Hysterectomies

Global Statistics Hard to Derive

Debate persists about the high incidence and medical necessity of hysterectomies and the related moral and ethical issues of such aggressive intervention. Women who have their uterus surgically removed are rendered infertile even if permanent contraception was not the primary or desired goal of the procedure. In most cultures, the ability to procreate is central to what it means to be a normal, functioning, feminine adult. Thus, the loss of the uterus by hysterectomy can be a pivotal moment when a woman reflects on her identity and her place within the family and wider community.

Approximately 600,000 hysterectomies are performed in the United States each year. The Canadian age-standardized incidence rate for hysterectomies was reported at 346 per 100,000 in 2005, representing a steady decline since 1997. Similarly, a 23-year retrospective study in Western Australia reported that the age-standardized rates for hysterectomies have declined by 23 percent, to 4.8 per 1,000 women.

However, there are significant differences in rates, type of procedure, and average length of hospital stay across geographic regions, socioeconomic, and ethnic groups, that are not explained by known risk factors. For example, in poorer Canadian provinces such as Newfoundland and Labrador, there continues to be a substantially higher than national average rate of 458 hysterectomies per 100,000 population. Similarly, American surveys report higher rates of hysterectomies in economically depressed regions than in more affluent regions, and higher rates among disadvantaged African American and Hispanic subgroups than among their white cohorts. In Western Australia, indigenous, women particularly those in rural areas, are more likely to have a hysterectomy than their non-indigenous urban counterparts. Health researchers call for international comparisons that would explore non-pathological factors such as ethnic, culture and access to care. Currently, international statistics are difficult to find or unreliable because they tend to be extrapolated from incidence and prevalence rates in Canada, the United States, the United Kingdom, and Australia, rather than generated from country-specific data.

Reasons for the Operation and its Evolution

Most hysterectomies in North America (70 to 90 percent) are performed for the treatment of chronic benign gynecological disease. A hysterectomy is deemed medically necessary when a women has uterine fibroids (more common among black women); uterine or vaginal wall prolapse (more common among those who have had multiple or unsupervised deliveries); painful and prolonged bleeding, especially among women in the years prior to menopause; or when a woman is living with persistent and debilitating symptoms of endometriosis that do not respond to less aggressive medical treatments. Under these conditions, a hysterectomy is regarded as elective or nonemergent, whereas a hysterectomy for the treatment life-threatening complications during or immediately after childbirth is considered an emergency.

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