Hysterectomy Among Women of Reproductive Age-Reply

In Reply.—  Dr Fribourg has ascribed loftier intentions to our report than we had. Our primary objective was to report the annual number and rate of hysterectomy among women of reproductive age by age, race, geographic region, and surgical approach. Our only purpose in citing the controversy over unnecessary hysterectomy and the recent reports of cardiovascular disease was to indicate that factual information on the trends and differences in hysterectomy rates by important demographic variables might be helpful to those who want to study the determinants of hysterectomy.We agree with Dr Fribourg that the subject of justifiability of surgical procedures is a difficult one. Before branding a given procedure "unnecessary," one should be able to distinguish between honest differences in competent clinical decision making, good but misguided intentions, and dishonorable motives on the part of the physician. One also should know the duration and degree of the patient's disability,