Should we stop using the term 'hysterectomy', if yes then why?

Abstract

Historically, hysterectomy (the Greek term ‘hystera’ plus the Latin ‘ectomy’) was first used in the literature 150 years ago when Charles Clay (1843) performed the first documented procedure.1,2 However, hysterectomies were once part of the treatment protocol for hysteria, and this begs the question: Can it be represented with a better term? The word ‘Hystera’, denotes the womb, which caused the mental health condition called hysteria. The etymology of hysteria has been dynamic since it was coined in the early 19th century. This error, prejudice and offensive practice persisted for hundreds of years as evidenced by the history books. Even the archaic Greek and Egyptian periods reference the concept of a ‘wandering’ or ‘moving womb’.3 Hippocrates, Plato and Aretaeus continued this belief that the ‘hystera’ is migrating in the woman's body causing spasmodic disease. Hysteria was believed to be solely attributable to women, characterised by extreme excitability and emotional overflow. Sigmund Freud spent time studying patients with hysteria. Modern psychiatry has fragmented the blanket diagnosis of hysteria into numerous psychological disorders.4 Given how hysteria has formed the basis of modern terminology with varying connotations and undertones, one topic remains prevalent – its connection to women's health and mental health.5 The use of the word ‘hysterectomy’ involuntarily establishes and confirms the old belief that women are susceptible to mental illness due to the hypothesis of having a moving or spasmodic uterus. Today when people use the word hysteric or hysterical, they mean, ‘an uncontrollable outburst of emotion or fear, often characterized by irrationality, laughter, weeping, etc.’, according to Urban dictionary. ‘Hystera’, although having the meaning of ‘womb’ is still carrying the historic incorrect and offensive association with being the cause of mental illness. Medicine is beautiful in its development, not only scientifically but also ethically. With growing awareness at an individual and societal level, the medical fraternity is recognising gender diversity and their respective medical needs.6 Understandably, changing medical vocabulary is a laborious process, but history has shown that changing terminology is possible. In 1961, the diagnostic term Trisomy 21, which some called ‘Mongolism’, had misleading connotations, and the World Health Organization dropped the word in 1965 after a request from the Mongolian People's Republic.7 The surgical removal of an anatomical part of the body is indicated by the EnglishLatin postfix ‘ectomy’. Consistent with the Latin nomenclature for womb, is the term uterus. The logical combination yields ‘uterectomy’. In support of clear and understandable communication with patients, especially in the context of informed consent before surgery, one can ask the question why clinicians, after explaining the pathology of the uterus and the recommendation to surgically remove the uterus, then proceed with asking for consent to perform a ‘hystera’‘ectomy’? Of note, the term uterectomy has already been used, although in veterinary literature. At this stage, we propose the terms: uterectomy, uteruscopy, and uterotomy. It is imperative to change the terminology to ensure a generic anatomical and surgical meaning, removed from the loaded word, hysteria.