A funny thing happened to Natalie Shaw when she sent out routine announcements to radio stations about a seminar on hysterectomies.
Nobody used them.
Another funny thing happened when she asked some gynecologists what they thought about such a seminar. The response was less than enthusiastic: Only 2 out of 15 thought it might be useful. The rest said, in effect, "Forget it."
Shaw also recalls that she got a kind of "oh-you-poor-pitful thing" fisheye from a bookstore clerk when she asked about books on hysterectomy -- there aren't many -- and she had to conculde, finally, that "despite women's liberation and everything else," this subject is "still taboo."
"And," she says, "even though we don't want to believe it at this point, it reflects our culture and we're still pretty far from being able to talk about it."
Shaw is a social worker, so she made her own hysterectomy five years ago into a learning experience. So much so that her gynecologist started sending some of his patients to her for counceling and guidance.
She has drawn from her own problems of adjustment -- before, during and much longer after than she was led to expect -- and from the experiences of other women, including "the lady in the next bed" in the hospital as well as those who came to her for help and collegues at the Community Psychiatric Clinic, where she is the social work coordinator. And she has discerned a pattern. . .
Dr. Oscar Dodek, cochairman of the George Washington University medical school's Endocrine and Infertillity Divison, has begun teaching a postgraduate course at G.W. on new techniques for an old operation.
Originally performed in the mid 19th century, but not very much practiced since the advent of the hysterectomy, the operation, a ,myomectomy , involves the surgical removal of fibroid tumors -- leaving the reproductive organs intact.
Modern medical technology, Dr. Dodek believes, has made this operation a viable alternative to hysterectomy, if:
No malignancy exists.
The patient is of childbearing age.
Approximately 25 percent of all women will have fibroid tumors of the uterus. They almost never are cancerous. Black women seem especially prone to them -- about three times more so than white women -- and black women seem to develop them at an earlier age. Although not all fibroids require surgery, Dr. Dodek notes that when they do, the hysterectomy has been the surgery of choice even though "many of [these women] want to retain the option of having children, or having more children.
"They don't want to be sterilized," Dr. Dodek says, "but a hysterectomy on a woman under 40 must be considered a sterilization procedure."
The myomectomy fell out of favor, Dr. Dodek says, because it is intricate surgery and used to have serious complications. New techniques and technology have minimized the complictions, hes says, and although there may be an eventual recurrence of the fibroids and an eventual hysterectomy, "Meanwhile, these women can have a family. . . Patients are told that tumors may be too numerous, too deeply embedded in the uterus to remove them. There really is almost never a situation where you cannot leave the uterus and safely remove the fibroid."
As far as this operation is concerned, then, Dr. Dodek finds himself allied with critics who charge that too many of the 800,000 hysterctomies performed on American women each year are unnecessary. "The fact that someone has fibroids should not be a reson to have them sterlized," he says.
Women -- from the ancient fertility goddess Astrate, on down through the ages -- are indoctrinated form babyhood with the concept that female equals fertility, equals fruitfulness.
When even the most liberated woman, whatever her age, is faced with the prospect of hysterectomy, something deep in the dark recesses of her mind is bound to whisper, "you might as well be dead ."
"The myths about women being valued for beauty, youth and fertility are very much a part of our unconscious," is how Shaw puts it. "And they do come out before this operation."
Getting that kind of fear out in the open and facing up to it is one of the things Natalie Shaw wants to help women do. Too often, she says, "The minute a women hears the doctor say 'surgery' she just turns off and doesn't hear anything after that. . ."
There are other fears as well, which recur over and over among the patients she has seen, "a pattern of people not being able to say out loud," things like:
"Will I be a whole woman afterwards?"
"Will I be over the hill?"
"Will I be menopausal?"
"What about estrogens?"
"Will I lose sexual desire?"
"And every operation deals with body-image loss," says Shaw, so there is also the question of "How will I look? What will the scar look like?"
Many gynecologists, male and female, make a point of meeting with both potential hysterectomy patients and their husbands, who, says Shaw "can be very affected, especially those who have some feelings about their own masculinity" and may wonder, "if a woman has no uterus, will they still be potent men?"
But many other doctors, she has found, do not have such meetings.
"I would like to get women more involved in the process itself," says Shaw, "not only to know the facts, but to ask their doctors questions, to get a second opinion if they're not sure. Mostly I want to tell people that they're not crazy to have all these thoughts beforehand, that it's normal, part of the human condition, part of the way we've been brought up to think about ourselves." Even through, by and large, the fears are groundless.
Women, Shaw believes, "easily form groups," so the workshop with both a gynecologist and a social worker or nurse or psychologist seemed a natural and useful project.
"A woman," she says, "shouldn't have to go through this alone.