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Awaiting moderation 62146 Article

Uterus: appearance and function

Some of the mechanisms of heavy, uncontrolled bleeding are not understood. Gaining insights into this phenomenon is obviously vital if improved ways to alleviate it are ever to be developed. A small protein called endothelin, discovered in the late 1980s, has been found to cause constriction of blood vessels in many parts of the body, and may be responsible for eventually ending any episode of blood loss. Recent research has revealed high levels of this protein in the endometrium around die time that the menstrual bleed comes to an end.
While this research has been going on, the uterus has attracted increasing attention at a more general level. It has long been regarded by many people as a safe haven for a developing baby during pregnancy, but an unqualified nuisance thereafter. A 1987 editorial in the prestigious British medical journal Lancet expressed this view when it said:
for the woman who is not interested in having children, or whose family is complete, this solution [hysterectomy] is often attractive ... [it promises] relief from her symptoms and other expected benefits — greater reliability at work, availability at all times for sexual intercourse, saving on sanitary protection, freedom from pregnancy and freedom from uterine cancer.
Today, views such as this are being scrutinised due to a growing body of evidence which suggests that the uterus and cervix play an important part in sexual satisfaction for some women and men. For perhaps as many as one in three women, contractions of the uterus contribute significantly to their experience of orgasm. As noted earlier, in pre-menopausal women the cervix also produces lubricative mucus for some days each menstrual cycle. This mucus, which is apparent in the days before ovulation, may be associated with increased interest in sex and less friction during intercourse. In addition, some men and women find that the tapping of the penis on the cervix during intercourse contributes to the pleasurable sensations they experience.
The uterus also seems to have psychological importance for some women, being associated with self-images of femininity and sexual attractiveness. This may be especially relevant in cultures where women's reproductive functions are highly valued. There is also a perception among some women that their partners treat them differently (find them less sexually attractive) after hysterectomy, suggesting that some men's notions of womanhood are closely allied to the presence of the uterus.
It is still the case — and this is controversial — that many surgeons remove both ovaries along with the uterus during hysterectomy procedures when there is no apparent ovarian disease or disorder. What's more, some women believe that they have not been consulted about this in advance. The reason typically given is prevention of ovarian cancer, which affects about one in seventy women, mostly over the age of sixty. Ovarian cancer is diagnosed in about 900 Australian women each year and about 550 die from it. The symptoms of pain, bleeding and swelling are usually not obvious until the disease has progressed to an advanced stage.
It is hoped that research findings indicating a role for the ovaries in women's long-term health will cause a reappraisal of this practice, especially as the risk for developing ovarian cancer in retained ovaries after hysterectomy is only about two in every 1000 women. The available evidence indicates that even post-menopausal ovaries make sex hormones. These may be of value to women's health, particularly in helping maintain sexual interest and responsiveness, and bone strength. However the clinical evidence is inconclusive. It is clear that the long-term effect of removing the ovaries along with the uterus in the pre-menopausal years is to increase a woman's risk of heart disease — perhaps to three times that of non-hysterectomised women. Furthermore, other research suggests that removal of both ovaries and the uterus increases the risk of osteoporosis, with increased loss of bone density and a higher incidence of fractures.


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