Camilla Parker Bowles is having a hysterectomy today at the King Edward VII hospital. Full marks for choice of venue. It's one of London's swankiest hospitals. A stone's throw from the dinky shops of Marylebone High Street and within spitting distance of Langan's bistro and other overpriced eateries.
Dame Judy Dench had her knee done only last week, and my own dear mother-in-law talked Bupa into funding her hip replacement there. A quietly spoken, discreet doorman sits at the front desk, a uniformed porter helps you in with your bags, and when you ring up to check how your loved one is, a human being picks up the phone. So far, so non NHS.
But should she be parting with her womb (aka uterus) at all? Hysterectomies are very "last century". If you have cancer, a hysterectomy may be essential and even life-saving. But the vast majority of hysterectomies are still performed on women who have heavy periods. And, according to Nice guidelines, the operation should be a last resort after other less drastic treatments have failed.
Clearly, Camilla is unlikely still to be having periods. So, she is most likely to be having her hysterectomy because her womb is full of large, painful fibroids which are non-cancerous lumps in the muscle of the womb, or because the womb has prolapsed and is trailing southwards. According to gynaecologist Nick Morris, "Camilla's probably got a stage IV prolapse and an enterocele and hysterectomy's the only option." In other words, a womb that's descended so far, it's protruding out of the vagina and loops of bowel that bulge into the vagina.
Prolapses happen because of the flawed design of female anatomy. Repeated pregnancies weaken the support system that keeps the womb hoisted up in place. Getting older and the loss of oestrogen after the menopause don't help. Coughing, constipation, heavy lifting and obesity add extra strain and make prolapse more likely. Hunting isn't mentioned, but I can't imagine that jigging up and down on a horse helps.
If you have a prolapse, hysterectomy is considered the best option in the UK. The French are forging ahead with ambitious pelvic reconstructions and meshes can be used to try to hold the descending organs in place. But Nick Morris says the meshes can be uncomfortable and tend to work their way free.
A hysterectomy is no picnic. Up to a quarter of women have a minor complication after the op, usually heavy bleeding , infection or bruising. Far fewer develop a more serious problem like bowel or bladder damage.
On the plus side, one study found that after their hysterectomy, 95% of women felt their femininity was intact or improved and 90% said their sex life was better. Another study found that more than half of the women who'd been depressed before their op, felt better afterwards.
Hysterectomy is still done far too often for the wrong reason; namely, heavy periods. But Camilla is probably having it done as a last resort for a massive prolapse, and in that case, it's a sensible option. I wish her a speedy recovery.
