The common complications that once upset women during their convalescence should by now have been relegated to the pages of medical history. Women after hysterectomy were said to become depressed, obese, lose their sexual drive and have an earlier menopause. It is now accepted that depression in an older woman after hysterectomy is unlikely because she is already reconciled to the end of her childbearing years.

Obesity could be a complication if the hysterectomy induces a sudden menopause that is left untreated. The fear that a shorter vagina reduces sexual pleasure is without foundation. After hysterectomies, some women in the not so distant past suffered nerve damage to the genital and pelvic area, in the similar way that a man does after a radical prostatectomy. But changes in hysterectomy technique now avoid this.

Some women may have continued to have had regular cycles beyond the normal menopausal age because they were taking HRT. Having a total hysterectomy will allow them, if this is thought advisable, to continue with this, and even to take oestrogen-only treatment. Most doctors would also recommend bis-phosphonates (such as Fosa-max) and vitamin D with calcium, as well as HRT, to prevent osteoporosis.

Dick Cheney and DVT

Dick Cheney, the US Vice-President, tested his cardiovascular system to extremes by flying more than 25,000 miles (40,000km) in 60 to 70 hours.

As would be expected in a man of his age and build with a history of multiple coronary thromboses, he failed the test and developed a deep-vein thrombosis (DVT). Fortunately, it doesn’t seem to have given rise to a pulmonary embolism or, if he had any pulmonary complications, they must have been too small to cause appreciable trouble.

DVT is the clotting of the blood in one of the larger veins of the body’s extremities, usually those in the calves, thighs or the pelvic veins and can affect anyone who remains immobilised for any length of time, whether sleeping soundly in a deck chair on a French beach all afternoon after a heavy lunch or being entrapped in an aircraft seat for thousands of miles.

The common risk factors other than immobilisation and age are smoking, a history of thrombo-embolic troubles, such as previous coronaries, hypercoagulability disorders, obesity, renal disease, malignancies, surgery within the past three months and, of course, in women the Pill, HRT or pregnancy.

An earlier history of DVT or pulmonary embolism is important but asking about DVTs is not always helpful. Most small DVTs pass unnoticed as they occur in the lesser veins of the calf and are dismissed as being the result of nothing more than travel stiffness after a long flight. The patient has noticed only vague pains over the veins of the calf, possibly some tenderness, and he or she may wonder whether their leg is not a trifle redder than usual. Careful tests are needed to detect these DVTs. Next time the Vice-President travels, he will have to step up his anticoagulation precautions — DVTs are not confined to economy class.

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