enemies of uterus

Today it happened again. There was this young lass in her early thirties, referred to me for fitness. Being a physician getting patients for pre- op assessment is routine work, but lately a few things had started disturbing me. Over the years I noticed that patients undergoing hysterectomies were getting younger and younger.
Let us see, what the indications for hysterectomy are. Here are a few standard ones.

1-Uterine Leiomyomas

2-Dysfunctional Uterine Bleeding

3-Genital Prolapse

4-Endometriosis and Adenomyosis

5-Chronic Pelvic Pain

6-Pelvic Inflammatory Disease

7-Endometrial Hyperplasia

8-Cervical Intraepithelial Neoplasia, Invasive Uterine Cancer, and Other Cancers

9-Obstetrical Indications

10-Hysterectomy and Oophorectomy for the Prevention of Cancer

If you analyze the list you will see that these indications are not totally age dependent but most of these indications are commonly seen in peri menopausal or menopausal ladies. For more details about hysterectomy you can visit this link http://en.wikipedia.org/wiki/Hysterectomy

I am not very sure about the figures here at my place because we Indians are notoriously poor in record keeping. Even if we manage to keep some records they would either be illegible or inadequate. I did some mental arithmetic based on my being part of the local medical community and came up with these figures. One third of the major surgeries done here is hysterectomies and thus evolved the term Enemies of uterus. (The Term युटेरस के दुश्मन ( यूकेडी) sounds more appealing to me.)
What is happening here? Why are gynaecologists and surgeons bent upon removing as many uteri as possible? Looking around, discussing with colleagues and friends I came up with some surprising and funny conclusions. I found out new and novel indications for hysterectomy and would like to share them.

In my profession there is a phenomenon called fashion. Sometimes a drug is in fashion; sometimes an investigation or a particular therapy is in fashion. I am practicing in a small district place hence the fashions are also mundane. A few years back getting an x-ray done was mandatory, today ultrasound enjoys that status. Intensive coronary care units have yielded their pride of place to intensive care units. At present hysterectomy is in fashion at my place. It can be in various forms, TAH or total abdominal hysterectomy, vaginal hysterectomy, laproscopic or laproscopically assisted vaginal hysterectomy and you can get it done on demand.

I have already narrated the medical indications for hysterectomy, but looking for answers for this spurt in numbers I found that there are more urgent and compelling indications for this procedure than the medical indications.
The commonest indication is competition .If gynaecologist "X" has done 15 surgeries then gynaecologist "Y" must do more. Surgeon "Z" does not want to lag behind so he also makes all the efforts to equal or surpass the figure. If some one points out the need for proper work up and evaluation then the argument is --some one else will do it, so why not I? This creates a vicious cycle .Every one is pedalling furiously.

When a big industry is started, ancillary units come up very fast to support and feed the industry. Similarly here many sub-indications crop up. It is necessary to get a hysterectomy done because the family doctor in the village gets a hefty commission for referral. So he plants the seeds in the mind of the patient and the family and usually is able to convince them of the necessity of nothing less than hysterectomy even for simple cervicitis.

When medical indications are not the guiding principals then age also ceases to matter. It hardly matters that a 22 year old under goes hysterectomy and increases her risk for cardiac events. Gets early menopause and osteoporosis. Partially loses or compromises with her sexual proclivity. She may develop a sense of loss of womanhood and may develop some psychiatric problems .In India a girl child is hated even by the mother /grandmother similarly a uterus is being rejected by its very own holder. This makes me think -------

It makes me think about a society where uterus is not inborn but an option. At the time of conception you have the choice of a girl child either with or without a uterus. The conception of course being in vitro. This is possible as in future we have the option of surrogate uterus, like today we have surrogate mothers. This surrogate uterus could either be in a lab or in animal kingdom. (So far veterinarians are not enemies of uterus).Think of the possibilities. The positive side being the girl in future will be able to maintain her figure throughout without having to worry about the disfigurement caused due to repeated child births.

So what do you think?