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AFMedic09

C&p Dr. Rec. Hysterectomy

Question

Went for my C&P on my deferred claim of Uterus prolapse, cyctocele, rectocele, and incontinence. The Dr. said she was recommending a hysterectomy. Not sure what that means, or if she even saw the cyctocele or rectocele because she didn't put the speculum in sideways. (Placed in normally and openined up would support the top and bottom of the pelvic wall, when placed sideways and opened it will reveal prolapse.) Anyway, she said it's not going to get better until the VA does a hysterectomy. I am 32, but I really can't keep living my life with the pain, and embrarassment this defect causes. Any advice or crystal ball predictions for the outcome of this C&P? BTW, I saw this same Dr. in my initial C&P in April 2011. She did the exact same exam then, but these issues were deferred for further development.

Edited by AFMedic09

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Rating criteria for cystocele/rectocele are at Diagnostic Code (DC) 7623 at 38 CFR 4.116 http://www.benefits....ART4/S4_116.DOC . Rating criteria for uterine prolapse are at DC 7624 (see the earlier link) . The C&P examiner's recommendation is just that, a recommendation, and is not ratable until the event occurs. .

If a hysterectomy is indicated because of the prolapse, it would be service connected. Rating criteria for a hysterectomy are at DC 7618. SMC-k is an issue. If the hysterectomy is done, I'd suspect that any rating under DC 7624 would be reduced.

If the ovaries are removed as well, there has to be evidence that the ovaries were diseased (and service connectable) and the oopherectomies were not for the convenience of the patient. If service connection for hysterectomy with oopherectomy is indicated, the DC is 7617. SMC-k is an issue.

The traditional repair for a cystocele/rectocele is the Anterior and Posterior colporraphy, or A&P Repair. If the A&P is done, I'd suspect that any rating under DC 7623 would be reduced.

On a rant ... some ladies want the oophers taken out while one is mucking around inside, even though there is no ovarian pathology, "just in case" to prevent a future operation for ovarian CA. After this surgical castration, there is hormone replacement therapy (HRT). While HRT has gotten way better through the years, it does not provide all the same hormones, or in the correct amounts for you, or at the right time for you. At age 32, if you have no ovarian pathology and do not have a family history of ovarian CA, you might want to consider keeping the oophers. Of course, you need to discuss this with your GYN.

Went for my C&P on my deferred claim of Uterus prolapse, cyctocele, rectocele, and incontinence. The Dr. said she was recommending a hysterectomy. Not sure what that means, or if she even saw the cyctocele or rectocele because she didn't put the speculum in sideways. (Placed in normally and openined up would support the top and bottom of the pelvic wall, when placed sideways and opened it will reveal prolapse.) Anyway, she said it's not going to get better until the VA does a hysterectomy. I am 32, but I really can't keep living my life with the pain, and embrarassment this defect causes. Any advice or crystal ball predictions for the outcome of this C&P? BTW, I saw this same Dr. in my initial C&P in April 2011. She did the exact same exam then, but these issues were deferred for further development.

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Thank you for your VERY informative post. I would not opt. to have my ovaries removed. I do not have any issues with them aside from the occasional cyst. I am rated for a TVT I had done while on active duty which lifted my bladder. However, that procedure had its own complications, and is no longer effective. Being that I am only 32, and while I do not plan to have any more children, would your recommendation be to hold off on the hysterectomy? The doctors have always said that would be the ultimate result of my issues, but the time was never discussed. Now the C&P Dr. told me that I need to have this done or else my issues will not be resolved. I am a scared to have this procedure done at 32...but at the same time living with having to wear pads and never knowing when I won't be able to control it is something I would like to move on from. Thank you again for your response.

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Being that I am only 32, and while I do not plan to have any more children, would your recommendation be to hold off on the hysterectomy? Generally speaking, I am a big fan of holding on to one's body parts until they have to go ... but that's just me. I know of several women who swore they would never have a child, or would never have another child ... but in their mid-40s aggressively sought a a pregnancy with hormonal shots, IVF, etc., as well as voodoo. Generally speaking, this was associated with a new marriage.

Reversing a tubal ligation/clipping is not unknown, but a hysterectomy is kinda permanent. While I have read of some recently performed uterus transplants, it is not known whether the transplants will take in the long run, whether ovule implantation is possible, whether one could carry the fetus to term.

​ With any surgery, there are attendant dangers. There may be some psychological issues as well, ie., "i am no longer capable of conceiving, so what further use am I?"

So, I am reluctant to advise you either way.

The doctors have always said that would be the ultimate result of my issues, but the time was never discussed. Now the C&P Dr. told me that I need to have this done or else my issues will not be resolved. It was probably somewhat inappropriate for the C&P examiner to make that comment, as they strictly are supposed to evaluate a current condition and not enter into any therapeutic relationship. If any recommendations are to be made, it should be that you need to see you personal physician/PCP.

I am a scared to have this procedure done at 32... That's not an inappropriate feeling.

but at the same time living with having to wear pads and never knowing when I won't be able to control it is something I would like to move on from. It is difficult to recommend what you should do without knowing a lot more, which I should not and do want to do. However, the A&P repair (particularly the 'A' side, might go a long way in solving some incontinence problems. After an A&P, I'd recommend Kegel exercises. But, you really need to speak with your GYN or your urologist about the chances for success (I say GYN as well as a urologist because there is a long-term turf war between the two specialties WRT incontinence treatments).

Thank you again for your response. No problem.

Thank you for your VERY informative post. I would not opt. to have my ovaries removed. I do not have any issues with them aside from the occasional cyst. I am rated for a TVT I had done while on active duty which lifted my bladder. However, that procedure had its own complications, and is no longer effective. Being that I am only 32, and while I do not plan to have any more children, would your recommendation be to hold off on the hysterectomy? The doctors have always said that would be the ultimate result of my issues, but the time was never discussed. Now the C&P Dr. told me that I need to have this done or else my issues will not be resolved. I am a scared to have this procedure done at 32...but at the same time living with having to wear pads and never knowing when I won't be able to control it is something I would like to move on from. Thank you again for your response.

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