Issue #27, November 2009
In This Issue:
Tradition & Gratitude – Clenching & Grinding – Hysterectomy & Informed Consent
JoAnne’s Motivational Minute: Tradition & Gratitude
By JoAnne Boettcher-Verigin
It’s hard to believe that Thanksgiving is almost here, but next week, it is! Some of us will give our time to help those less fortunate than ourselves. Some of us will take part in religious observances. Many of us will gather with family and friends for the traditional feast, sometimes traveling hundreds of miles to be together.
The one common thread is the role of human connection through the holidays – from Thanksgiving through the winter celebrations. Whether you observe Christmas, Hanukkah, Eid Ul-Adha, Kwanzaa, Solstice or other occasion, most likely there is a big emphasis on being with and giving to others.
Our home was always a hive of activity during the holidays when I was growing up – all the planning, baking and wrapping! I especially remember the first Christmas we celebrated after the end of World War II, with aunts and uncles finally home again. Everyone gathered at our home and helped decorate the tree. It seemed there was a story behind every ornament: the beautiful glass ball that my Great Aunt Maggie bought for me when I was five; decorations my mother had made from cast-off jewelry; paper chains I made in school; endless strands of silver icicles that had to be placed one by one, just so.
And there were other reminiscences. Mother and her siblings never failed to talk about their childhoods in the Midwest. They talked about trips to their grandmother’s house, not by car but by sleigh, kept warm by hot rocks their mother had heated and tucked in under their blankets.
As I grew up and started my own family, and as my own parents grew older, it became my responsibility to carry on these traditions and add to them. Now as I look at my grown children and their children, I see them add their own traditions while still maintaining the old.
It seems to me that those memories and traditions add stability to the family in unstable times – both the families we’re born into and the families we choose for ourselves. They serve to remind us what really is important in life. I am thankful this year for all of those memories – and for the opportunity to look ahead and make new ones.
As you engage in your own traditions, I hope you will stop and take stock and be grateful, too. Although times are hard for many of us now, when we recognize and honor our connections to friends and family, and the love and comfort that they give us, the going can seem just a little bit easier.
Have a wonderful holiday season!
A thankful heart is not only the greatest virtue, but the parent of all other virtues. – Cicero
Dr. Verigin’s Comment: Why You Might Grind Your Teeth – and What to Do about It
By Gary M. Verigin, DDS, CTN
The first time I ever heard about clenching and grinding teeth was not when I was in dental school. It was when I was an undergrad taking abnormal psych at UC Berkeley. One of our course field trips was to Angews Asylum in Santa Clara – a state-run mental hospital. I vividly remember walking down a long corridor, listening to a psychiatrist brief us on what we would be seeing that day. Then he stopped and asked if we could hear any noises coming from behind the closed doors to our left. In fact, we could – a sound like the low chatter of geese or ducks, which intensified the closer we got. But once the doors were opened, we could see that, of course, there were no birds at all: just dozens of patients lying on cots and mattresses, making this noise. We looked to the psychiatrist for explanation.
“They’re grinding their teeth,” he said.
The next time I heard about grinding was during my third year occlusion class in dental school. At that time, it was thought that grinding most often occurred when a person’s teeth didn’t fit together, or occlude, properly: the habit was an attempt to wear down the teeth so they would fit better. Dentists were often blamed for causing this unconscious behavior by not placing a new filling or other restoration properly. So we were taught to be extra diligent in testing occlusion and adjusting restorations as needed. Our teachers had us take impressions of the teeth, cast study models and mount them on a semi-adjustable instrument called an articulator. Then we would place colored carbon paper or wax over the biting surfaces to help us see which teeth were not evenly matched when the articulator was opened and closed. We were to keep detailed records of the steps we took to adjust the teeth on the model so we could replicate them later on in the patient’s mouth.
And so we were taught that this would bring an end to the patient’s grinding and clenching behaviors. But we didn’t work on these patients long enough to know if we indeed helped them or not. The story on the clinic floor was that they would be transferred to other students who needed credits in that phase of dentistry to meet their degree requirements.
Why You Might Grind
We’ve already looked at some of the main reasons why people clench, grind or brux in a previous issue of Biosis. But a quick web search will reveal plenty of other theories about causes – some sensible, some on the edge of the improbable.
One doctor we know grew up in a family of butchers. After years of slaughtering cattle, he could see which cows were sick just by looking at them. They would slice the throats of cows and then cut the jaw muscles. Upon slicing the jaw muscles of the sick cows, parasite eggs would pour out onto the floor. This is why people grind their teeth at night – because parasites inhabit the jaw muscles. Jaw grinding happens primarily at night when parasites are more active.
The chiropractors who run the Center are by no means alone in this belief. According to an eclectic, non-medical site called Innvista,
Bruxism is the abnormal grinding, clenching, and gnashing of the teeth, often observed in cases of parasitic infection. This is more noticeable in children, especially at night, and may be a nervous response to an internal foreign irritant. In “conventional” medical material, they still maintain that the cause of this remains unknown and controversial.
Other camps suggest psychological reasons. These days, it’s common to point to the daily assault of bad news about the economy, job losses and the rippling effects of those problems, or any other sources of psychological stress. Others point to popular Freudian explanations such as inhibited hostility, frustrated sexuality and displaced aggression. Of course, there is plenty of evidence to support psychological theories, at least in some cases.
Other suggested causes for which there is evidence:
- SSRI (antidepressant) and other drug use
- Smoking and alcohol consumption
- Obsessive-compulsive disorders
- Sleep disorders
- Hypersensitivity of dopamine receptors in the brain
- Overuse of GABA-inducing analogues used in treating anxiety and insomnia
And of course there’s still the culprit of misaligned teeth.
The truth of the matter is that there appears to be no single cause of clenching, grinding and bruxing. The important thing, if you do grind your teeth, is to get help for it, as the habit is one that damages teeth over the long-term. Moreover, it can cause significant pain in the jaw and throughout the head, face, neck and back.
How Do You Know If You’re Grinding?
When people are asked if they clench or grind their teeth, most say that they don’t. But when we examine their teeth, gums and muscles, we find that 80 to 90% of our clients exhibit at least one symptom of clenching. Some dental researchers put the clenching rate even higher. For instance, in 1988 Scripps Institute lecture, Gene McCoy, DDS, of San Francisco cited a survey he took of 100 of his own patients – 95 of whom exhibited signs of what he called Dental Compression Syndrome (DCS). While this phrase still isn’t popular in discussions of clenching and grinding, I find that it really states the main issue in a precise and meaningful way.
Now, when people say that they don’t grind their teeth when the evidence strongly suggests that they do, it’s not because they’re lying. Usually, it’s because they engage in the behavior while sleeping. So if they’re married or have a partner, they may ask them if they’ve ever heard grinding or clenching sounds, or if they’ve noticed cheek muscles tensing up. Other tell-tale signs of grinding include a stiff jaw, sore or aching facial muslces and even pain in the teeth themselves. Some may wake up with headaches.
If any of these signs and symptoms turn up, it’s to your benefit to consult a dentist for help in diagnosing the problem and working up a plan to deal with it and minimize ongoing damage to the teeth, gums and muscles.
Examining the Grinder’s Mouth: What Does the Dentist Look For?
Obviously, the dentist first examines the teeth for signs of damage or occlusal problems that may be contributing to the grinding habit. And with this, there are eight major things a dentist looks for:
- How do the unworn teeth come together? Ideally, upper and lower teeth should only touch briefly upon swallowing. Otherwise, they should always be slightly apart.
- The biting surfaces of the molars should be rounded and not exhibit worn down, flattened or cupped out cusps. If there are polished, cupped out areas or dimples on the surfaces, they may be due to positive ions being emitted from focal points of high stress.
- The edges of the front teeth should appear symmetrical, and the cuspids (“eye teeth”) should be pointed. Their biting surfaces should not be worn, chipped or frayed.
- Do the gum tissues fully cover the roots of the teeth, or are some root surfaces exposed? Receded gums often indicate that the teeth are receiving some increased and undue pressure.
- Are defects visible on the necks of the teeth, where the root meets the crown? Grinding can cause a particular wedge-shaped defect known as adivot or notching of the root surface in this area. McCoy calls this “hard tissue fatigue.” The pathological loss of this hard tissue is known asabfraction (from the Latin, ab = away, and fractio = the act of breaking; so, literally, “breaking away”).
- Normally, tooth surfaces should be smooth. Stressed teeth will often have a washboard appearance, showing wavy, parallel lines, especially where root and crown meet.
- If mercury amalgam fillings are present and under severe strain, they will show wavy lines on top, as the pressure compels molecules in the amalgam to rearrange themselves in this fashion. You can see the same effect by bending a paper clip back and forth a few times, then looking at the stress configuration you’ve produced.
- In an x-ray image of the teeth, how much root is showing in the bone? Usually, 60 to 65% of a tooth is situated within bone. Under chronic (ongoing) compression, the alveolar (jaw) bone diminishes horizontally so that only about 40% of the tooth is covered, even if no periodontal pockets are present. The more compression, the more bone loss.
The dentist investigates a few other areas, as well:
- How do the face muscles appear – specifically the masseters and buccinators (chewing muscles)? Does the face appear symmetrical? Do the muscles appear to twitch even when at rest? Do they exhibit any hypertrophy; that is, do they look enlarged?
- How do the muscles of mastication (chewing) react upon gentle probing? If there is discomfort in any of them, it’s a sign of overuse, usually associated with habits such as clenching and grinding.
- Are there any extra bone growths on the inside of the jaw bones? If so, this growth may be due to the Piezoelectric effect. When the collagen in the teeth and bone is compressed – as it is by habitual clenching and grinding – both negative and positive electrical currents are produced. The negative ions are said to stimulate bone growth, while the positive currents create an occasional taste of metal in the mouth if metal restorations are present.
How the Dentist Can Help
The most common treatment for chronic clenching, grinding and bruxing is the use of a device called a splint or night guard. It’s usually made from plastic or acrylic, which may be hard, soft or semi-hard, and fits over the upper teeth as a barrier and cushion between the arches – though somtimes night guards are made for both arches.
While effective, however, this is a Band-Aid sort of treatment. Ideally, the causes of the grinding should be ferreted out and dealt with directly to eliminate the behavior that’s creating the problems. Specific types of treatment depend, of course, upon those causes.
Once the root cause of the behavior has been addressed, restorations can then be provided to the damaged teeth so as to regain their proper size, shape and position. The mandibular condyles (round bumps on a bone where it joins with another bone) can be gently and properly repositioned within the TM Joint-fossa complex so that all teeth correctly contact each other with equal pressure.
9 Thing You Can Do to Stop or Reduce the Force of Grinding
- If stress is causing you to clench and grind, do what you can to remove or deal with the stress more effectively. Consultation with a therapist, pastor or other appropriate advisor can be helpful for some. Massage therapy or other bodywork can likewise be helpful, as can yoga, t’ai chi and other regular exercise – even just walking for a half hour each day. And a good, nutritious, whole foods-based diet can do wonders.
- Train yourself to keep “lips together, teeth apart.” One of our patients did this by placing sticky notes all around her, wherever she was, as reminders to let her jaw muscles relax.
- Don’t smoke.
- Avoid alcohol.
- Reduce consumption of caffeine, including that found in chocolate and soft drinks, as well as coffee. While you needn’t cut out caffeine all together, many report less of an urge to clench when their caffeine use goes down.
- Avoid chewing gum and biting on pencils or your fingernails, as these habits reinforce the habit of grinding.
- Increase your mineral intake to soothe overworked muscles.
- Try using a biofeedback device of some kind.
- Cranial osteopathy treatments can help realign bones in a way as to reduce the tendency to clench and grind.
Healthy, attractive mouths are seen in all walks of life, rich, poor, highly educated or not. These mouths are seen in people who think well of themselves and have come to appreciate the deep physical and psychological roles their mouths play in their life. They know that teeth can make or break careers or interpersonal relationships.
Psychiatrists have found that improvement of unhealthy mouths or unattractive mouths produces a profound emotional response in some people. On the other hand, they are often baffled by the occasional person who becomes emotionally disturbed as a result of the loss of all their teeth. The emotional castration is not easily treated by the psychiatrist and cannot be undone by the dentist.
A sensible approach seems to be one of learning the problems and potentials of one’s mouth. Intelligent action will follow. – Robert Barkley, Preventive Dentistry
Unused Dental Benefits? Three Reasons to Use Them Before Year’s End
- If you’re paying your premium, you should get what you pay for. If you don’t have dental work that needs to be done, you still should have regular cleanings and exams to prevent the need for extensive treatment later. Two visits a year is ideal, though if you have gum disease, more frequent cleanings are recommended.
- Your benefits don’t roll over. As the saying goes, “Use ’em or lose ’em.”
- Your deductible doesn’t roll over either. If you don’t meet it this year, you have to start over from scratch the following year.
Give us a call at (209) 838-3522 to arrange to use your benefits before 2010 arrives.
The…patient should be made to understand that he or she must take charge of his own life. Don’t take your body to the doctor as if he were a repair shop. – Quentin Regestein
Informed Consent and The H Word: An Interview with Rick Schweikert
We take the concept of informed consent very seriously in our practice. Each client has the right and need to know what kind of treatment Dr. Verigin recommends and why, how it may affect them (benefits and risks) and other options at their disposal, including the option of pursuing no treatment at all. Consent alone is not enough, and this is why Dr. Verigin spends so much time teaching and counseling his clients: to ensure that any consent given is truly informed.
For too often we have seen how much damage can be done in the name of dentistry when consent is largely informed in name only. The most glaring examples, of course, involve mercury amalgam fillings. When pro-amalgam dentists recommend them, they seldom call them what they are. Rather, they call them “silver” fillings or “amalgams,” despite the fact that they’re made of more than 50% elemental mercury. Neither do they tell patients of the risks. If asked, they will typically say that there are none – a blatant lie rooted not in deceit or malice but misinformation or ignorance. In such cases, no person consenting to these fillings can be said to have given informed consent. And those times when risks become reality and these toxic fillings poison the body, contributing to systemic, chronic illness and dysfunction, practices like ours become a source for education and treatment, to help undo the damage so people can detoxify and heal.
Informed consent is a legal condition whereby a person can be said to have given consent based upon a clear appreciation and understanding of the facts, implications and future consequences of an action. In order to give informed consent, the individual concerned must have adequate reasoning faculties and be in possession of all relevant facts at the time consent is given.
* * *
In cases where an individual is provided insufficient information to form a reasoned decision, serious ethical issues arise.
A recent book we recommend brings such “serious ethical issues” to the fore.
The H Word by Hysterectomy Educational Resources and Services Foundation (HERS) founder Nora W. Coffey and Pittsburgh writer Rick Schweikert chronicles a year spent in bringing attention to the physical, mental and spiritual damage hysterectomy causes – much of which, contend the authors, could be prevented if consent were truly informed. For the truth is, hysterectomy is almost never medically necessary and almost always detracts from a woman’s health – facts that many gynecologists and other physicians don’t know or disregard, just as in the case of conventional dentists with respect to mercury.
In alternating chapters, the authors recount a year of demonstrations coordinated by the independent, nonprofit HERS Foundation in which women and men distributed educational material about hysterectomy outside of hospitals in each state in the nation. Also, in each state, productions of Schweikert’s powerful play un becoming were staged to further educate people about the true nature of this all too common medical procedure. In some locations, the activists were met with outright hostility and even aggression from doctors, nurses and hospital administrators. In all places, women and men alike expressed gratitude for the educational material and knowing that they or their wives were not alone, that their post-hysterectomy illnesses were not “all in their heads” but real and predictable outcomes of the procedure.
Recently, our dental team member Lisa spoke with co-author Schweikert via email to learn more about the reality of hysterectomy, its impact on the lives of women and the men in their lives and the importance of informed consent.
Rick Schweikert, Co-Author of The H Word
Lisa (L): Before reading The H Word, I had this idea that hysterectomy (removal of the womb) and oophorectomy (removal of the ovaries, or female castration) [H/O] were things that were common in the past, rarer – though still performed – now. And judging from the reactions of others with whom I’ve discussed the book, this seems a common misconception. Why do you think people remain so unaware, especially when health and health care issues are so prominent in the media and public discourse? For instance, with respect to women’s health, Abramson critiques HRT (hormone replacement therapy) at length in his Overdosed America but says nothing about hysterectomy. Why do you think the H/O issue is all but ignored?
Rick Schweikert (RS): As we demonstrate in Chapter 5 of our book, hysterectomy and female castration experimentation are nothing new – including, as Mary Daly notes in GYN/ECOLOGY, its fairly widespread use to “elevate the moral sense of the patients, making them tractable, orderly, industrious, and cleanly.” In 1914, the Mayo Clinic began recommending hysterectomy for such benign and otherwise treatable conditions such as the repair ofcystocele, i.e., a prolapsed or sagging bladder. The subsequent 60 years have seen a monopolizing of “women’s health” by gynecology, which is a surgical specialty. The surgery of choice (often referred to as “the goldmine of gynecology”) is hysterectomy, with about 75% of hysterectomized women also being castrated at the time of surgery.
The numbers of “reported” hysterectomies performed in the US spiked in the 1970s. A Congressional hearing on unnecessary surgery in 1976 found that hysterectomies for cancer prevention or sterilization were unjustified. The second Congressional hearing in 1993 concluded that “90 percent are performed more out of folklore and tradition than proven effectiveness.”
The media attention following these hearings led many to believe that the problem of hysterectomy had been dealt with, but nothing was done to stop doctors from performing medically unwarranted hysterectomies. Hysterectomy consent forms were created, but they don’t arm women with the information they need to provide informed consent. They’re merely a way to document the woman signature, to protect doctors and hospitals from lawsuits.
Today. the Food and Drug Administration, the American Medical Association and the American College of Obstetricians and Gynecologists are all run by doctors. Gynecologists are all but immune from criminal or civil recourse. There’s no governing body for gynecologists that doesn’t have an inherent conflict of interest.
The rate of “reported” hysterectomies has remained at about one out of every three women by the age of 60. We say “reported” because doctors and hospitals aren’t required to report hysterectomies performed in federally-funded hospitals (e.g., on Indian reservations and military hospitals, where hysterectomy rates are very high), hysterectomies performed abroad (medical tourism) and outpatient hysterectomies. The number of unreported hysterectomies is unknown, but outpatient hysterectomies and the proliferation of robotic hysterectomy are estimated to increase the number of total hysterectomies performed in the US to levels exceeding those that preceded the hysterectomy rate prior to the Congressional hearings.
If you were to begin asking your friends and family if they know anyone who’s had the surgery, you’d find that many women are reluctant to talk about it. But as our book makes very clear, you’ll find no corner of this country that hasn’t been altered by hysterectomy. This is especially true for women of color and in the South, where hysterectomy is often referred to as “the Mississippi appendectomy.”
The media has written extensively on the subject and there have been many books, such as Dr. Robert Mendelsohn’s MALePRACTICE, so it’s difficult to say why so many people are unaware of this ongoing iatrogenic epidemic.
L: What is the main problem with H/O? Is it a matter that the procedures are physically harmful or that they are done too often, or both?
RS: Clearly, it’s both. If the number of medically unwarranted hysterectomies performed was only 25%, it would be alarming. Whatever number you choose – Congress’ estimate that 90% are medically unwarranted or the HERS Foundation’s estimate of 98% – the number is staggering beyond belief.
There is no question in most people’s minds that removal of the male sex organs is damaging, but rather than list the ways that removal of the female sex organs is damaging, it would be best to direct your blog visitors to the HERS Foundation website where they can watch the Female Anatomy Videoor see the Adverse Effects Data to learn the problems women report after hysterectomy.
L: What are some of the main (or most common) ways in which h/o affect women’s health and wellbeing? And as The H Word makes clear, it’s not just women who are affected. How are men affected? Families?
RS: It took an entire book to answer this question fully, but hysterectomy is the surgical removal of the uterus: a reproductive, sexual, hormone-responsive organ that supports the bladder and bowel, and provides structural support throughout the pelvis and even to the spine. For example, the uterosacral ligament (attached to the uterus and the sacrum in the lower back) must be severed to remove the uterus, which is why a vast majority of hysterectomized women report severe back pain following the surgery.
Whether the surgery is performed abdominally, vaginally, laparoscopically or by a gynecologist-controlled robot, a hormone responsive sex organ is removed, and if the cervix is also removed, the vagina is shortened and sewn into a closed pocket. Blood and nerve supply travel through the pelvis along with ligaments that must be severed. That blood and nerve supply radiates out from the pelvis to the extremities, which is why women experience tingling in their hands and feet, a profound loss of sexual feeling, femoral neuropathy (which is sometimes permanently crippling) and a host of other irreversible lifelong problems.
Women who experienced uterine orgasm before the surgery will not experience it after the uterus is removed. Osteoporosis and cancer are more common in hysterecomized women, and hysterectomized women have a three times greater incidence of cardiovascular disease than women with an intact uterus. When the ovaries are removed, women have a seven times greater incidence of cardiovascular disease.
And how are the partners of hysterectomized women and their families affected? When you consider that nearly 80% of hysterectomized women report “personality change,” it’s not surprising that confidentially most women say all of their relationships are altered after the surgery. Diminished or absent sexual desire is reported by about 75%. 68% report difficulty socializing; 49%, being unable to maintain previous level of employment; and 40%, loss of maternal feeling.
The daughter of pioneer movie-maker Louis B. Mayer has written of her mother’s hysterectomy and how it splintered their family’s life. “The operation was routine,” she wrote, “but nothing was ever the same. Overall, it was the worst calamity that ever hit our family.” Her mother’s illnesses after the surgery, she remembered, “were like an ominous cloud over my life for the rest of her years.”
L: What are the typical justifications for H/O? Why are these procedures deemed medically necessary? My sense from reading the book is that most conditions can be treated differently or are self-resolving, needing no treatment at all. What are the 2% of cases in which H/O might be medically necessary? What alternate treatments (including the option of no treatment at all) exist for the remaining 98% of cases?
RS: Most typically, hysterectomy is recommended for heavy bleeding, which is often caused by submucosal fibroids. No woman ever needs a hysterectomy for fibroids. Most women never know they have them, and they tend to shrink and calcify at menopause. If a woman who is fully informed of the problem and the treatment options decides she wants the fibroids removed, myomectomy is still a major surgery, but in the hands of a skilled surgeon it will remove the fibroids, leaving the female organs intact.
The growing age group for hysterectomy is young women who are often told they have endometriosis, but for the women who contact HERS, endometriosis is misdiagnosed nine out of ten times.
All too often, women tell us their doctor recommended hysterectomy simply because they had no plans for having (more) children, and many women don’t recall why the surgery was done at all.
Every woman is unique, and no one problem can be treated with a broad brush. We discuss many alternatives to the most common justifications for hysterectomy in the book. Hysterectomy is never “needed,” because that would assume that the woman has no choice in the matter. But even if a woman has cancer, it’s her choice whether she treats it or not. For example, if the cancer has spread beyond the uterus or ovaries, removing those organs may not prolong the woman’s life.
Many hysterectomies result from obstetricians pulling and pushing babies out of women. “Spontaneous deliveries,” as they’re now referred to, are time-consuming for doctors. Women don’t need doctors to have babies, but once a doctor gets involved, time is money. Have you ever heard of a baby that didn’t come out? It does happen, but only in very rare instances, such as when the placenta happens to block its own exit by attaching to the cervix (placenta previa), making a C-section lifesaving for both the baby and the mother. And when the placenta doesn’t detach from the uterine wall (placenta accreta), sometimes a hysterectomy is the only way of saving the mother’s life. But placenta previa can often be managed conservatively and occurs in only 1 in 200 pregnancies. Placenta accreta occurs in only 1 in 2,500 pregnancies. By any measure, the surgery is rarely lifesaving.
L: A complicating issue you deal with at length in the book involves the matter of informed consent. While women who undergo hysterectomies may well have signed an “informed consent” form, you say that this consent is not always truly informed. As a result, you say the surgery becomes a form of assault, a criminal act. I was captivated by that stark description, and I was wondering if you could elaborate on it some.
RS: Consent to surgery is more than a piece of paper with a woman’s signature. At minimum it requires full disclosure of the diagnosis, prognosis, options in treatment (including no treatment at all), and the consequences of those options. The minimum information every woman requires before being asked to sign a hysterectomy consent form is available for free in the 12 minute video on the HERS website. No woman can be said to have provided consent without it.
But it’s not we who determined that unconsented hysterectomy falls under the rubric of assault. It’s the law. Legally, unwanted touching, whether it’s rape or unconsented surgery, is considered battery.
Each year there are almost five times more women needlessly hysterectomized and castrated in this country than report being raped. Rape is a criminal offense, while the unconsented removal of the female organs isn’t a punishable crime.
L: How can surgeons get away with performing procedures like H/O even when women directly say they do not want it – as in so many of the cases described in your book?
RS: Many women expressly state that they don’t want the surgery, and they even write this into their consent forms prior to exploratory surgery. But once you’re in the hospital, doctors have time and again prevailed in the courts because of what is called the “reasonable physician standard.” Most “reasonable” gynecologists perform hysterectomies for benign conditions. So, although women do not consent to the surgery, the reasonable physician standard has protected doctors who do what other “reasonable” physicians might do in the operating room…regardless of the woman’s wishes.
L: Why don’t physicians do more to educate their patients, to ensure fully informed consent?
RS: This is the million dollar question that each gynecologist needs to be asked.
Why didn’t doctors inform the public that lobotomy did more harm than good? Why are so many unnecessary c-sections performed? Why isn’t the public informed of the dangers of in vitro fertilization?
There are many answers to why doctors perform unwarranted hysterectomies. Some say it’s sexism; some say it’s money; some say it’s power. Maybe in some instances it’s all of those. But mostly doctors perform the surgery because they can get away with it.
The male organs are visible, and no man will believe you if you tell him that sex will be the same after removing his organs, or that he won’t be damaged by their removal. But the uterus and ovaries aren’t visible, and their functions are a mystery to most people.
Most women don’t understand that the uterine contractions they experience during labor are produced by the same muscles that create the pleasurable contractions during uterine orgasm. There’s no way to identify where the sensation of orgasm emanates from – until the uterus is removed.
If you don’t know that one of the ligaments that must be severed to remove the uterus also provides support to the lower back, then how are you to know you’re likely to have back problems after the uterus is removed?
It’s about power first, which includes the money that doctors are handsomely rewarded for removing uteri. But another question comes to mind: why is it that we trust doctors more than we trust car salesmen or politicians? I certainly understand the desire to trust doctors, but it’s not necessarily a good place for trust. It’s far better to inform the public as much as possible, such as this book does, so women can make the best choice for themselves and be in control of the decision making process.
L: Considering the arrogance and dismissiveness of many in the medical profession, as chronicled in your book and elsewhere, how can women prepare themselves to be their own advocates?
RS: The only solution is to change the law. Doctors must be stopped from performing unconsented hysterectomies, and the only way to do it is to require them to provide consent, based on centuries of documentation and anatomical fact.
In the meantime, that’s why we wrote The H Word. The subtitle is “The diagnostic studies to evaluate symptoms, alternatives in treatment, and coping with the aftereffects of hysterectomy,” but it’s about lot more than that. It’s the most complete source for the information required for informed consent, as told through the stories of talking with women in every corner of this country. Proceeds from the book benefit the HERS Foundation.
Education is the key, and education about the many lifelong functions of the female organs should be taught to every girl and woman.
For more articles like this one, as well as health news, tips and video, visit our blog, Know Thy Health.
Could we change our attitude, we should not only see life differently, but life itself would come to be different. – Katherine Mansfield