Hi Judie,

This is a delicate matter, you may want to email me privately. I am a 48 yr. old woman. I have a vaginal prolapse. It has made me incontinent, I have to be very careful if I am going out. Intercourse with me husband is also and issue because of it. Secondly I have very heavy periods and heavy clotting. In order to correct the prolapse the doctor told me that the uterus would need to be removed because it would only cause another prolapse. I've had three son's. I can live with the heavy periods, but the prolapse has become a serious issus for me. Would it be a sin to have a hysterectomy for the reasons I have given? Menopause doesn't seem to be coming anytime soon.

Thank you for your advice.

Dear Anon

Because there are other women who are concerned about this same sort of problem I have chosen to post your question and Dr. Anthony Dardano's response as he is an ob/gyn and his advice is always helpful:

First let me start out with the statement that hysterectomy for the condition you describe would be morally permissable. The heavy periods with the clotting, etc., might be treated medically but this alone if symptomatic enough and refractory to all conservative therapy could be treated by hysterectomy without moral consequence. The prolapse you describe is actually a uterine prolapse where the uterus actually descends down into the vagina and can even come out totally in more severe cases. The cause of this is a general relaxation of the supporting ligaments usually from childbirth. The uterus is attached anteriorly to the bladder and posteriorly to the rectum so that when the prolapse progress, the anatomical relationship of the normal pelvis is distorted and the urinary incontinence and rectal incontinence(or the opposite of severe constipation) occurs. Of course the fact that we humans walk upright further aggravates the condition as the ligaments become more and more relaxed by the pull of gravity. Menopause might correct your bleeding problem but will not correct the proplase and incontinence. Fortunately there is a wonderful operation which I have done numerous times which can turn your life around. The procedure is a trans-vaginal hysterectomy along with an anterior-posterior repair (also called a cystocele-rectocele repair). In a younger patient when preservation of fertility is an issue, the uterus can be temporarily preserved and just the bladder suspended. However, this is only temporary as gravity will again force the uterus down and the hysterectomy will eventually be necessary. Your doctor has given you good advice. The operation I described is of course necessary and morally permissable. If you choose to go ahead with the surgery, do so in good conscience. May God bless you.

Anthony N Dardano, MD, FACOG, FACS

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