Women's Bodies, Women's Wisdom (45 page)

In a review article of sexual functioning following cervical cancer treatment, a group of European sex researchers con cluded that there was considerable vaginal and urinary nerve disrup tion following surgical treatment for cervical cancer. It is unknown to what extent pelvic surgery for benign disease might be cutting nerves important for female orgasm. Though the nerve pathways for female orgasm haven’t been well worked out, animal studies provide some clues. In 1986, British primate researcher Alan F. Dixson, Ph.D., D.Sc., studied the genital sensory feedback in marmosets (small monkeys) and showed that two separate sensory pathways existed in the female: one that was fired by either clitoral or labial stimulation and a separate neural pathway for vaginal and cervical stimulation. On the other hand, for women who have experienced pain with intercourse for years or who have had pelvic pain from uterine or ovarian problems, a hysterectomy can greatly enhance the quality of their sexual experiences and the overall quality of their lives. (The Wurns report that many women with chronic pelvic pain who’ve undergone their treatment of manual adhesion removal end up experiencing far more pleasurable sex lives. Belinda Wurn’s own situation was what led the couple to their current approach. Following hysterectomy and radiation for cervical cancer, Belinda had a great deal of pelvic pain and difficulty with sex. This led the couple on a worldwide search for therapies that would help her. The end result is the Wurn technique, which has undergone rigorous documentation of its effectiveness (see
chapter 5
, page 134).

Women who suffer from loss of sexual desire or general loss of energy following hysterectomy should have their estrogen, testosterone, and DHEA levels checked and then use natural hormones to restore their levels to normal. In my experience, the best replacement consists of natural testosterone in a skin cream base. The usual dose is 1 to 2 mg every day or every other day. This must be prescribed by a health care practi tioner and prepared by a formulary pharmacist. Some women, but not all, are helped by DHEA; the usual dose is 5 to 10 mg once or twice per day. A few women feel best on 25 to 50 mg per day.

Menopause.
Removal of the uterus alone does not necessarily re sult in menopausal hormone levels in a woman who is still ovulating. It always results in cessation of menstruation. Even if the ovaries re main, however, their blood supply will be altered. This changes the hormonal milieu of the body and may result in menopausal symptoms and an earlier menopause. In one study this occurred in about 50 percent of the sample.
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(Many women report hot flashes for several months fol lowing hysterectomy, even when the ovaries are left in place. The same thing can happen after removal of an ovary alone, with no other surgery. It sometimes takes a while for an ovary to recover function post operatively or for one ovary to take over the function of two.) There is some evidence that women who have had hysterectomies have an ear lier onset of osteoporosis than other women, even when the ovaries are left in. And clearly, anything that impairs ovarian function in any way can result in decreased libido.

Urinary Problems.
Women who have had hysterectomies are more likely to develop stress urinary incontinence later in life. The reason for this is that the nerves innervating the bladder are very close to the uterus. Some of the nerve fibers may be damaged during hysterectomy.
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Heart Disease.
Some studies have shown an adverse cardiovascular effect from ovarian removal prior to a woman’s natural menopause (the average age of natural menopause is fifty-two). Since the ovaries continue to contribute hormones even after menopause, it is possible that there are adverse effects from ovarian removal even after menopause.
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After Menopause: Nature’s Hormonal Treatment

Fibroids often shrink dramatically once a woman reaches menopause (usually between fifty and fifty-two). Women with fibroids frequently experience symptoms only when they are in their mid-to late forties, the age when hysterec tomy is most often performed. If a woman prefers it, hysterectomy can be avoided by keeping the fibroids manageable until they naturally shrink during menopause. This can usually be accomplished by a combination of dietary change, progesterone therapy, stress reduction, exercise, and watchful waiting.

After menopause, any hormone replacement therapy may theoreti cally cause a woman’s fibroids to grow again, but the low levels of hormones used in such therapy generally do not cause problems.

Natural Healing Program for Fibroids

See the Master Program for Optimal Hormonal Balance and Pelvic Health, chapter 5, pages 123–136.)

Women’s Stories

Fibroids, like other disorders, don’t just come out of nowhere and land on your uterus. When you become willing to be in a relationship with your uterus by letting its messages speak to you, you have taken the first steps toward healing, instead of just masking or eliminating symptoms. After you get in touch with the messages from your uterus, you can choose the treatment that works best for you, whether it’s surgery, diet, acupuncture, or a combination of these.

Many women can correlate the onset of their fibroids with the on set of verbal abuse from their mates, job stress, or other problems in their relationships with the outside world. Inner work is often very use ful for finding new ways to deal with these hurtful or limiting situations.

Shirley: Fibroids and Creativity

Shirley, a nurse in her mid-forties, had been experiencing irregular periods and heavy menstrual flow when she was diagnosed with a small fibroid at the time of her annual exam. Shirley had been in treatment for an eating disorder and codependency a year before this. When I diagnosed her fibroids, she was in the midst of a career change, trying to decide whether to leave a stifling but lu crative management job.

I suggested she go on a whole-food diet and supplementation program and use castor oil packs. I also asked her to think about what she really wanted to do, what she would find truly satisfying. As she thought about it, she realized that her creativity had been stifled at work. She asked her body what it was telling her and to reveal it to her in dreams or meditations. Several months later, she told me, “I learned to surround myself with healing energy and love through the use of castor oil packs, meditation, and therapy.”

She used Reiki treatments, a type of energy treatment similar to therapeutic touch, involving healing with the hands. Two weeks after her office visit with me, she reported, “I had a vision of the masseuse lift ing a bowling-ball-shaped apparition from my abdomen. She had me draw it, and I drew what looked like a burr that you would find on your socks in the woods. It had exactly forty-five spikes on it. [Shirley was forty-five years old.] My apparition, the burr, represented me and how I cling to things in an unhealthy way. It symbolized clinging to work and people through whom I try to find fulfillment. From my dreams and meditation, I learned that my uterine growth was a physical manifesta tion of my own stifled creativity that could never be expressed fully through depending upon others. Through my emotional and physical healing process, my fibroid reduced in size, and I was led to a more creative, satisfying job in direct patient care.” Her follow-up exam three months later showed that her uterus was much smaller, and I could find no fibroid.

Marsha: Unsupportive Relationships

Marsha, a massage therapist from out of state, first came to see me in 1986, when she was forty-one years old, to get a second opinion about her fibroids. Though her uterus was only moderately enlarged, to the size of a twelve-week pregnancy, and she was having no symptoms, she had been told that she should have a hys terectomy. Her mother had also had fibroids and had had a hysterectomy, but Marsha wanted to avoid surgery. She had mistreated herself for years by overeating and getting involved in harmful relationships with abusive men. She had undergone three abortions and had no children. When she came for her first visit, she had already started a macrobiotic diet to keep her fibroids from growing.

Since everything else was normal on ultrasound testing, I affirmed Marsha’s choice to treat her fibroids with dietary changes and sug gested that she visit her gynecologist back home every six months. Given her insight into her own patterns of behavior, I felt she should work with alternatives to surgery. She followed the treatment plan in her home area.

Four years later, she returned to see me because she had had several episodes of very heavy bleeding and her gynecologist had strongly sug gested surgery. Marsha, who was in the twelve-step program Sex and Love Addicts Anonymous, told me that she had just gotten out of a very unhealthy, addictive four-year relationship. She was still completely consumed by the relationship, even though both of them had agreed that it was over. She told me that she had begun to appreciate that “all the anger I’ve felt toward my old boyfriend has been a way to avoid doing my work on myself, my emotions, and my past.” Now she began to take responsibility for her life and her situation and to get on with self-healing. Through her recovery work, she was finding that every relationship she’d ever been in since her childhood, with an alcoholic father, had been dysfunctional. She admitted that she was very good at creating drama in her life to fill the void of deadened feelings within herself and to compensate for her lack of connection with her own body.

Marsha was just starting to realize the profound connection between her relationship and her sense of self, and how they manifested in her body. She knew that not all the aspects of her fibroid were re lated specifically to food, yet she used food to cover up her emo tions. Her recovery, one day at a time, has gradually put her in touch with her inner wisdom. When I saw her for a checkup in 1992, her fi broid size was stable and she was having regular periods. She had en tered a stage of healing that is sometimes necessary for many women, though not all: She felt the need to withdraw from men for a time and be mostly with women. Each time I saw her, she was more centered, more positive, and stronger. She realized that her fibroids were a sig nal, calling her back to herself and her own life.

Louise: Children and Loss

Louise is a woman who is willing to assume partnership in her health care and who is not afraid to express her views. A producer for a radio station, she came to see me for a second surgical opinion regarding her fibroid uterus. Her fibroid had devel oped shortly after her second daughter had decided to leave home for boarding school. After her visit to me, Louise wrote the following let ter to her gynecologist, who had suggested a hysterectomy.

Dear Dr. ———,

On your recommendation I went to get a second opinion for hysterectomy because of my uterine fibroids. Let me tell the story behind my process, in hopes that you can incorporate a broader, less conventional approach to other women who present with fibroids in the future.

First, I was struck by how powerless I felt by your recommen dation for surgery. Suddenly, I began to think of myself as sick, dis eased. But my heart was telling me, “No, there’s nothing the matter with you!” So I followed my heart’s voice. I got my hands on everything I could read about fibroids, especially books and articles pre senting alternatives to surgery.
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I have learned how many unnecessary hysterectomies are performed each year in this country, and I learned of the significant, often long-term postoperative problems.

Even the small amount of research I did on the function of the uterus, especially postmenopausally, suggests that it is integral to overall good health. Chemical hormones cannot substitute for the magnificent functioning of the female organs.

So I became determined to keep my uterus—and not just for physical reasons. You didn’t ask me anything about my feelings, about my family or lifestyle, or about how a hysterectomy might affect all that.

My two beautiful daughters have both left home within a year’s time. My nineteen-year-old is in her second year of college, and my fifteen-year-old has gone away to private school in Vermont, at
her
insistence. Though I am supportive of them, at the same time it is a major life adjustment for a mother to have them both leave home so close in time. My children are gone, the off spring of my uterus, and then you tell me I should have my uterus removed as well. No, thank you. I’ll hold on to it for the time be ing and, I expect, always. If I had a life-threatening disease of the uterus, I might feel differently.

All of this may sound bizarre to you, but I firmly believe that we contribute to illness in our bodies. The flip side is that we can contribute to healing our bodies as well. I urge you to take a little extra time with your patients to hear their full story. If I had not questioned what you were telling me, I might have been one of those unnecessary hysterectomies. It would have been a convenience, perhaps, to be rid of the heavy periods, but it would have been at such a cost—in dollars, lost work, long-term hormone replacement therapy, and long-term psychological damage.

Please give your patients all the options, and the time to consider them.

Sincerely,

Louise T.

Louise’s gynecologist is not unusual. We doctors are not trained to listen to our patients’ feelings about what their diseases mean to them. Larry Dossey, M.D., in his book
Meaning and Medicine,
tells the story of Frank, a patient with chest pain whom he admitted to the coronary intensive care unit. Frank was able to change his heart rate at will by thinking about what his chest pain
meant
to him. He told Dr. Dossey that if he let the pain mean a heart attack, he immediately got anxious thinking about his damaged heart, clogged vessels, the loss of his job, and the possibility of another heart attack. But if he let the chest pain mean just a muscle ache or indigestion, he felt relieved and his heart rate came down. Dr. Dossey discovered that Frank’s heart monitor acted as a “meaning meter.” The same is true for fibroids.