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updated 10/15/2008 12:19:07 PM ET 2008-10-15T16:19:07

Q. My husband and I are struggling with an issue that causes us much sadness. We so wanted a daughter that, from the day our oldest son was born, we determined we would have Rachel Hope one day. When we planned our second child, we just knew she was Rachel. We had the prettiest pink outfits. Then the ultrasound said it was a boy.

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I immediately withdrew. I wanted to die and I wanted the baby to die. I went to counseling and had to learn to love the baby no matter what. It was difficult, but I did. Now I love him so much more I feel that my oldest gets left out.

Still, there is this hollow place in my heart for Rachel. I dream about her, think about her and on occasion shed tears for her. So does my husband. We started couples therapy and discussed how we would get over this. Our counselor suggested we have a mock funeral or release a balloon with her name on it symbolizing letting her go. I don't want to let her go. I want my baby. Either way, I've had a partial hysterectomy so that won't happen. It is overwhelming. How can I deal with this void?

A. You are coping with two difficult things here — the loss of the idea of having a daughter, because your baby was a boy, and the loss of future opportunity to have a daughter, because of your hysterectomy.

Your regrets are very real. Some people don’t especially regret things they don’t and won’t have. But many feel the same sadness you do. Often, they feel such an absence in their life because of happenstance — they regret never having had a son, a sister, a brother.

If this is an experience you long for, you must accept not having it. Like all losses, you must grieve for it, process it and accept it over time. It is a true loss and is monumental to you.

There are plenty of reasons you might long for a daughter, from missing out on having had a sister to not having a close relationship with your mother to having had your best childhood friend move away at a young age. Examine what it meant to you to have a daughter. Understanding the source of your longing, and what this daughter represented to you, will help your suffering diminish.

Meanwhile, the hysterectomy indicates the loss of possibility. Even women who choose not to have children, or who have as many children as they want, can feel a great sadness over the shutting of this door. Their feelings are exacerbated by the abrupt hormonal changes of instant menopause, which often follows a hysterectomy when the ovaries are also removed, and can lead to depression. Other difficult symptoms, like night sweats, sleeping trouble and painful sex, can make you feel depressed even if the source is not hormonal.

It might or might not help to concretize your feelings of loss into a funeral, release of balloons, or other kind of ceremony. Let your own feelings guide you in terms of whether this will help.

Visits to a gynecologist and a psychiatrist are warranted. It might be advisable to start hormone therapy (depending on your medical history) or an antidepressant if the depression is moderate to severe.

As for wanting to die and wanting your baby son to die: Women are so influenced by hormones when they are pregnant that this also isn’t shocking. Fortunately, you dealt well with it. After all, you love your son. I am concerned, though, that your elder son is getting left out. You should work on making sure to be inclusive and attentive toward both sons, and being thankful for the children you do have. Working through loss can take time, and a lingering sadness about the daughter that never was may be with you in bits forever, but it should not interfere with your life and other joys.

Dr. Gail’s Bottom Line: The regret over a life experience never had is very real, and needs to be mourned like any other significant loss.

Dr. Gail Saltz is a psychiatrist with New York Presbyterian Hospital and a regular contributor to TODAY. Her latest book is “Anatomy of a Secret Life: The Psychology of Living a Lie.” She is also the author of “Amazing You! Getting Smart About Your Private Parts,” which helps parents deal with preschoolers’ questions about sex and reproduction. Her first book, “Becoming Real: Overcoming the Stories We Tell Ourselves That Hold Us Back,” was published in 2004 by Riverhead Books. It is now available in a paperback version. For more information, you can visit her Web site, www.drgailsaltz.com.

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