About Modesty During Hysterectomy
Approximately 600,000 hysterectomies performed
each year in the United States. Some women have positive experiences,
but sadly others are left feeling marginalized by the lack of
respect given to their modesty. Many women prefer only female
medical personnel for gynecological surgeries and procedures.
It is estimated that 85% to 90% of
all hysterectomies are unnecessary so it is important
for you to get a second opinion preferably from a naturopathic
or integrative medicine physician and do some research on alternative
options before you proceed with a hysterectomy to make sure
that it is really necessary. Check out Why
Are Hysterectomies Often Unnecessary?
Procedures for ensuring a woman’s dignity
and modesty vary greatly across hospitals for hysterectomies.
Some hospitals have policies that restrict male nurses from
providing intimate care to women in OB/GYN wards, while other
hospitals believe that the gender of the healthcare provider
is irrelevant to the procedure. The other issue is that prior
to surgery and then for a period of time after, some patients
are heavily sedated leaving them unable to either advocate for
themselves or recall what happened or who provided care. For
many women, this is quite disconcerting.
Before you consent to surgery, there are two
principles that should guide your discussions with your providers:
1) communicate your all your wishes and concerns to
everyone involved in your surgery—even if you think they
are obvious and 2) get the agreements you make
with your doctor and gynecology department at the hospital in
There are three domains around which
you should have careful conversations and record all your agreements:
Types of hysterectomy:
a) Vaginal Hysterectomy - A
surgical procedure in which the uterus is removed through
the vagina. One or both ovaries and fallopian tubes may be
removed during the procedure, as well. This surgical approach
avoids visible scarring and typically allows for a quicker
recovery, as well as less postoperative pain and complications
as compared with other types of hysterectomy. Risks associated
with the vaginal approach include a slight but serious risk
of shortening or damaging the vagina.
b) Laparoscopic-Assisted Vaginal
Hysterectomy - This type of surgery employs video
technology to provide the surgeon with greater visibility
when removing the uterus through the vagina. The laparoscopic-assisted
approach entails three small external incisions: one in the
navel, through which the laparoscope (small video camera)
is inserted, and two others in the lower abdomen for the use
of surgical instruments. This procedure may be preferred because
of the rapid healing time, a less noticeable scar, and less
pain, although actual surgery time is longer than the abdominal
approach. Because of the longer time in the operation room
and the use of extra electronic equipment, this procedure
is also costlier than others. Risks associated with the laparoscopic-assisted
vaginal approach include a slight risk of bladder injury and
urinary tract infection.
c) Abdominal Hysterectomy
– This type of hysterectomy is fairly standard and remains
the most common approach for removing the uterus and other
reproductive organs. When performing an abdominal hysterectomy,
surgeons can either use a vertical incision or a "bikini
cut" incision depending on the scope of the surgery.
The vertical incision cuts vertically from the navel to the
pubic hair line, while the bikini cut is a horizontal incision
made directly above the pubic hairline. The abdominal hysterectomy
approach results in a longer recovery period and more noticeable
external scarring but requires less specialty surgical skill
and may be less costly and more widely available than other
d) Laparoscopic-Assisted Abdominal
Hysterectomy – This type of surgery requires
only one incision for both the laparoscope and the removal
of the uterus. This approach is an alternative to the three-puncture
laparoscopic-assisted vaginal approach; however, the laparoscopic-assisted
abdominal approach is only appropriate for a supracervical
hysterectomy (meaning the cervix is healthy and does not need
removal). The laparoscope has the potential to be a useful
tool for total and radical hysterectomies as well, however
most surgeons prefer the traditional abdominal approach for
There is no getting around the fact that you
will be exposed to many people for the procedure. It is the
job of doctors and their assistants to make you feel as comfortable
as possible. In that effort, they are likely to either skip
over details of what they will be doing, or they will try to
make it sound as clinical as possible. The basic truth is that
once you are in the operating room your legs will be placed
into stirrups and your doctor will perform a pelvic exam on
you. Your gown will then be removed (yes that means you will
be naked) or pulled up to allow access to your abdomen and genitals..
Your vagina and rectum will be prepped (cleaned) inside and
out, and if you are having either an abdominal or laparoscopic
hysterectomy your abdomen will also be cleaned. You will then
lie there for at least another 3-5 minutes until you are dry.
At that point, you will be draped. There will be openings in
the drape for your vagina and abdomen. A urinary catheter will
be inserted and depending on the procedure, other objects like
a speculum or uterine manipulator will be inserted through your
vagina. Once the surgery is finished, the incisions are closed,
the draping will be removed from your body, at about the same
time if you were anesthetized you will be “awakened”
and likely given more sedation, then you will be taken to the
PACU where they will care for you for about 1-2 hours. You will
then be taken to a regular room.
The description above is very general and may be different
for your doctor or hospital, but the purpose is to give you
a frame for asking questions. For example, you might ask if
you will be covered while your doctor examines you in the Operating
Room or you might ask to be awake for the exam. You can also
ask who will insert the catheter or if the catheter can be inserted
while you’re awake. Lastly, you may be more comfortable
if your doctor or her assistant perform the vaginal prep rather
than the hospital scrub nurse/circulating nurse. Also, be sure
to ask about the windows in the Operating Room. In some hospitals,
there are windows everywhere so that people can watch procedures.
Some hospitals screen windows for gynecological procedures and
others do not.
Be aware that accidentally cutting a hole in your bladder
is a potential complication of hysterectomy. Patients
are often not informed that their bladder could be perforated
during hysterectomy. The standard of care calls for bladder
perforations to be identified in surgery and repaired while
the patient is still under anesthesia. The repair of bladder
perforation can either be done vaginally or through an open
abdominal surgery. Whichever technique is used, an urologist
or urogynecologist should be called into the operating room
to perform the repair. This means that your gynecologist could
call in an urologist while you are under anesthesia without
your consent. Most urologists are male. Check out experiences
of some hysterectomy patients who had bladder perforations.
People Who Will Be Involved in Your
Patients rarely consider the fact that there
are a number of people in and out of an Operating Room before
and during a surgery. Your doctor will have an assistant to
help with the procedure. Generally the doctor selects his/her
assistant. The hospital will assign several medical personnel
for the operation including nurses, anesthesiologist or nurse
anesthetist, surgical scrub technicians, and a scrub/circulating
nurse. The job of a scrub / circulating nurse is to make sure
all the tools are ready for the doctor, bring you into the Operating
Room, prep your body for surgery, and record information about
your preparation. Generally, you only meet anesthesiologist
or nurse anesthetist just before the surgery. There will also
likely be 2 other surgical scrub technicians involved. Their
job is to bring things to the scrub nurse, doctors or assistants,
clean up discarded items and assist in any other way they are
asked. You should be aware that nurses can take breaks in the
middle of surgeries. When this happens, a team comes in to relieve
them. This means that they could bring in male nurses to replace
the female nurses during their breaks.
Some hospitals allow medical students to participate
in hysterectomies. Some hospitals especially teaching hospitals
still allow medical students to practice pelvic exams on gynecological
surgery patients without their consent. See more information
Questions you might
1.) Who is going to assist
the surgeon? Do not assume you know this. A doctor will often
have someone in her office that does most of the surgeries
with her. If that person is unavailable, the doctor will call
someone else and usually not bother to tell you unless you
ask. If you want to have an all-female team, you must tell
her that you only accept a female assistant.
2.) Who will the scrub/ circulating nurse
3.) Who will be the anesthesiologist?
4.) Who will be the surgical scrub technicians?
5.) Who will be the PACU nurse?
6.) Who will be performing which procedures
on you? For example, ask who will be suturing you, placing
your legs in the stirrups, undressing and dressing you, etc.
7.) Is there any chance that medical students
will be present? If so, what role will they play?
8.) Can someone such as my husband, friend,
or family member be present with me for the surgery?
9.) Ask who would be your urologist or urogynecologist
if you had a bladder perforation. Repair of bladder perforation
is often done while you are still under anesthesia.
This is the area that perhaps is the most ignored by patients.
Many patients genuinely do not want to know what is happening
and want to be sedated for as long as possible—that is
absolutely their right. However, if you wish to be aware of
what is happening, you need to make your wishes clear to your
doctor and thoroughly ask your anesthesiologist or nurse anesthetist
about his/her plan.
First of all, be aware that “awake” to a doctor
is different than “awake” to a layperson. Patients
are often given Versed
or other sedatives prior to entering the Operating Room to alleviate
stress and help you to relax. While Versed
is an anti-anxiety medication, it also has a powerful amnesia
is also known as a date-rape drug. It is used to make a person
compliant and induces conscious sedation. It causes
a person to not remember. It's a dangerous drug which is not
in the best interest of patients. Many patients will not be
able to remember anything while under its influence. If you’re
prior to being brought into the Operating Room, you will likely
not remember who is in the room, being placed on the OR table
or being prepared for anesthesia. So while the doctor may say
you will be “awake,” be sure to clarify what that
means. Further, once surgery is over, you will likely be give
few more doses of Versed, again that means you will likely not
remember being in the PACU.
One hysterectomy patient who spoke up that she did not want
any male medical personnel present was given Versed
so she could not advocate for herself. She ended up with a male
anesthesiologist, a male assistant, and a male circulating nurse
against her wishes. You are no longer able to advocate for yourself
once you are given Versed because it causes you to have a powerful
amnesia effect. Versed
gives medical personnel the opportunities to do many things
without your consent. Versed
also legally invalidates any patient testimony regarding their
There is no reason for you to be given Versed.
You should write on your consent form that you do not give consent
to be administered at all.
All three of these areas are vital to your care and
your concerns about modesty. Remember that a conversation
is not enough. Once you have come to an agreement with your
doctor about the issues above, you need to be sure that you
write those directives on your consent form.
Important Tips For Women Concerned About
Modesty During Hysterectomy:
1.) You should write a list of expectations that you and
your doctor sign. Make several copies of the list. Then when
you sign your hospital consent forms and any other form you
are asked to sign, note by your signature that you have a
list of expectations that are attached and have the person
witnessing your signature initial that note.
Your list of expectations should be
clear and direct. For example:
- I withhold consent for any sedation until after I have
been brought to the OR and have been placed into stirrups.
- I withhold consent for Versed.
- I withhold consent for any male medical personnel or
medical students being present during my surgery or observing
my surgery. If my wishes cannot be accommodated for an all-female
team, the surgery must be cancelled or postponed.
- The only person I allow to insert the urinary catheter
is my doctor.
- I only give consent to Mary Smith to assist Dr. Jones
in my hysterectomy.
2.) Try to get all consent forms prior to the day of surgery
and read them carefully. Write in any changes or requests.
3.) Visit the hospital you will be having the surgery at
and ask to speak to the nursing supervisor and/or manager
of the gynecology dept. Discuss your wishes about who you
want to be present. Make sure you indicate if you don't wish
for even female medical students to be there. Some women who
want an all-female team are open to female medical students
observing their gynecological surgery.
4.) Insist that they do not give you an IV until you have
been prepped for surgery. Check out how
female urinary catheterization is done.
5.) It is prudent to have an advocate not employed by the
hospital such as your husband present the whole time for pre-op,
surgery, and post-op to make sure that your wishes are honored.
This is the only way you can have a guarantee that your wishes
will be honored. Remember that someone else could come in
middle of your surgery including a sales representative, a
janitor, or other nurses. Check out Why
You Should Have a Personal Advocate For Surgery?
6.) Walk out and cancel the surgery if you see that
your wishes will not be honored for an all-female medical
team. Patients need to stand up to show medical professionals
that they are not willing to compromise.
7.) Find another doctor if she is not willing to work to
accommodate your wishes.
Other Related Articles:
is Female Urinary Catheterizations Done?
Are Hysterectomies Often Unnecessary?
For OB/Gyn Patients
What You Should Know About
Sedation and Versed?
Women's Health Network - Hysterectomy
Research Network - Hysterectomies: What You Need to Know
Bladder Perforation During Hysterectomy Medical Negligence?