When to Refuse Proposed Surgeries in Gynecology

Hello! Today we’ll discuss cases where it’s better to refuse proposed surgical treatment. Despite the many advancements in medicine, surgery is not always necessary. As the great surgeon Pirogov said, "The best surgery is the one that has been avoided." Let’s look at when surgery is not needed and observation is the best choice.

1. Cervical Erosion

Many people mistakenly believe that cervical ectopia (formerly known as cervical erosion) requires mandatory surgical intervention. In fact, this is a physiological condition that doesn't require treatment. Cauterization can be harmful as it interferes with the full diagnosis of the cervical condition.

• When surgery is not required: presence of cervical dysplasia or inflammation, which require treatment.

2. Nabothian Cysts of the Cervix

These are harmless cysts on the cervix, formed as a result of blocked glandular ducts. They don’t require treatment and are not dangerous.

• There’s no need to remove them, even if they hinder the placement of an intrauterine device (IUD).

3. Ovarian Cysts

3.1. Simple Cysts up to 3 cm

These cysts are safe and don’t require surgery unless they grow or cause symptoms. We simply monitor them with regular ultrasounds.

3.2. Endometriotic Cysts

If the cyst is small and doesn’t cause symptoms, these cysts can be monitored. Surgery is not needed unless there’s chronic pain or other complications.

4. Uterine Fibroids

Small uterine fibroids (up to 3-4 cm) located on the outer side of the uterus don’t require removal if they don’t cause pain, don’t interfere with the menstrual cycle, or affect fertility.

• If the fibroid doesn’t change the shape of the uterine cavity, it can simply be monitored.

5. Functional Ovarian Cysts

Follicular cysts and corpus luteum cysts are typical functional cysts that often resolve on their own within 2-3 months. Surgery is not necessary in these cases if the cyst doesn’t cause pain or complications.

• When surgery is not required: if the cyst doesn’t rupture or increase in size.

Conclusion

Remember, any surgery should be well-justified. It’s important to understand that even seemingly harmless procedures can carry risks and should only be performed when absolutely necessary. If surgery is being recommended, always evaluate all risks and consult multiple specialists.

Be mindful of your health and don’t rush into surgeries unless absolutely necessary!