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A needed update and alert for women who have been advised to have a hysterectomy. Many others have cautioned against this still too frequently done operation, but Payer is able to add to the debate with recent research findings and suggested treatment alternatives. Payer herself was at risk for hysterectomy: at age 33, while living in Paris, she was discovered to have large fibroid tumors. In this country, she most likely would have had a hysterectomy--in Paris, only the fibroids were removed. When the problem recurred years later in the US, she had to fight to have just the simpler procedure done. Payer begins here by banishing some of the medical myths still widely held as gospel in the profession: to those who argue that hysterectomy will have no effect on sex, since sexual response is an emotional experience, Payer says, ""If your sexual response is only in your mind and heart, this may be true, but if you feel something a bit lower in the body, read the next chapter""--the uterus does undergo physical changes during sex, including rhythmic contraction. Another recent finding: the uterus has been found to secrete substances such as prolactin that affect other organs in the body--perhaps considerably (it is not just ""an organ to hold babies""). And although vaginal hysterectomy is often considered to be a less serious alternative to abdominal hysterectomy, the vaginal procedure can more drastically interrupt nerve pathways. Payer covers in orderly fashion the common indications for hysterectomy--from fibroids to cancer--and without going overboard, suggests when alternatives may be favorable. She never gets wild-eyed about it, although she does quote Lily Tomlin: ""If you have a psychotic fixation and you go to the doctor and you want these two fingers amputated, he will not cut them off. But he will remove your genitals."" In spite of all the recent attention to unnecessary hysterectomy, this is still true; so Payer's level-headed advice and updates are welcome.

Pub Date: Aug. 27th, 1987
Publisher: Pantheon