ABSTRACT
However, the presence of a significant number of nulliparae in the series of vaginal hysterectomies reported by Campbell [9] and Heaney [10], in contrast to many others, proves that this is more a question of making the attempt with an appropriate mindset and proper guidelines, than to the contraindications themselves. Dargent [11], Kovac [12], and Querleu [13] have a low proportion of nulliparous women in their series. In Kovac’s [8] series, 34.5% of nulliparous women were subjected to vaginal hysterectomy in contrast to Dorsey [14], who had 45.3% undergoing laparoscopic hysterectomy but none vaginal hysterectomy. In the author’s personal series of 5344 vaginal hysterectomies, there were 368 nulliparous women, constituting 74.8% of the hysterectomies in nulliparous women [15] – which goes to prove that descent, space, and access are adequate to perform a hysterectomy in a nullipara via the vaginal route, provided that the surgeon is keen to do so. In 256 nulliparous women, the indications for hysterectomy were dysfunctional uterine bleeding (DUB), fibroid, and/or
adenomyosis and an additional 112 nulliparous virginal women with severe mental handicap [16]. However, the true picture becomes clear only when abdominal hysterectomies and their indications are analysed simultaneously. In the author’s last consecutive 1000 abdominal hysterectomies, there were 108 nulliparous women. In all of them, vaginal hysterectomy was contraindicated and it was performed in none because of nulliparity itself. The surgeon must start making an unbiased assessment under anaesthesia as if the patient
were a multiparous woman. This should bring about a change for the better!
