Love your uterus and have children at the right age
As March 8 is coming up, I would like to ask you to say a few words to our sisters about the problems we encounter in our daily work.
If I were to talk about the humanistic care we gynecologists give to our sisters, I would say, “Protect the uterus and have children at an appropriate age! Let the uterus fulfill its mission.
Why do you say this?
God has given women the supreme duty of conceiving the next generation and ensuring the reproduction of human beings. The uterus is the place where the fetus is conceived, but it is also an organ that is very susceptible to pathological changes. As we age, the incidence of diseases such as fibroids, adenomyosis and even cervical cancer increases significantly, all of which require surgery and, in some cases, the removal of the uterus. In our daily work, we often encounter some older patients who have not yet had children but need surgery for the above-mentioned disorders. Whether it is the disorders themselves or the surgical treatment, the result is bound to affect fertility and even make some women infertile for life. How devastating is it for a patient to learn that these disorders may affect her future fertility? As a gynecologist who encounters these problems on a regular basis, I thought I should let everyone know.
How can we avoid the effects of these diseases on fertility?
The best way is to complete the fertility task before the uterus becomes diseased. If possible, women should marry themselves off before the age of 25 and have children before the age of 30. Why does the national Marriage Law set the age of marriage for women at 20 years old? Because 25-30 years old is the best age for childbirth. Missing this period means an increase in age and an increase in the chances of uterine pathology. The longer the uterus is infertile for a fetus, the greater the chances of pathology. Don’t think that someone had their first child at the age of 40, I can have it just as well. When disease creeps in, all we have to deal with is thinking about how to protect the uterus and protect fertility. You media are delighted with the news of successful IVF at 60, but you don’t know how many people cannot conceive naturally at the age of 35 or 40, and how many people suffer from repeated failed IVF. A person’s life can be long, but a woman’s fertility period is only 10 years of prime time.
However, in reality many women tend to postpone marriage or childbirth for one reason or another. How can these women care for their uterus to ensure good fertility?
We know that there are certain patterns of diseases. Diseases such as uterine fibroids, adenomyosis and cervical cancer mostly occur in women over 30 years old. Diseases always occur from nothing, from small to large, from mild to severe. Although some diseases cannot be prevented, they can still be detected early and treated early. Nowadays, the means of examination and treatment have been improved, and medical technology is not afraid of what you can’t do, but of what you can’t think of. As long as a certain disease is suspected, it can be clearly diagnosed by different methods. For women, an annual pelvic ultrasound and cervical cytology examination is very necessary. Ultrasound can detect fibroids less than 1 cm in diameter and adenomyosis lesions, while cervical cytology can detect cervical lesions at an early stage, including precancerous cervical lesions and early cervical cancer. Meanwhile, for women who have sex and do not intend to have children for the time being, they should take good contraceptive measures, avoid repeated abortions and prevent pelvic infections, so as to reduce the occurrence of diseases that endanger female fertility, including endometriosis, pelvic adhesions and tubal obstruction. These are all common diseases that affect female fertility. In our clinical work we encounter many female patients with secondary infertility due to abortion.
In our daily life, we still encounter women who have uterine problems, especially fibroids and adenomyosis, or even cervical cancer, discovered before they have children, what should be done for these patients?
Although I talked earlier about how these diseases can affect fertility, there is no need to worry too much. Modern medicine has advanced to the point where it is possible to remove the lesions while preserving the uterus and fertility, depending on the nature and extent of the lesions in the uterus. For example, in the case of fibroids, if the patient can become pregnant, pregnancy can be carried to full term while the fibroids are present in the uterus. If infertility is caused by fibroids or adenomyosis, surgery can be performed to remove the fibroids or adenomyosis and preserve the uterus and fertility. Even in cases of tubal adhesion infertility due to surgery, IVF, a technique to assist in pregnancy, can be used. A few years ago, I treated a patient who had more than 60 fibroids, large and small, removed by two cesarean operations. There are countless patients who have conceived and given birth naturally after surgery. As for patients with cervical cancer, they can also choose conical hysterectomy or wide cervical excision according to the degree of lesion, thus preserving the uterus and fertility.
The prevention of cervical cancer is actually very simple
The reluctance to have children early after marriage or even not to have children, as well as sex without marriage are social realities that are difficult to change over time.
There is no way to prevent some diseases, such as fibroids and adenomyosis, which are hormone-dependent diseases and there is no good way to prevent their occurrence. There is no good way to prevent these diseases because it is impossible for a woman not to have a period, and the presence of hormones can lead to the development of these diseases. And cervical cancer is a disease caused by HPV infection, from precancerous lesions to cervical cancer takes a period of time, if detected and treated at this stage, cervical cancer can be prevented, this newspaper should do a good job of publicity. Yangcheng Evening News: What are the methods to detect precancerous lesions of the cervix and early cervical cancer at an early stage.
The methods are actually very simple, mainly cervical cytology examination. For patients with abnormal cytology examination and then colposcopy and tissue biopsy, a clear diagnosis can be made. It is also important to tell you that cervical HPV infection does not indicate the presence of cancer in the cervix, just like hepatitis B virus infection does not necessarily lead to liver cancer in every case.
What are the main methods used for cervical cytology screening?
Currently, there are two main types of cervical cytology, one is simply applying cervical cells on a slide, and the other is called cervical liquid-based cytology, which is significantly more accurate than the former. This is because liquid-based cytology is done by brushing the cells off the cervix, then putting them inside the cytoprotective solution, concentrating all the cells by centrifugation, and then spraying them evenly on the slide, so that they can be seen comprehensively. I think this is the biggest contributor to the prevention of cervical cancer.
How significant is cervical cytology screening?
The incidence of cervical cancer may be reduced by more than 90% if every woman who is sexually active visits the hospital once a year for a cervical cytology exam. The cervix is located deep in the vagina and is easily exposed. Cervical cytology often indicates an abnormality before a lesion can be seen with the naked eye. If the cytology is normal, it will be fine for a year. If the cervical cells are abnormal, then colposcopy and tissue biopsy can be done to clearly diagnose precancerous and early stage cancer. For these patients, we then have the means to preserve the uterus as well as the reproductive function, and a cure can be achieved. However, nowadays, many patients come to the clinic at an advanced stage and cannot even undergo surgery. What is the reason? It is the lack of attention to cervical cytology. If the patient is detected at precancerous stage or even stage 0, a conical hysterectomy or simple hysterectomy can be done according to her specific condition; however, if the patient reaches stage 1 or 2, a more extensive resection is required; if the patient reaches stage 3 or 4, there is no way to treat surgically and only radiotherapy can be relied on. The later the stage of cervical cancer, the worse the treatment effect.
Is there any other way to detect the problem besides cytology?
Sexual intercourse is an effective method for early detection of cervical cancer. Why is that? Because normal sex does not bleed. If there is a lesion on the cervix, the punching and rubbing on the cervix during sex will often cause bleeding, even if it is a small amount of blood, it is a danger signal to be alerted. By the time the lesion bleeds naturally and then is seen again, it is often very advanced. Such a procedure was done just this morning. The patient was 28 years old and recently had a small amount of bleeding after intercourse twice. She was alert and came to see the doctor right away and was diagnosed with cervical carcinoma in situ. I performed a conical hysterectomy to preserve her uterus. Compared to this patient, another patient seen a few months before was not so lucky. This patient started having sex at the age of 16, had 7 abortions and had not yet had children. This time, she visited the clinic with sudden vaginal hemorrhage at 5 months of pregnancy and was found to have advanced cervical cancer. According to her condition, she could no longer continue her pregnancy and the fetus was aborted after vascular interventional chemotherapy, followed by hysterectomy. When asked about her medical history, she had already had bleeding after intercourse some time before her pregnancy, but did not pay attention to it. The result due to her ignorance is really saddening and helpless.
By talking to you, we have learned that cervical cancer is a preventable disease and what would you like our government and health care sector to do in this regard?
More than 2,000 years ago, the Yellow Emperor’s Classic of Internal Medicine already mentioned that “the upper doctor treats the untreated disease, the middle doctor treats the desired disease, and the lower doctor treats the existing disease”. Our ancestors have long appreciated the importance of disease prevention. For the prevention and early diagnosis of cervical cancer, the key is to strengthen the education, so that the majority of women understand the knowledge in this area and accept the relevant examination voluntarily and consciously. The maternal and child health care network in China is very sound, and patients can receive examinations in this regard as long as they go to hospitals. In addition, in many countries, even in Taiwan, Hong Kong and Macau, cervical cytology screening has become a government-paid health care program, and we have done some work in this regard, but if this program can become a free annual medical checkup for every woman, it will be a blessing for the majority of our female friends, which requires a strong appeal from your media.
A woman always has to defend her uterus to the death
When you were out in the clinic we observed many patients with uterine diseases who were still adamant about keeping their uterus even after having children.
I still lament this today, that a woman is not living for herself, but for her husband, when it comes to the issue of keeping her uterus.
Are you saying that she is worried that her sex life will be affected by the removal of the uterus?
Yes, that is their main concern. They are worried that the removal of the uterus will cause loss of femininity, that it will affect their husband’s sexual pleasure, and some even think that the removal of the uterus will turn them into men, which I would say is ignorance on their part. There was once a patient whose fibroids had grown to the size of a 6-month-old fetus, and she went to many hospitals and was told to have her uterus removed, but she strongly disagreed. She came to me and the first thing she said was, “If you want to cut my uterus, I will leave. Although I fulfilled her wish and the operation was successful and the uterus was preserved, I still think she should cherish herself and not delay her condition by defending her uterus to the death just for her husband. It should also be known that removal of the uterus has little effect on sexual life.
Is it true that removing the uterus does affect sex life?
Many people ask me if cutting off the uterus makes them male. In fact, they are worried that hysterectomy will affect their sex life. In fact, the uterus is not the main organ for maintaining femininity, and it is not the organ for sexual intercourse, it is the place where the fetus is conceived. The ovaries are the main organ for maintaining female characteristics, and they secrete estrogen to maintain female characteristics and sexual response. There was a patient who had adenomyosis so severe that she was in pain every month, and she did not want to undergo surgery. How bad was her pain? She said that when she was in pain, she wanted to reach out and pull her uterus out and throw it away. Until she finally couldn’t hold on anymore, she underwent a hysterectomy at my suggestion. After the operation, she told me that her sex life was better than before. I asked why? She said she didn’t have the pain that she felt during the week of the month, and that she could do whatever she wanted without the interference of her period.
Of course the ovaries are very close to the uterus, and part of its blood supply comes from the uterine arteries, so cutting off the uterus has some effect on the blood supply to the ovaries, but another part of the blood vessels carried by the ovaries themselves can still ensure the blood supply to the ovaries to maintain the function of the ovaries to secrete sex hormones. It is because removal of the uterus affects part of the blood supply to the ovaries that we pick out the fibroids and preserve the uterus in patients who do not need to have their uterus removed, such as those with fibroids and limited adenomyosis, but only if her condition permits. In this regard, we also have many new techniques that have been applied in the clinic, such as hysterectomy with preservation of uterine vessels and hysteroscopic endometrial resection, which are new techniques designed to preserve the uterus or to preserve ovarian function. What I want to emphasize about the removal of the uterus is that the uterus is really important for women, but when it really needs to be removed, that is also necessary.
Many women think that if they cannot keep the uterus, it is important to keep the cervix.
Preserving the cervix ensures that the length of the vagina and the structure of the pelvic floor are not altered, but studies have shown that neither removal of the cervix at the time of hysterectomy nor preservation of the cervix has any effect on pelvic organ function, with no difference in frequency of sex, desire, sexual initiation, or orgasm. Therefore, preservation of the cervix should depend on the patient’s request and there is no absolute indication, provided of course that the cervix itself is not diseased.
It’s hard to think of her losing her uterus at 20
Do you remember how you felt when you removed the uterus of your first patient and whether thoughts of pity arose?
I can’t say that if I removed 1,000 uteruses, all because they needed to be removed, I wouldn’t feel pity. If a doctor regrets or regrets his actions, it is when he makes a mistake in judging or treating the patient. If I had any pity, it was when I first graduated more than 20 years ago. A girl in her 20’s was operated on for fibroids, and she kept bleeding from her uterus after the operation, and she couldn’t stop the bleeding by all means, so her uterus was finally removed.
The doctor will consider when to preserve the uterus and when to preserve the cervix, these are still very important for a woman, right?
There are indications for all of these. If the patient is young and has benign lesions, such as fibroids or focal adenomyosis, we will preserve the uterus; if the lesion requires removal of the uterus and there is no cervical lesion, we will preserve the cervix if the patient requests it. For relatively older patients, total hysterectomy will be considered to avoid the occurrence of cervical cancer.
Does it mean that older patients are more likely to have cancer?
Endometrial and cervical cancers occur significantly more often during menopause and menopause than during childbearing years. Most of the patients we treat for these two types of cancers are after their 40s and 50s. Therefore, women who have completed their reproductive tasks, are approaching menopause, and have relatively less sex can opt for a total hysterectomy if they develop uterine fibroids or adenomyosis. This is because the removal of the uterus itself does not have much impact on sexual life, while keeping it may produce new tumors.
Humanistic approach to uterine disorders treatment techniques
Removing the uterus is a cruel thing to do, how to show humanistic care?
For benign uterine lesions, simple removal of the uterus has little impact on the patient, so the best humanistic care is to master the indications for hysterectomy and decide whether to remove the uterus in conjunction with the patient’s wishes. This is not the case for patients with cervical cancer. Since extensive hysterectomy for cervical cancer is very likely to injure the urinary nerve innervating the bladder, resulting in prolonged difficulty in urination after surgery, the nerve innervating the bladder is isolated and protected during surgery, which is radical cervical cancer surgery with preservation of the nerve, and the patient’s urinary function is rapidly restored after surgery. For patients with early-stage cervical cancer who have not had children, extensive cervical excision can also be performed to preserve the reproductive function. In the past, the ovaries had to be removed during cervical cancer surgery, but later studies found that the chance of cancer cells metastasizing to the ovaries was low and the cancer was not dependent on ovarian hormones, so the ovaries can be preserved for patients with non-menopausal cervical cancer. The humanistic approach to the treatment of uterine disorders is also reflected in the application of laparoscopic and negative surgical techniques. Both surgical techniques can avoid the long incision in the patient’s abdomen, reduce the trauma to the patient, and enable the patient to quickly resume normal life and work after surgery, including, of course, sexual life!
On the occasion of the 8th of March, as an elder brother can you say a word of advice to the sisters?
Sisters have to love themselves, not simply the uterus.