examination of the swelling subsequently con-
firms the diagnosis. The operation closes the
defect that allows fluid to seep into the scrotum.
Complications after surgery are rare though could
include anesthetic reaction, unusual bleeding, or
infection. Secondary hydrocele generally heals on
its own.
See also HERNIA; TESTICLES; VIRUS.
hypogonadism Dysfunction of the gonads
resulting in inadequate production of sex hor-
mones. In men the TESTICLES(also called testes) are
the gonads that produce ANDROGENSand in women
the OVARIESare the gonads that produce ESTROGENS.
In primary hypogonadism the ovaries or testicles
themselves fail. Genetic reasons for such failure
are TURNER’S SYNDROMEin females and KLINEFEL-
TER’S SYNDROMEin males. These genetic disorders
result from errors in the sex chromosomes.
Hypogonadism may also be central, a result of
problems with the endocrine mechanisms that
regulate the function of the ovaries or testicles.
The most common of such problems are traumatic
injury, surgery, RADIATION THERAPY, and CHEMOTHER-
APY. Tumors of the PITUITARY GLAND, untreated
HYPOTHYROIDISM, and EATING DISORDERS such as
anorexia nervosa that result in severe NUTRITIONAL
DEFICIENCY, may also cause central hypogonadism.
Symptoms of hypogonadism depend on the
developmental stage of the individual. Primary
hypogonadism that occurs in childhood, such as
resulting from Turner’s syndrome or Klinefelter’s
syndrome, causes absence of PUBERTYand failure to
develop SECONDARY SEXUAL CHARACTERISTICS. Hypo-
gonadism that develops in adulthood results in
menopausal symptoms such as HOT FLASHES in
women and diminished LIBIDO, ERECTILE DYSFUNC-
TION, and sparsity of facial HAIRin men.
The diagnostic path includes BLOOD tests to
measure blood levels of estrogen, TESTOSTERONE,
FOLLICLE-STIMULATING HORMONE (FSH), LUTEINIZING
HORMONE(LH), and thyroid hormones. Treatment
for primary hypogonadism in most situations is
HORMONE THERAPYto restore blood levels of the sex
hormones to normal levels for the person’s age.
When hypogonadism is central, treatment targets
the underlying cause. Hormone therapy initiates
puberty when hypogonadism occurs in childhood.
However, FERTILITYissues may remain even with
treatment though other symptoms typically
improve.
See also CHROMOSOMAL DISORDERS; CHROMOSOME;
GYNECOMASTIA; HORMONE; SEX CHROMOSOME; THYROID
GLAND.hysterectomy A surgical OPERATION to remove
the UTERUS. Hysterectomy may be treatment for
ENDOMETRIAL CANCERor for noncancerous condi-
tions that cause significant symptoms and do not
respond to less invasive treatments. Among such
conditions are UTERINE FIBROIDS, UTERINE PROLAPSE,
DYSFUNCTIONAL UTERINE BLEEDING (DUB), and
ENDOMETRIOSIS. Whatever its reason, a consequence
of hysterectomy is immediate loss of FERTILITY.
Hysterectomy is the second-most common opera-
tion women undergo in the United States;
CESAREAN SECTION(surgical CHILDBIRTH) is the most
common. Surgeons in the United States perform
more than 600,000 hysterectomies each year.Surgical Procedure
The ANESTHESIAfor hysterectomy may be regional,
such as epidural block, with sedation or general
(deep sleep). The choice of anesthesia depends on
the type of hysterectomy the woman is having,
the woman’s preferences, and the recommenda-
tions of the surgeon and anesthesiologist.
A simple hysterectomy removes only the uterus
(sometimes called a supracervical hysterectomy); a
total hysterectomy removes the uterus and CERVIX.
Both operations leave the OVARIESin place to con-
tinue providing hormones that carry the woman
to a natural MENOPAUSE if she has not already
reached that stage of her life. Radical hysterec-
tomy may be necessary when endometrial cancer
or CERVICAL CANCERis the reason for the operation.
In radical hysterectomy the surgeon removes the
uterus, cervix, and upper VAGINAalong with much
of the tissue that supports these structures.
The operation may be an OPEN SURGERY, in
which the surgeon makes a long incision through
the SKINand layers of MUSCLEto expose the uterus,
or laparoscopically assisted vaginal hysterectomy,
in which the surgeon removes the uterus through
multiple small incisions in the abdomen and
vagina and removes the uterus with the aid of a
lighted, magnifying laparoscope that displays the
pelvic structures on a monitor. A laparoscopicallyhysterectomy 291