When vNOTES and other minimally invasive approaches began reshaping what gynecologic surgery could look like, the immediate assumption in some circles was that easier recovery would mean more procedures. Lawren Honken MD, mscp, an obstetrician-gynecologist with nine years in practice, describes a different response. Techniques such as vNOTES have expanded the choices available, particularly for hysterectomy and salpingectomy, and can make recovery considerably less burdensome. They have not, Honken says, changed how patients get counseled or automatically lowered the threshold for recommending surgery in the first place. The reasoning is direct: "Surgery still carries meaningful risks, so I explain the options and help each patient choose based on her symptoms, goals, values, and priorities."
That framing, centered on values and priorities rather than on what is technically feasible, is the throughline in Honken's approach to women's health across the full arc of a patient's life. Caring for women from reproductive years through perimenopause means witnessing how the same symptom can carry entirely different weight depending on where a patient is in her life, what she has already been through, and what she is trying to protect. Two patients presenting with identical findings may, reasonably and correctly, choose opposite courses of treatment.
Long-term relationships do more than allow for better-informed recommendations. For patients who have experienced assault, birth trauma, or damaging healthcare encounters, continuity of care means they do not have to repeatedly retell and relive painful experiences every time they seek help. As Honken puts it:
"Long-term relationships let me understand a patient's history, values, preferences, and what helps her feel safe."That kind of safety is not incidental to clinical decision-making. For patients carrying significant trauma histories, it is often the precondition for any meaningful shared decision-making to occur at all.
Honken is equally pointed about one of the more persistent failures in women's healthcare: the tendency to treat a normal test result as evidence that a patient's symptoms are not real, or at least not worth serious attention. Pelvic pain, vulvovaginal concerns, sexual health, and perimenopausal symptoms all fall into this category with troubling regularity. The distinction Honken draws is precise and worth holding: encouraging women to understand what is normal, without normalizing suffering. Asking why. Making sure patients know their options exist.
That distinction, between what a test can detect and what a patient is actually experiencing, is where surgical philosophy and clinical humility converge. A physician willing to say "the test is normal and the symptom still matters" is also a physician less likely to reach for an intervention as a way of appearing to act. The most defensible surgery, in this view, is the one a patient chose after understanding her alternatives, not the one that filled the space left by an unexplained result.
