pleasurably to breast stimulation. Without a uterus, no such response occurs. When the uterus is removed because of fibroids, the ovaries are usually left intact. This lessens the degradation.
Research indicates that a retained sexual nature retards aging. Some women recount the removal of their uterus as entering the operating room young and emerging old. Chronic dysthymia (despondency) is frequently observed. Many women are also disappointed in their lack of bladder control after surgery. Others are plagued by intestinal adhesions which are not considered to be rare following abdominal surgery and can actually be life-threatening. Alternatives to radical surgery should first be carefully explored before any decision to operate is made.
The Dangers of Uterine Morcellation
About 500 000 women undergo surgical removal of their uterus (hysterectomy) each year in the United States, making this operation one of the most common gynecological surgical procedures (Gaba 2014; CDC 2002).
Historically, removal of the uterus through an incision in the abdomen was the standard method of performing a hysterectomy (Glasser 2005). In recent decades, however, laparoscopic hysterectomy has become increasingly popular. A laparoscopic operation involves making only a few small holes in the patient’s abdominal wall through which fine surgical instruments are inserted to perform the operation. Naturally, this approach is more appealing from a cosmetic perspective because it causes considerably less scarring than a traditional abdominal hysterectomy (Reich 1994). However, laparoscopic hysterectomy poses an important obstacle: how to remove the excised uterus from the patient’s abdominal cavity (Kho 2014).
The medical community overcame this barrier by developing a procedure called morcellation. Morcellation involves shaving or shredding the tissue to be removed into smaller pieces that can be extracted with laparoscopic instruments. Although morcellation offers an effective means of removing the uterus without leaving a large scar, it poses a grave danger that the medical community has overlooked until now. During the uterine morcellation procedure, small pieces of tissue and cellular debris can be spread through the abdominal cavity. If any malignant cells are present in the morcellized uterine tissue, deposition of tissue debris in the abdominal cavity during morcellation can give rise to disseminated cancer, which has a very poor prognosis (Kho 2014).
Although most uterine fibroids are benign, unsuspected uterine cancer is identified in about 1 in 350 women undergoing surgery for fibroids. In these cases, unsuspected cancer that was contained within the uterus, and which could have been resected completely through a vaginal or abdominal hysterectomy, may be spread to other parts of the body during morcellation (Kho 2014; FDA 2014).
On April 17th, 2014, the US Food and Drug Administration issued a statement discouraging the use of morcellation procedures for the removal of uterine fibroids and hysterectomy (FDA 2014).
Morcellation runs the risk of other complications as well including injury to nearby organs and dissemination of fragments of uterine fibroid tissue, which, even if not malignant, can deposit elsewhere in the body and cause problems (Milad 2013; Kho 2014; Takeda 2007).