Sally Kwenda was 38 when she was diagnosed with stage II cervical cancer. The discovery was by chance as she had gone for screening after participating in a cancer sensitisation initiative organised by her former employer. The doctors recommended immediate surgery. When she was about to undergo the procedure, the doctor said that they had to remove her uterus, a procedure known as a hysterectomy. This was necessary to prevent the cancerous cells from spreading.
Hysterectomies are fairly common. In cancers of the uterus, cervix or ovary, they are recommended when the disease has spread and targeted therapy is not an option.
Sally had desperately wanted to have a child, especially since a decade earlier, she had lost two children even before they turned one. And now, this procedure would definitely put an end to her dreams of holding her own baby again. While this saddened her to no end, she would be wheeled into the theatre in March 2007 and would undergo the procedure. She had the uterus and cervix removed.
Dr Nicholas Nyasoro, a gynaecologist at Kisumu’s Jaramogi Oginga Odinga Teaching and Referral Hospital, says that hysterectomy is a major and a critical procedure which takes about 45 minutes to one hour. “The procedure can be fatal if not carefully done,” he says.
Just like any major surgery, he points out, possible complications can arise at the point of administering anaesthesia, post-surgery infections and excessive bleeding.
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“Injury to the adjacent structures such as the bladder, rectum and the large intestine and bit of small intestines, can also occur,” says Dr Nyasoro.
Fortunately, Sally’s surgery went without a hitch. Her recovery was spectacularly uneventful too, and she made sure to attend all the checkups she needed to. But three years after the surgery, she went in for a regular checkup only for the doctor to tell her that she had colon cancer and it would require surgery. Additionally, it needed to be done immediately lest the cancer cells continued spreading. And so she underwent a surgery that successfully got the cancer out.
But that was not the end of it all. She would be diagnosed with cancer of the rectum a year later. For that, she underwent a successful colostomy operation. “In 2016, the doctor said that the cancer was in remission and I could finally breathe.”
And despite battling three cancers, the one thing that plagues her mind is her inability to bear children. This isn’t so much from her lack of acceptance but the stigma from the society.
“People ask me where my children are all the time, but I smile and proudly talk about myself. Deep inside though, I cry. I wish God allowed me to have a womb to carry a baby,” she says.
Today, at 51, Sally spends her days raising cancer awareness in a bid to keep women from experiencing the kind of pain she has gone through.
“I do this in the hope that by championing for early screening for cancer, I can prevent someone from getting such adverse medical interventions,” she says.
A last resort for fibroids
Hysterectomies, Dr Nyasoro says, are fairly common procedures.
“In a week, the hospital receives an average of 12-15 surgeries to be done by a gynaecologist out of which at least six are hysterectomies,” says Dr Nyasoro.
But cancer isn’t the only reason to get the uterus taken out. In fact, the most common reason to have a hysterectomy done is uterine fibroids.
“Fibroids are abnormal growths that develop in or on a woman’s uterus. Sometimes these tumours become quite large and cause severe abdominal pain and heavy periods that necessitate removal of the uterus,” he says.
That said, doctors will explore non-surgical and alternative options before they recommend the procedure especially because once it is done, a woman can’t bear children.
“If a woman still wants to conceive, it is better to take out the fibroids and leave the uterus intact. However, in 25 per cent of the cases, the fibroids recur in five years, and may present differently from the first time.”
Abnormalities in the uterus
Other times, the reason to have the uterus removed can be due to a congenital malformation.
“These are cases where one is born with a malformed uterus. This comes with chronic pain. The uterus is disfigured to the point where it can’t possibly have a baby grow in it,” says Nyasoro
The pains will commonly manifest at puberty and a doctor can recommend a hysterectomy.
A complicated child delivery
A hysterectomy can also be done as a life-saving measure for a woman when having a caesarean delivery. This is usually done due to arising complications like excessive bleeding. It can also be done after a vaginal delivery.
“A subtotal hysterectomy, (where only the uterus is removed and cervix left intact) is done where a woman is bleeding excessively due to the uterus being unable to contract after childbirth. Or the uterus is torn and unrepairable,” explains Dr Nyasoro.
How it is done
A hysterectomy can be done in any of two ways:
1. The abdomen is cut open and the womb is extracted or
2. A vaginal hysterectomy where uterus is removed through the
vagina. This is considered the safer option even though studies show that it is less practised by Kenyan doctors compared to the abdominal one.
3. A laparoscopy – allows a surgeon to access the inside of the abdomen and pelvis without having to make large incisions through the skin.
Does it affect a woman’s sex life?
Dr Nyasoro says that this depends on the reasons that led to the procedure. A hysterectomy done because of fibroids can improve a woman’s sex life.
“A woman’s sex life can either improve, reduce or remain the same depending on the prevailing conditions before the surgery. When one has fibroids, she tends to bleed and experience pain during sex. When this is corrected through surgery, the pain and bleeding stops and she can have a great sex life,” adds the doctor
“For a patient who had a hysterectomy because of cancer that might still need continuing treatment of chemotherapy and radiotherapy, the procedure does not change their sex life.
Extended hysterectomies, where the uterus is removed together with the ovaries, are common in patients who have cancers. Once the ovary is removed, the major source of sexual hormones, libido could be affected.