In the West there are many reasons why a hysterectomy is performed on a woman. This 'major' surgery is not usually a first course of action if a patient is experiencing gynaecological problems. The patient's general health and age will be taken into consideration. A range of diagnostics will be used to determine what is the root cause of the health problem. The patient will discuss their treatment plan with a medical professional and be consulted every step along the way. A partial hysterectomy could be deemed the right treatment.
There may be times when western health services do not meet expectations but it is hard to imagine that a young woman would undergo a hysterectomy following a basic ultra sound test.
Sadly this is what is happening in parts of India.
A BBC investigation has revealed that thousands of hysterectomies performed on Indian women, are unnecessary, motivated by the greed of unscrupulous private doctors.
The BBC investigation included an interview with a young woman called Sunita. Aged around 25, she was unsure of her exact age, her hysterectomy was performed following a medical consultation regarding heavy menstruation.
In the West of course such radical treatment would only be a last ditch effort. Other means, such as non-surgical intervention, diagnostics and perhaps minor surgery, would be used as treatment. More importantly the cause of the heavy bleeding would be found.
In the case of Sunita an ultrasound test was all that preceded her operation.
She told the BBC reporter "I went to the clinic because I had heavy bleeding during menstruation. The doctor did an ultrasound and said I might develop cancer. He rushed me into having a hysterectomy that same day."
Such an important decision would not normally be rushed unless there was hard evidence of an immediate threat to life. Instead alternative treatments would be discussed with all the possible scenarios explained.
No such care for some women in India.
Sunita lives in a small village in Rajasthan, north-west India. The BBC investigator discovered that around 90% of all women in the village had also undergone a hysterectomy. Many of the women were young, aged in their 20s and 30s. Far too young normally to be offered a hysterectomy.
In the case of Sunita, unless her ultra sound test showed firm evidence of an aggressive, untreatable cancer, more investigations would be undertaken.
Menorrhagia, heavy menstrual bleeding, is one of the most common types of abnormal bleeding from the uterus. It can be hormonal, as in the case of a patient with thyroid problems. There are many possible causes and most are treatable, without major surgery.
When questioned the doctor who performed the hysterectomy on Sunita denied wrong doing. He admitted that he often did no other tests than an ultrasound before performing the operation. He claimed that he took biopsies from the uterus once it had been removed from the patient. As the investigator points out, that is too late. It also means that finding any evidence as to whether or not the surgery was necessary may prove impossible.
Campaigners, including the charity Oxfam, are now pushing for change. Sadly statistics from Indian states such as Rajasthan, Bihar, Chhattisgarh and Andhra Pradesh, show that the problem is not isolated. Many women aged under 40 in these regions have also undergone a hysterectomy.
The accusation is that the surgery is unnecessary and solely performed to make money.