& Sexual Health
L. Lyons, MD, to Address Quality of Life Post Hysterectomy at AAGL’s 38th
Global Congress of Minimally Invasive Gynecology
Abdominal Hysterectomy Rates Far Too High
Twenty years ago, in 1989 Thomas
L. Lyons, MD, of the Center for Women’s Care & Reproductive Surgery in
Atlanta developed the Laparoscopic Supracervical Hysterectomy (LSH). It
leaves the cervix in place a keystone support for the anatomy, and since
then he has trained hundreds of surgeons on the procedure. Studies have
shown that women experience improved sexual function and can resume
intercourse two weeks after the surgery, an outpatient procedure.
Recuperative time is one week or less.
However, a shocking 60-65% of
the 600,000 hysterectomies annually in the U.S. are still performed
abdominally, with long incisions. Recuperation time involves several
days in the hospital and 6-8 weeks out of work. In 2005, the American
College of Obstetrics & Gynecology expressed that the number of
abdominal hysterectomies should be lowered to less than 30 percent.
“The regrettable fact is that,
even though LSH has proven effective for thousands of women worldwide,
many members of our own professions still do not offer it as a viable
option,” said Dr. Lyons.
“However, smart health consumers
are much more proactive in researching their own options on the
Internet, and many are not willing to settle for the way it’s always
been done,” he said.
Potential Complications with Total Hysterectomy
“Less is more in surgery,”
explained Dr. Lyons. The LSH or sub-total hysterectomy spares the
cervix, which is a small, doughnut shaped mass of tissue at the base of
the uterus, and helps prevent pelvic prolapse.
Additionally, leaving the cervix
in place can help prevent the problem of dehistence, which is the
vaginal incision’s breaking open during intercourse. Depending on the
size of the opening, a woman may herniate bowel into the vagina; the
bowel might become entrapped, causing potential compromise to the blood
supply and the bowel might die.
“When the cervix is removed,
there’s no buffer—and the vaginal incision has to heal before
intercourse is comfortable again,” he said.
Dehistence is not a factor for
patients who have had LSH because the cervix is still in place. Dr.
Lyons explained that over the past two years, this has been a major
topic of discussion on the American Association of Gynecologic
Better Sexual Function Post
Dr. Lyons and some researchers
believe that for many women, the cervix may contribute to sexual
“Leaving the cervix in place
helps prevent unnecessarily shortening the vaginal canal,” said Dr.
Lyons. Research from a Finnish study in 1983 found pain upon intercourse
pre-hysterectomy was better relieved by the cervix-sparing procedure.
Another study of the same women determined that the frequency of orgasms
decreased in women who had their cervix removed but not in those who
hadn’t had it removed.
Additional data collected about
sexual function post-surgery often don’t even begin comparisons until
one year after the procedures (either abdominal, laparoscopic,
cervix-sparing or not) are performed. In those studies, sexual function
customarily returns to normal after a year, no matter how the procedure
“When I lecture about it, I
comment that it’s only a year,” said Dr. Lyons drily.
Often surgeons hesitate to
recommend procedures that they are unable to perform, even though they
are easier on the patient. Seeking Dr. Lyons through Internet research,
patients come to him from around the world for advanced laparoscopic
procedures with quick recovery times.
Sexual Problems Cloaked by Other Issues
Although 99 percent of
gynecologic patients visit their gynecologist with a problem related to
sex, according to Thomas L. Lyons, MD, few walk through the door
expressing that as the problem. Issues are usually described as pelvic
pain, abnormal uterine bleeding or infertility, he explained.
Endoscopic pioneer Dr. Lyons is
a featured presenter and panelist at the American Association of
Gynecologic Laparoscopists’ 38th Global Congress of Minimally
Invasive Gynecology, November 15-19, 2009, in Orlando. One of AAGL’s
early members, he is a world -renowned expert who has performed
telesurgery and lectured for them since 1995. He will serve as a
panelist on Endoscopy and Sexual Health.
The AAGL Global Congress is the
pre-eminent meeting for physicians interested in providing optimal
patient care through minimally invasive gynecology. Performed through
tiny incisions, laparoscopic or endoscopic procedures involve less pain,
less risk and less recuperative time.
From the standpoint of physical,
emotional and economic wellbeing, and overall quality of life,
endoscopic procedures make more sense than ever.
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