Women often wonder if an empty space remains after a hysterectomy, but you can be sure this does not occur. Organs such as the bladder, bowel and intestine reposition themselves and take up the space.

I have heard that some women get depressed after a hysterectomy. How likely is this to happen?

Recent studies suggest that, overall, rates of depression in women who have a hysterectomy are less than they were in the same women before they had the operation. In individual cases, however, depression may be increased due to complications of the operation or regrets about having it. Hysterectomy can actually reduce levels of depression in women for whom the operation relieves painful and heavy periods.

How can I improve my health before having a hysterectomy?

Avoid smoking, have regular physical activity, and keep your weight under control. Doing these things reduces the risks associated with surgery and post-operative complications. If you are having heavy bleeds, you should take iron supplements to increase your haemoglobin level.

Will I have an early menopause if I have a hysterectomy hut keep my ovaries?

In theory, removal of the uterus and cervix, but not the ovaries, should not produce menopause. The only change should be an end to your periods and removal of the problems that made the surgery necessary.

In practice, however, a significant number of women whose ovaries remain after this sort of hysterectomy do experience symptoms of menopause up to four years earlier than might be expected. Possible explanations are that the surgery inadvertently altered the blood supply to your ovaries, or the condition that caused you to have a hysterectomy in the first place, such as endometriosis or cysts, had already reduced the natural life of your ovaries.

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It has been known for centuries that drinking during pregnancy can cause problems with the health of the baby. In the 1720s ‘gin epidemic’, the Royal College of Physicians stated that parental drinking was a cause of ‘weak, feeble and distempered children’.

Alcohol is classed as a teratogen (an agent or drug that can cause malformation of an embryo or foetus). Professor David Smith from Washington points out that ‘there is no known teratogen yet studied in man which clearly shows a threshold effect where the substance is quite safe to a particular level, beyond which it is teratogenic’. In effect, he is saying that the experts cannot say that one glass a week would be fine but two glasses are not. As the World Health Organization states, ‘no alcohol during pregnancy is the only safe limit’.

By day 36 of pregnancy, the neural tube of the embryo opens and a rudimentary system is formed. If a teratogenic substance like alcohol is drunk at this most crucial time, it can result in various malformations in the newborn (e.g. defective heart and muscular skeletal abnormalities).

Remember that you will be two weeks pregnant before you know you are. You only know that you might be pregnant when your period is late.

However, although the first three months are the most critical, the teratogenic effects of alcohol continue throughout pregnancy, affecting, at the later stages, brain development and function, in particular. Low birth weight and congenital abnormalities have all been linked to the teratogenic effect, with the probability of twice the risk of abnormalities.

The placenta does not act as a barrier. Alcohol is a low molecular substance which is quite capable of crossing the placenta and entering the baby. It does not take a mathematician to work out that, in relative terms, a dose of alcohol must have a much more profound effect on a minute developing embryo than on the much larger mother.

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Living with breast cancer is similar in many ways to grieving other losses. As those of you who have suffered the loss of a dear one or other life tragedies already know, grieving is a complex and demanding task. It takes patience and courage. You will find, as time passes, that you experience a wide range of feelings and reactions. Some common feelings include:

? Shock, disbelief, denial, and anger

? Active suffering in the mourning process, letting the pain penetrate and register, letting yourself feel and express joy and sorrow

? Acceptance (and this happens only slowly)—coming to peace with yourself, your altered image, the loss of your former state of health and your sense of immortality, perhaps the loss of body parts and perhaps the loss of the potential to conceive and bear a child. You have lost who you were and will grow into who you will be.

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Breast cancers are classified as being either estrogen and progestrone receptor positive or negative. This will be one of the things described by the pathologist who reviews your tumor cells. Those cells which are er/pr positive require estrogen to grow and divide. Tamoxifen acts as an estrogen blocker (anti-estrogen), making any remaining cancer cells unable to respond to estrogen. The cells then die.

Many node-negative postmenopausal women whose breast cancers are er/pr positive will be given tamoxifen for five years in lieu of systemic chemotherapy. Older women whose breast cancers are er/pr negative may well receive chemotherapy. Occasionally, the situation demands that postmenopausal breast cancer be treated with both chemotherapy and tamoxifen.

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The technique of reconstruction may involve a saline implant, an expandable saline implant, a flap of tissue (muscle, fat, skin) moved from the abdomen (TRAM flap) or from the back (latissimus dorsi flap), and not infrequently both a flap and an implant. To determine which choice you prefer, you should do two things: first, schedule an appointment with one or more plastic surgeons to discuss your options; second, find women who have had the different procedures you are considering and talk to them. Although your plastic surgeon will be very knowledgeable about the various procedures, unless she has undergone the surgery herself, she will not know what it feels like to live with the results of the surgery on and inside the body ever after.

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Children this age also need reassurance that they will be cared for while you are in the hospital or having treatments. They need to know that their daily lives and routines will be disrupted as little as possible. If you will be spending time in the hospital, they may like to have a calendar to mark off the days you will be away. Some might like a special blank book to write or draw in. Others might want to write you notes while you are in the hospital; give them paper, cards, envelopes, and stamps. Frequent short phone calls are a boon.

Invite your children to accompany you to the hospital when you are going for a short appointment. Particularly if you ask your doctor or nurse to suggest a good time for a visit, your children will be welcomed; they will be interested in meeting your caregivers and seeing where you are spending so much time. Children are rarely frightened by the treatment areas; indeed, they are generally quite reassured by seeing them. Their fantasies are much more frightening than the realities.

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Having made a careful decision, trust yourself and trust your new doctors.

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Childhood play activities have been regarded as indicative of the type of sexual orientation a girl is likely to develop. If homosexuality grows out of a female’s rejection of her femininity, as psychoanalytic theory suggests, then this rejection may be expected to become manifest not only in a girl’s gender identity and personal traits but also in the play activities she chooses or avoids. Thus, it has been thought that extended tomboyishness or lack of interest in typical girls’ activities may reflect a deeper rejection of feminine roles and a tendency to adopt masculine roles instead. Moreover, it has also been suggested that typical girls’ play activities provide a sort of “training ground” for feminine roles in later life. Activities such as playing house, playing with dolls, or dressing up in their mothers’ clothing, for example, have been seen as providing girls with an opportunity to “rehearse” adult feminine roles and to develop the types of interpersonal skills that go along with such roles. Again, psychoanalytic theory would suggest that girls with little experience in typical girls’ play activities might be less able to accept their own femininity or feminine roles later on.

Research in this area has consistently found homosexual women to have been less attracted to typical girls’ activities and more attracted to boys’ activities during childhood than were their heterosexual counterparts. It has been reported, for example, that homosexual women were more likely to have been tomboys in childhood and to have continued their tomboyishness into adolescence. Other investigators, comparing homosexual with heterosexual psychiatric patients, reported that while they were growing up the lesbians were more likely than the heterosexual women to have disliked dolls and girls’ games and to have been tomboys who preferred boys’ games. According to another investigation, homosexual women were less likely than heterosexual women to report that as children they had played “grown-up lady” games, pretended to have a baby, “mothered” a doll, or played house with themselves as mother.

Gender traits

Many theorists believe that the development of sexual orientation in women is related to the degree to which they define themselves as “feminine” and embrace popular expectations of the way women should behave. Thus, heterosexuality would be expected to develop most frequently among girls who have strong feminine identities and feminine interests. They include a tendency to be accommodating toward males, to seek personal fulfillment through the roles of wife and mother, and to anticipate “completion” through a physical and emotional union with a man.

The development of a homosexual life-style in females, it has been suggested, is related to a more “masculine” orientation. According to psychodynamic theory, for example, homosexuality may represent a woman’s rebellion against her place in the world and a desire, conscious or unconscious, to attain the privileges and status that men enjoy. Whereas for men marriage is seldom an overriding concern, for women marriage—and thus heterosexuality—is supposedly definitive of their lives, e.g., their principal investment is in homemaking and motherhood. Homosexual women, it has been proposed, reject this life-style and seek instead a relationship with another woman in which neither partner rigidly adheres to a conventional sex role.

The investigations that have addressed the question whether homosexual and heterosexual women differ with regard to their gender traits give mixed results. One study found that homosexual women, compared with their heterosexual counterparts, described themselves as having been more masculine during childhood. Another study, however, compared homosexual and heterosexual females on projective tests and found no evidence that the homosexual women were more rejecting of the female role.

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