It is now admitted by those surgeons in London who have had much
experience of hysterectomy for fibroids, that the immediate results of
preserving at least one healthy ovary in this operation are admirable,
especially in women under forty years of age, for the retention of an
ovary is of striking value ‘in warding off the severity of an artificial
menopause’ (Crewdson Thomas).
Although I have left one or both ovaries in the performance of abdominal
hysterectomy for fibroids in more than 300 patients, in only two
instances have I found anything detrimental in the practice. In these
two patients it was necessary to remove one of the ovaries. Since 1906 I
have modified the method by leaving only one ovary, even when both were
healthy, and find that the immediate good consequences of the operation
are in no way impaired. There is reason to believe that whatever good
effects follow the practice of leaving a belated ovary (that is, an
ovary divorced from the uterus and left in the pelvis), they are
temporary, for in the course of a few years the ovarian tissue
disappears and the patients experience the usual symptoms of the
menopause. It is possible that the rate of atrophy of the secreting
tissue of a belated ovary depends on the age at which a patient is
submitted to hysterectomy.
In 1898 I performed subtotal hysterectomy on a woman, thirty-one years
of age, for fibroids, conserving the right ovary. Nine years later
(1907) I operated again for intestinal obstruction, and found this ovary
healthy and functional, for a ripe corpus luteum was visible on its
surface. Even a portion of an ovary, if it contain follicles, will
maintain menstruation.
In performing abdominal hysterectomy for fibroids, there are three
points which require consideration in relation to the subsequent comfort
of the patient, and they depend mainly on the conservation of a healthy
ovary. These three points relate to: (_a_) the patient’s comfort in
securing freedom from flushings; (_b_) if she be married, her marital
relations; and (_c_) if single, her nubility.
In regard to marital relations in women with a belated ovary, nothing
trustworthy is forthcoming, but I believe the retention of an ovary is
an additional factor in promoting domestic bliss. The question of
nubility is interesting; I am able to state that women who have had
subtotal hysterectomy performed, with conservation of one ovary, have
married and lived happily with their husbands; and I am of opinion that
the preservation of the vaginal segment of the neck of the uterus is an
important factor, as it leaves the vagina intact, and though such women
are sterile, they are certainly nubile.
Without overstating the case it may be said that a belated ovary is a
very precious possession to a woman under forty years of age, whether
she be married or single.
In regard to the fate of such ovaries, in the present condition of our
knowledge it may be stated that:--
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