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What Is It?
Facing surgery can be a frightening experience fraught with questions, doubts and uncertainties. However, most surgeries are elective, meaning that you decide if surgery is the best option for you and elect to have the procedure.
Millions of Americans undergo surgery every year, most of them women. Many women will face a recommendation for surgery that involves their reproductive system, typically called gynecologic surgery. For example, hysterectomy—surgery that removes the uterus and sometimes other parts of the reproductive tract—is the second most common gynecologic surgery after cesarean section.
Facing surgery can be a frightening experience fraught with questions, doubts and uncertainties. However, most surgeries are elective, meaning that you decide if surgery is the best option for you and elect to have the procedure. This decision process often gives you needed time to prepare, which is an important step. Research suggests that women who prepare mentally and physically for surgery have fewer complications, less pain and recover more quickly than those who don't prepare.
Following the invention of anesthesia in the mid-19th century, operations were developed for conditions ranging from appendicitis to uterine fibroids. Enthusiasm for gynecologic surgery was especially intense, and the first hysterectomy was performed in 1843 in Manchester, England.
Today, the trend in gynecologic surgery is toward less invasive techniques that don't require surgeons to cut into the abdomen with large incisions. Doctors are even trying incisionless surgery—a new technique where internal organs are removed through body orifices such as the mouth or the vagina. Also, new, faster-acting anesthetics have been developed that have fewer side effects than traditional anesthetic agents.
Settings for surgery have changed, too. Not long ago, having surgery meant being admitted to the hospital a day ahead and discharged a week later. Today, more than half of all surgeries, including many gynecological procedures, are done on an outpatient basis. Outpatient surgery refers to operations that do not require an overnight hospital stay. Instead, the surgery is performed at an ambulatory surgery center or a health care professional's office, and you return home in less than 24 hours. Now there is also a choice between hospitals' ambulatory surgery centers and free-standing ambulatory surgery centers, which are becoming more popular and can often be found in the suburbs, even in shopping malls. They are physically separate from—and sometimes even distant from—a hospital.
Generally, outpatient, or ambulatory, surgery is appropriate for healthy individuals and for simple procedures that can be done in 60 to 90 minutes and don't require a person to be closely monitored afterward. Outpatient surgery offers several advantages over surgery that requires hospitalization, such as:
However, if a large incision has to be made or if the risk of complication is high, same-day surgery or having surgery performed at a free-standing surgical center may not be an option. Outpatient surgery is not for everyone. Women with chronic conditions such as diabetes, heart disease or high blood pressure (hypertension), or who are otherwise at risk for complications that could require hospitalization, might not be eligible.
Same-day surgery also puts more responsibility on the patient to manage pain medications, keep incisions clean and follow through with postoperative care on their own. A woman who has small children to care for at home may be unwilling or unable to take on the added responsibility and may not be a good candidate for same-day surgery. If you face a recommendation for surgery, be sure to consider which type of setting will work best for you.
Preparing Emotionally
Surgery also has an emotional impact. A woman who has heard, perhaps incorrectly, that a hysterectomy will ruin her sex life or leave her tired for months, for example, may become depressed, fearful or angry with her body. For some women, the anticipation of being hospitalized and separated from family members makes coping difficult. Even simple procedures done in a doctor's office can provoke a strong reaction. Advances such as same-day surgery may make surgery more convenient, but they haven't necessarily made it less stressful. Regardless of what kind of surgery you have, stress is involved. Hormones released in response to stress can cause symptoms ranging from headaches to high blood pressure. Stress hormones can also weaken the immune system and disrupt the body's ability to manage pain and infection.
Some experts advocate preparing for surgery through a series of relaxation techniques: deep breathing, positive thinking and visualization—imagining or mentally seeing—a positive outcome from surgery and a quick recovery period, for example.
Preparing Physically
While emotional preparation is a necessary, often-overlooked step, preparing physically is also important for a successful surgical outcome. In the weeks before your surgery, you should:
If you decide to have surgery, discuss the following with your health care professional:
Legal Considerations
Once you've decided on surgery, had the necessary tests done and prepared mentally and physically, you'll be asked to sign a consent form. This may also be a good time to consider donating blood for your surgery, if you wish to, and drawing up advance directives. These instructions communicate your health care plans if you cannot speak for yourself in the future.
There are two kinds of advance directives: a living will and a health care proxy. States differ in the directives they recognize. Discuss your wishes with your health care professional and your lawyer, if you have one. State-specific directives are available from the National Hospice and Palliative Care Organization website at www.caringinfo.org, or you can obtain one from your local health department, state medical associations, a hospital admissions office or your primary care provider.
A health care professional is required to have a detailed discussion with you before your surgery so that you are fully informed when making the decision whether and how to have it. This is called obtaining your "informed consent" to have the procedure. The informed consent process should include discussion of the risks and benefits of the proposed surgery.
Consent forms differ from one health care professional to another and may include permission for additional procedures to be performed if needed. Ask to sign the consent form several days in advance to avoid being confronted with a list of risks immediately before surgery, which can create anxiety. Do not sign the consent form until you understand and feel comfortable about what is being done. Don't let this part of the process feel rushed. Ask questions if you need to.
Before surgery you may also be asked to sign a form allowing a blood transfusion to be performed, if necessary. Normally, blood donated to the Red Cross four to six weeks in advance of your surgery is shipped to the hospital a few days before your surgery. However, you can also donate your own, called an autologous blood donation. Or you can ask family members or friends with the same blood type to donate units of blood for you. You'll need to inform your surgeon whom you have chosen to donate blood for your use.
If you're considering autologous blood donation:
Call the Red Cross and ask about fees and insurance coverage and about freezing your blood if your surgery is delayed.
Financial Considerations
Familiarize yourself with the extent of your medical benefit plan before your operation so you will know what portion of the costs will be your responsibility. Your physician's office staff may be able to help you find out how much your medical benefit plan will cover. If your medical benefit plan will not pay all of the anticipated costs and you cannot afford the difference, then discuss this situation with your surgeon to see if you can work out an acceptable solution.
Some procedures and some health plans require pre-authorization before your operation. Become familiar with your insurance plan requirements to avoid unpleasant surprises after your surgery.
Understanding Pain
Knowing what to expect after surgery is as important as knowing what to expect beforehand. Pain is an inevitable part of surgery. Pain is the body's way of sending a warning to the brain that it has been damaged and needs attention. Although a normal reaction to surgery, pain can interfere with recovery by:
There are several ways to relieve pain after surgery. Narcotics, such as morphine and codeine may be prescribed for severe pain following surgery via IV, pills or patches. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, or other non-narcotic pain relievers may also be used, either as liquids or in pill form. Local anesthetic injections or anesthetic creams and patches may help prepare your body for a procedure or relieve pain afterward.
Depending on the type of surgery you are having, you may also be given pain relievers through patient-controlled intravenous analgesia (PCA), which is usually used in hospitals for acute pain following surgery. In PCA, the patient is connected to a machine called a PCA pump. When the patient pushes a control button, the machine delivers a dose of narcotic or other pain reliever through the veins. The doses are smaller than what would be given by injection, but because the drug goes directly into the bloodstream, relief can occur within seconds.
Ask the surgeon or anesthesiologist to discuss these options with you beforehand. Other nonmedical approaches to pain management can be very successful. These may include:
When preparing for surgery, discuss with your health care professional what possible pains to expect after your procedure and how to best manage any possible symptoms.
When your health care provider informs you that surgery is a recommended treatment option, there are a number of decisions for you to make. These include whether to have surgery at all, and if so, when to schedule it and whom to choose as your surgeon. Typically, several options are available before surgery and must be seriously considered. Generally, surgery should be considered only after more conservative measures have been exhausted. Though it may be tempting to take the last step first, because surgery may seem like the most definite solution, you need to remember that surgery may not be the only answer. Every procedure has risks, and no surgeon can guarantee a good outcome.
Because most conditions are not emergencies, alternatives to surgery are often good choices. One alternative may be watchful waiting to see if a condition improves or worsens on its own. For example, small fibroids that cause no symptoms may need no treatment at all. Fibroids shrink after menopause, so a woman who is close to menopause may try waiting to see if her symptoms subside once she stops menstruating. Fibroids and abnormal uterine bleeding may also be treated first with hormones or with minimally invasive surgery. By choosing to wait or investigating other options, women may be able to postpone surgery indefinitely.
Once the decision to have surgery has been made, a woman should have a clear idea of what is treatable by surgery and what is not. For some women, having too much detailed information about an impending operation is stressful. Still, a woman needs to be informed enough about the surgery to tell the surgeon what she wants done and what her wishes are in the event of unexpected findings.
Surgeries are designed to relieve symptoms, diagnose a condition or extend life. Having a good understanding of the procedure beforehand can make surgery less stressful and result in a better outcome. The informed woman should ask her health care professional what precisely an operation is meant to do, and if something is going to be removed, she should know why exactly.
If an operation can be done more than one way, a woman can weigh the benefits of having a less invasive procedure. A woman should ask the surgeon whether the procedure she is considering is one he or she does frequently or only on occasion. Often, a surgeon who is used to doing a procedure a certain way and has performed a lot of them has better results.
You should also discuss possible complications, such as infection, bleeding or reactions to anesthesia. Knowing what to expect after surgery allows you to feel more in control and better able to cope with recovery. Getting answers to certain questions can help. (See "Questions to Ask" section.)
Developing a good relationship with your health care team can help you feel more comfortable about your treatment and the outcome of your surgery. Some physicians are better communicators than others. Look for a physician who:
Getting a second medical opinion on any medical recommendation, if possible, can help make your options clearer to you. The advice of another health care professional can:
A competent health care professional should not be insulted if you decide to get further advice. Sources for finding a medical expert to provide a second opinion include your primary health care provider—ask him or her to refer you to another surgeon; family or friends who have had success with a particular health care professional; and a local medical society or national association of specialists. Your health insurance coverage may require a second opinion and require you to choose from its list of providers.
The steps you will take while preparing for any type of surgery are typically the same. Below, a number of practical issues are discussed, as well as information on surgeries that are common for women, primarily those related to your reproductive system.
What to bring to the hospital
The Presurgical Visit
The presurgical visit is generally scheduled the day before surgery. An anesthesiologist will examine you and review your medical history to determine what type of anesthesia is safe for you. You will be examined and questions will be asked about your health. Blood and urine samples will be taken. You may undergo an electrocardiogram, or EKG, which provides an electrical recording of the heart. If you have had a blood or urine test or EKG in the past 30 days, let your physician know—this may eliminate the need for these tests during the presurgical visit.
Preoperative Preparation
Just before surgery, preoperative preparation—or preop prep—takes place. The steps vary, but this is what you can expect:
Common Surgical Procedures
There are several reasons why gynecologic surgery may be recommended. Examples include symptoms caused by abnormal uterine bleeding, fibroids, pelvic pain from endometriosis (a disorder that occurs when some of the tissue that forms the lining of the uterus grows in other parts of the body) or other conditions, and uterine prolapse (when the uterus is no longer supported by muscles and ligaments, and drops into the vagina). All are common reasons why women seek surgical treatment from their health care professionals.
If you have one of these conditions, here are some of the procedures your health care professional may recommend:
How Anesthesia Works
One of the most common fears people have about any type of surgery concerns anesthesia. Anesthesia refers to the drugs and gases used during an operation to relieve pain. These drugs work by artificially putting you to sleep and by blocking messages to the brain. As a result, all or part of the body becomes insensitive to pain and feeling for as long a time as needed.
Anesthesia can be given by either an anesthesiologist (a doctor who specializes in anesthesia) or by a nurse anesthetist working under the supervision of a physician. For minor surgeries done in a health care provider's office, local anesthesia can also be given by the health care professional performing the procedure.
During surgery requiring anesthesia, the anesthesiologist adjusts the level of the drugs to heighten or lessen their effect. He or she also continually monitors a patient's breathing, heart rate, blood pressure, temperature and other vital signs, and performs blood transfusions, if necessary.
Before any operation, you should ask who will be administering and monitoring the anesthesia. Because it is difficult for a surgeon to operate and monitor a person's anesthetic at the same time, it is best if another person monitors the anesthetic. Minor procedures must be carefully monitored as well, because even sedatives can depress breathing.
The type of anesthesia used during surgery depends on a woman's age and physical condition; on the nature and length of the procedure; and on any personal history or family history of adverse reactions to drugs. Some operations can be done with more than one type of anesthesia. In some cases, a health care professional may steer you toward one type of anesthesia based on your medical history and the type of surgery.
The four types are: conscious sedation, local anesthesia, regional anesthesia and general anesthesia. Their effects range from a short-lived numbness to temporary paralysis or unconsciousness, depending on the blend of products used and how they are administered.
Many gynecologic surgeries are performed using an epidural injection—the type of anesthesia commonly used during childbirth. Epidurals are becoming increasingly popular because they can keep a person comfortable without causing grogginess or affecting a person's consciousness.
An epidural works by putting anesthetic drugs in the epidural space just outside the spinal cord, which affects the large nerves entering and leaving the spinal cord. These nerves are responsible for transmitting information to the spinal cord and brain about touch, temperature and pain. If too large a dose of the medications is given or if the needle is inadvertently placed inside the spinal sac, the anesthetic could affect nerves higher up in the chest that control breathing and heart rate. An epidural can also cause blood pressure to fall. The administration of an epidural requires a skilled anesthesiologist.
Some procedures demand a particular method of anesthesia, leaving you without a real choice. You may, however, be able to request that the smallest possible amount of a drug be administered, which may reduce side effects. Before receiving any anesthesia, you should discuss the options with your surgeon or anesthesiologist.
The anesthesiologist typically will discuss your surgical procedure and anesthesia-related issues before your scheduled surgery. Use this meeting to express any fears or concerns you have about anesthesia. You should also ask the following questions:
For safer surgery, it's important to share as much information as possible about yourself and your health history with the anesthesiologist including:
While there is not really a way to prevent necessary gynecologic surgery, you should carefully consider alternatives to elective surgery. The most common alternatives to hysterectomy as a treatment for fibroids, endometriosis and abnormal uterine bleeding, for example, are watchful waiting and hormonal therapies.
For example, birth control pills may be used successfully to treat abnormal bleeding or pain caused by endometriosis.
If you decide surgery is your best option, ask your surgeon:
Review the following Questions to Ask about preparing for surgery so you're prepared to discuss this important health issue with your health care professional.
While that answer depends on the type of surgery, the current trend in gynecologic surgery is toward less invasive techniques that don't require surgeons to cut into the abdomen with large incisions, and therefore have shorter recovery times. Also, new, faster-acting anesthetics have been developed that have fewer side effects than traditional anesthetic agents.
Settings for surgery have changed, too. Not long ago, having surgery meant being admitted to the hospital a day ahead and discharged a week later. Today, more than half of all surgeries, including many gynecological procedures, are done on an outpatient basis. Outpatient surgery refers to operations that do not require an overnight hospital stay. Instead, the surgery is performed at a hospital ambulatory surgery center, a free-standing ambulatory surgery center or a doctor's office, and you return home in less than 24 hours.
Women with chronic conditions such as diabetes, heart disease or high blood pressure, or who are otherwise at risk for complications that could require hospitalization, might not be eligible. Outpatient surgery may also not be appropriate if a large incision has to be made or if the risk of complications is high.
Same-day surgery also puts more responsibility on the patient to complete the necessary preoperative tests, manage pain medications, keep incisions clean and follow through with postoperative care on their own. You may not be a good candidate for outpatient surgery if you have small children to care for at home and are unable to take on the added responsibility.
In the weeks before your surgery, you should stop smoking and avoid excessive alcohol and eat a well-balanced diet including plenty of foods rich in vitamin C, which may help promote tissue healing; exercise regularly to build energy and maintain strength; and ready your home as necessary. If your doctor tells you to stop taking aspirin before the operation, avoid it for at least five days prior. (Do not stop taking aspirin unless you're instructed to do so, however.)
Once you've decided on surgery, had the necessary tests done and prepared mentally and physically, you'll be asked to sign a consent form. Now may also be a good time to consider donating blood for your surgery and drawing up advance directives.
Advance directives are instructions that communicate your health care plans if you cannot speak for yourself in the future. There are two kinds of advance directives: a living will and a health care proxy. States differ in the directives they recognize. Discuss your wishes with your physician and your lawyer.Talk to your health care provider about the options.
Most likely. Pain is an inevitable part of the surgery and recovery process. Pain is the body's way of sending a warning to the brain that it a certain body part has been damaged or injured and needs attention.
There are several ways to relieve pain after surgery. Narcotics, such as morphine and codeine, may be prescribed for severe pain following surgery. Acetaminophen, nonsteroidal anti-inflammatory drugs such as ibuprofen, and similar medications, may also be used, either as liquids or pills. Local anesthetic injections or anesthetic creams may help prepare your body for a procedure or relieve pain afterward.
Ask the surgeon or anesthesiologist to discuss medication options with you beforehand. Other nonmedical approaches to pain management can be very successful. These may include relaxation, applying heat or ice to the surgical site and massage and stretching exercises. When preparing for surgery, discuss with your health care professional what possible pain to expect after your procedure and how to best manage any symptoms.
For information and support on Preparing for Surgery, please see the recommended organizations, books and Spanish-language resources listed below.
American Academy of Orthopaedic Surgeons (AAOS)
Website: https://www.aaos.org
Address: 6300 North River Road
Rosemont, IL 60018
Phone: 847-823-7186
American Brain Tumor Association
Website: https://www.abta.org
Address: 2720 River Road
Des Plaines, IL 60018
Hotline: 1-800-886-2282
Phone: 847-827-9910
Email: info@abta.org
American College of Obstetricians and Gynecologists (ACOG)
Website: https://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: resources@acog.org
American College of Surgeons
Website: https://www.facs.org
Address: 633 N. Saint Clair Street
Chicago, IL 60611
Hotline: 1-800-621-4111
Phone: 312-202-5000
Email: postmaster@facs.org
American Society for Aesthetic Plastic Surgery
Website: https://www.surgery.org
Address: Central Office
11081 Winners Circle
Los Alamitos, CA 90720
Hotline: 1-888-ASAPS-11 (1-888-272-7711)
Email: asaps@surgery.org
American Society for Dermatologic Surgery
Website: https://www.asds.net
Address: 5550 Meadowbrook Dr., Suite 120
Rolling Meadows, IL 60008
Phone: 847-956-0900
American Society of Plastic Surgeons
Website: https://www.plasticsurgery.org
Address: 444 East Algonquin Road
Arlington Heights, IL 60005
Phone: 847-228-9900
Association for Professionals in Infection Control and Epidemiology, Inc.
Website: https://www.apic.org
Address: 1275 K Street NW, Suite 1000
Washington, DC 20005
Phone: 202-789-1890
Email: apicinfo@apic.org
Books
Prepare for Surgery, Heal Faster: A Guide of Mind-Body Techniques
by Peggy Huddleston
The Surgery Coach: Mind-Body Preparation for Faster, Better Recovery
by Joseph Casey
Spanish-language resources
Agency for Healthcare Research and Quality: Having Surgery? What You Need to Know
Website: https://www.ahrq.gov/topics/informacion-en-espanol/index.html
Address: Agency for Healthcare Research and Quality
Office of Communications and Knowledge Transfer
540 Gaither Road, Suite 2000
Rockville, MD 20850
Phone: 301-427-1364
Medline Plus: Surgery
Website: https://www.nlm.nih.gov/medlineplus/spanish/surgery.html
Address: Customer Service
8600 Rockville Pike
Bethesda, MD 20894
Email: custserv@nlm.nih.gov
HealthyWomen content is for informational purposes only. Please consult your healthcare provider for medical advice, diagnosis or treatment.