Hysterectomy when the uterus is grossly normal

Abstract

In about 15 per cent of all hysterectomies the uterus is basically normal in the gross anatomic sense. This surgical paradox arises from conditions peculiar to this organ. These conditions are:1. The uterus is dispensable without apparent physical damage to the female organism and can be removed to advantage when there is disturbed function without change in structure.2. The uterus is frequently found as the content of what amounts to a pelvic hernia and removed in the course of repairing that hernia.3. The menstrual flow for reasons still unknown may become prolonged and excessive for which hysterectomy may ultimately be the treatment of choice.4. The vascular congestion of the uterus and broad ligaments which occurs with the tidal surges of ovarian steroids produces pain in certain susceptible, usually emotionally unstable women, comparable to the mastalgia that many of these women experience. Hysterectomy gives these women relief because the operation eliminates much of the involved vasculature.5. The cesarean section operation for practical reasons limits reproductive performance. These limitations arise from interests of both patient and obstetrician. Contraception, resection of Fallopian tubes, and sometimes hysterectomy are all practices which carry increasing assurance, in this order, in achieving this reproductive limitation. Certain patients to whom tubal sterilization is unacceptable are sterilized by hysterectomy.6. The normal uterus is often removed prophylactically when laparotomy for adnexal lesions is carried out. In women who are past 35 and have completed their families, the gynecologist tends to weight the functional uselessness of the uterus against the potential of both disturbed function and organic disease in their subsequent years. In many of these cases hysterectomy is favored when this calculation is made.