Dr. Herbert Goldfarb, director of gynecological endoscopic surgery at NYU Downtown Hospital in New York, provided information about alternative solutions to hysterectomy in a segment on 20/20. Goldfarb answers some viewers' questions here.
QUESTION: For reasons of breast cancer I was given a hysterectomy five years ago at age 35. Since then, unable to take hormone replacement, I am suffering from hot flashes multiple times each day. I don't sleep longer than three hours without waking up. And intercourse is painful to the point of not being worth the pain. Any suggestion?
DR. GOLDFARB: The treatment of hot flashes related to surgical menopause is a real problem. Many oncologists accept that in spite of breast cancer vaginal estrogenic cremes can help reverse some of the sexual difficulties.
QUESTION: I had a hysterectomy four years ago, I'm 57 now. Being single for some time, I didn't have sex until recently and I discovered my uterus was MUCH SHORTER and could not accommodate my partner, and [sexual intercourse] was very painful. Although my partner was very careful and caring, it was just not the same. My doctor NEVER explained that my uterus would be shorter. If he had I would not have had a hysterectomy! (My uterus had dropped and I was going through the change so, a hysterectomy was highly recommended). When I asked my doctor if this could be fixed, he gave me a prescription for Librex, a pill that is for lubrication, which wasn't the problem. However, he (doctor) said it would help loosen up the uterus tissue and with more "practice" my uterus would probably become stretched enough to enjoy and accommodate my partner. I never got an answer if an operation could correct this or not? Can an operation be done to lengthen my uterus? Or do I have to go through life like this?
DR. GOLDFARB: Hysterectomy can sometimes result in a shortened vagina which results in pain during intercourse (dysparunia) The vagina can actually be lengthened by frequent intercourse. As an alternative plastic vaginal dilators can be used to dilate the vagina in conjunction with vaginal estrogenic creme.
QUESTION: Is there any connection with having a tubal ligation and starting perimenopause at an early age? I had the surgery when I was 32 years old and started perimenopause at the age of 35. I too have lost a lot of my sex drive. I also have friends in the same situation and we are all wondering the same thing.
DR. GOLDFARB: It is unusual to have such sequela after tubal sterilization. If extensive coagulation has been performed, then it's conceivable that blood supply to the ovary can be interrupted. It's also possible that the menopause was coincidental, but it's highly unusual.
QUESTION: I have been diagnosed with vaginal prolapse. I also have some bladder leakage. I have been advised to have a partial hysterectomy. My vagina can be seen upon exam, but it is not protruding out. I am 42 years old and have already had an endometrial ablation with balloon, a few years ago, for excessive bleeding. My periods are now "normal." Do you recommend this procedure for me at this time, or should I wait? If I wait … how long do you suggest? Thank you in advance for you advice.
DR. GOLDFARB: Vaginal prolapse can be treated by laparoscopic support surgery. Hysterectomy is not necessary. In addition, after hysterectomy a significant number of women suffer recurrence and have subsequent prolapse of the vaginal vault.