Oophorectomy

Oophorectomy (or ovariectomy) is the surgical removal of an ovary or ovaries. In the case of animals, it is also called spaying and is a form of sterilization. The term "castration" is occasionally used in the medical literature instead of oophorectomy.

In the case of humans, oophorectomies are most often performed due to diseases such as ovarian cysts or cancer; prophylacticly to reduce the chances of developing ovarian cancer or breast cancer; or in conjunction with removal of the uterus.

They are also performed on trans men to eliminate the production of estrogen and to stop menstruation, most often in conjunction with a hysterectomy.

Techniques

The removal of an ovary together with a Fallopian tube is called salpingo-oophorectomy or bilateral salpingo-oophorectomy if both ovaries and tubes are removed. Oophorectomy and salpingo-oophorectomy are not common forms of birth control in humans; more usual is tubal ligation, in which the Fallopian tubes are blocked but the ovaries remain intact. In many cases, surgical removal of the ovaries is performed concurrent with a hysterectomy. The surgery is then called "ovariohysterectomy" casually or "total abdominal hysterectomy with bilateral salpingo-oophorectomy" (sometimes abbreviated TAH-BSO), the more correct medical term. However, the term "hysterectomy" is often used colloquially yet incorrectly to refer to removal of any parts of the female reproductive system, including just the ovaries.

When performed alone (without hysterectomy), an oophorectomy is generally performed by abdominal laparotomy, where a small, telescope-like device, about the width of a pencil, with a light on one end and a magnifying lens on the other—is inserted through a small cut near the navel. An attached camera allows the surgeon to see the abdominal cavity and pelvic organs on a video monitor.

Other small (1/4 to 1/2 inch wide) cuts are made in the abdomen, through which the doctor inserts slender instruments with which to cut and tie off the blood vessels and fallopian tubes. The ovaries are detached and removed through a small incision at the top of the vagina. The ovaries can also be cut into smaller sections and removed through the tiny abdominal incisions. The cuts are all closed with stitches, which will likely leave small scars.

Benefits

Reduced breast cancer risk

Women with a risk of breast cancer, especially those women with mutated BRCA1 and/or BRCA2 genes, have been shown to have a significantly reduced risk of developing breast cancer after prophylactic oophorectomy. In addition, removal of the uterus in conjunction with prophylactic oophorectomy allows estrogen-based hormone replacement therapy to be prescribed to aid the woman through her transition into surgical menopause, instead of mixed hormone hormone replacement therapy, which has a significant contribution to breast cancer as well.

Reduced ovarian cancer risk

Women with a risk of ovarian cancer, especially those women with mutated BRCA1 and/or BRCA2 genes, have been shown to have a significantly reduced risk of developing ovarian cancer after prophylactic oophorectomy. Risk is not reduced to zero, however, because the possibility of developing primary peritoneal cancer, which is basically ovarian cancer that begins outside the ovaries, does persist.

Reduced problems of endometriosis

In rare cases, oophorectomy can be used to treat endometriosis. This is done to remove a source of hormones that fuel uterine lining growth, thus reducing the overgrowth responsible for endometriosis.

Oophorectomy for endometriosis is usually a last-resort surgery, since hormonal agonists such as Lupron are usually prescribed first to alter the hormonal cycle. Oophorectomy for endometriosis is often done in conjunction with a hysterectomy as a final shot at removing all traces of endometriosis in cases where non-surgical treatments such as hormonal agonists have failed to stop the uterine overgrowth.

Risks

Hormonal

Choosing to have this procedure done as part of bottom surgery, will require use of testosterone for the majority of ones life. In the event of detransition, replacement estrogen or a non-hormonal biphosphonates (such as Fosamax and Actonel) will be required to prevent osteoporosis.

Longevity Risk

Removal of ovaries causes hormonal changes and symptoms similar to, but generally more severe than, menopause. Women who have had an oophorectomy are usually encouraged to take hormone replacement drugs to prevent other conditions often associated with menopause. Women younger than 45 who have had their ovaries removed face a mortality risk 1.7 times greater than women who have retained their ovaries. Retaining the ovaries when a hysterectomy is performed is associated with greater longevity. However, hormone therapy is commonly believed by many doctors to mitigate the mortality risks of oophorectomy. Mortality risks for trans men who have undergone these procedures have not been adequately researched.

Cardiovascular Risk

When the ovaries are removed a woman is at a seven times greater risk of cardiovascular disease, but the mechanisms are not precisely known. The hormones produced by the ovaries cannot be truly replaced. The ovaries produce hormones a woman needs throughout her entire life, in the quantity they are needed, at the time they are needed, and released directly into the blood stream in a continuous fashion, in response to and as part of the complex endocrine system. This risk is enhanced by the testosterone given as part of HRT for trans men and should be carefully watched.

Bone Density Risk

Some studies have found that increased bone loss or fracture risk is associated with oophorectomy. Reduced levels of testosterone in women is predictive of height loss, which may occur as a result of reduced bone density. Since hormone replacement therapy for trans men adds testosterone the risk of bone density loss is mitigated.

Sexuality Risk

Oophorectomy generally greatly impacts sexuality in ciswomen, reducing or eliminating the ability to have an orgasm, and lowering sexual desire. This reduction is greater than that seen in women undergoing natural menopause. Some of these problems can be addressed by taking hormone replacement. Increased testosterone levels in women are associated with a greater sense of sexual desire, and oophorectomy greatly reduces testosterone levels. This issue is moot for trans men, however, since their hormone replacement therapy adds more testosterone than is lost. Reduction in sexual wellbeing was reported in women who had been given a hysterectomy with both ovaries removed. The oposite has been reported for trans men.

Statistics

According to the Center for Disease Control, 454,000 women in the United States underwent this type of operation in 2004. There are no available statistics as to how many of these procedures were done for trans men.

External Links

• http://en.wikipedia.org/wiki/Oophorectomy
• http://healthgate.partners.org/browsing/browseContent.asp?fileName=14848.xml&title=Oophorectomy
• FTM International

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