How are these for some startling stats: One third of all American women will eventually have their uterus removed. Half a million women in the U.S. have a hysterectomy each year, according to Lauren Streicher, MD, Assistant Clinical Professor of Obstetrics and Gynecology at Northwestern University’s Feinberg School of Medicine in Chicago, and author of the new book, The Essential Guide to Hysterectomy: Advice from a Gynecologist on Your Choices Before, During, and After Surgery.

“Hysterectomies affect not only a woman’s health, but also her sex life, relationships, and her family. And most women who undergo hysterectomy are not offered appropriate alternatives or a minimally invasive approach,” she says.

Here, Streicher helps answer women’s most common hysterectomy questions:

What is a hysterectomy?
A hysterectomy is a surgery that removes a woman’s uterus. In the procedure, either the whole uterus or just a portion of it is removed, and the fallopian tubes and ovaries may be removed as well.

Why is a hysterectomy performed?
A doctor may decide a hysterectomy is necessary for multiple reasons. The most common cause for a hysterectomy is fibroid tumors. A hysterectomy may also be performed in extreme cases of endometriosis, prolapse of the uterus, adenomyosis, chronic pelvic pain, and abnormal vaginal bleeding. About 15 percent of hysterectomies are performed because of cancer or pre-cancerous cells of the uterus, ovary, cervix, or endometrium, according to Streicher. The procedure removes the cancerous cells and prevents the cancer from spreading.

Do alternatives to a hysterectomy exist?
“While many hysterectomies are appropriate and beneficial, there are still too many women who have unnecessary surgery or who are not offered less invasive alternatives,” Streicher says. Alternatives treatments such as hysteroscopic myomectomy, uterine lining ablation, and uterine artery embolization do exist, and while they aren’t viable options in all cases, they should be discussed with your healthcare provider. “The more information a woman has prior to surgery, the better the choices she will make, and the better her long-term outcome will be,” she says.

How is a hysterectomy performed?
How your doctor performs a hysterectomy depends on both a woman’s health history and the reason for the surgery. A hysterectomy can be performed by removing the uterus through a five- to seven-inch incision in the abdomen, an incision in the vagina, laparoscopically through three to four small incisions in the abdomen, or robotically. In most cases, laparoscopic surgery has all the benefits of a robotic surgery, but with a much lower price tag, Streicher says.

Do I still need to have Pap tests after a hysterectomy?
A woman still needs regular Pap tests to screen for cervical cancer if she has a partial hysterectomy and does not have her cervix removed, or if her hysterectomy is for cancer. Either way, any woman who has a hysterectomy should still have regular pelvic exams and mammograms.

What are the physical effects of a hysterectomy?
After the procedure, a woman may no longer become pregnant. If she has not yet entered menopause at the time of surgery and her ovaries are left in place, they will continue to produce estrogen. However, she may enter menopause at an earlier age. If her ovaries are removed during the hysterectomy she will enter menopause and encounter symptoms caused by a lack of estrogen such as hot flashes, vaginal dryness, and sleep problems. She may also be at risk of developing osteoporosis at an earlier age, according to The American College of Obstetrics and Gynecologists.

What are the emotional effects of a hysterectomy?
“Very few women are thrilled about having to have a hysterectomy. Even though intellectually you know it’s the right thing to do and will benefit you in the long run, it’s a complex decision that is often psychologically difficult,” says Streicher. Some women feel depressed because they can no longer have children, and, if they have entered menopause after the surgery, hormonal changes can cause emotionally difficult symptoms. Still, she may feel relieved because the symptoms she was having are no longer present.

What are the sexual effects of a hysterectomy?
Most women experience increased sexual satisfaction after a hysterectomy, according to research from the University of California, San Francisco. For example, women who previously experienced discomfort or heavy bleeding during sexual intercourse may feel more sexual pleasure post-surgery because of the loss of symptoms, according to The American College of Obstetrics and Gynecologists. However, because the uterus has been removed, the uterine contractions that the woman may have felt during orgasm will no longer occur and can decrease sexual satisfaction for some women. A minority of women report developing sexual dysfunctions following a hysterectomy. When a woman no longer produces estrogen, her vagina often takes a trip to the desert… and I’m not talking Las Vegas!

Have more questions? Should you keep your cervix? Your ovaries? What are the possible complications? Is hormone therapy necessary following the procedure? These and other questions are addressed in Streicher’s new book, The Essential Guide to Hysterectomy: Advice from a Gynecologist on Your Choices Before, During, and After Surgery.

Remember: Suffering in silence is OUT!  Reaching out is IN!