Not so hysterical now? Psychotherapy, menopause, and hysterectomy

In the context of the body, the essentially female; wombs, menstrual cycles, and concurrent hormones, have seen women ascribed madness, insatiability, untrustworthiness, and danger. Female bodies have been identified in selective parts, considered in abstract, or envisaged as having overwhelming power over the mind. “Hysteria”, the problematic neurosis of uterine origin was at the heart of early psychoanalysis. This diagnosis enshrines a slippage from the physical to the fantastical, and ultimately to the denial of the lived reality of women’s and girl’s bodies. In apparent collusion with patriarchy the neglect of some female bodily experience is perpetuated in contemporary psychoanalytic theory. Nowhere is this more evident than around menopause and hysterectomy (as experienced by either client or therapist). There has been little or no exploration of how practitioners might best support clients for whom menopause is significant, or how we might facilitate women before or after gynaecological surgery. It is as if removal and psychological loss of the same female body parts that our forebears used to so neatly differentiate, diagnose, and pathologise women are now not of note. I am interested as to how we as psychotherapists reclaim female body narratives from this outdated theoretical paradigm to best serve clients experiencing menopause, gynaecological surgery, and mid life in the twenty-first century.

Gynaecological surgery

This chapter discusses the anaesthetic management of gynaecological surgery. It begins with a discussion of general principles. Surgical topics covered include hysteroscopic procedures; evacuation of retained products of conception (ERPC); suction termination of pregnancy (STOP); laparoscopy; sterilisation; hysterectomy (vaginal and abdominal); and ectopic pregnancy. It includes pertinent anaesthetic features for a series of additional miscellaneous gynaecological procedures.

Nursing care of gynaecological patients in hospital

This chapter looks at the care of the gynaecological patient within the hospital setting. It starts with pre-operative care, principles of enhanced recovery, the admissions process, post-operative complications and wound infections. The psychological impact of patients in gynaecological settings, the practical care of the patient, and long-stay and outpatient advice is given. It then covers the diagnosis, operative and post-operative care of hysterscopy, laparoscopic surgery, and major gynaecological surgery. Finally, different types of hysterectomy, their indications, and post-operative care are explained, and the chapter concludes with other surgical procedures.

1303 Obesity: A Growing Concern in Gynaecological Surgery

Introduction Obesity is becoming a major concern in healthcare. The rise in obesity has now reached alarming levels. Obesity is driven by the economic growth, unbalanced diet, and a sedentary lifestyle. Obesity has played a disastrous role in the health of many but significantly has had a detrimental health effect among girls and women. This review focuses on the effect of obesity on various aspects of women’s health including prognosis after gynaecological surgery. Method The search engine used for this literature review was Ovid MEDLINE. Only studies reported in English have been included in this review. The snowball and citation searching method was used to find further relevant articles. Results Various genetic components have been identified to increase the risk of obesity which is further exacerbated with the current obesogenic environment. Women with a BMI≥35 had longer surgeries and an increased rate of severe postoperative adverse events. Additionally, women with a higher BMI had an increased risk of cervical cancer due to under-diagnosis of cervical precancerous lesions, though obesity did not directly alter the association between preoperative biopsy and final tumour grade. Conclusions Despite increased awareness, obesity is still a major contributor of mortality and morbidity. Women in particular are facing severe consequences of the obesogenic environment. In women obesity not only increases their risk of developing gynaecological conditions but also adversely affects prognosis after surgical treatment. In the face of an obesogenic environment, it is important to sought out potential ways to reduce the risk of surgical complications in obese patients.