Hysterectomy consists of the removal of the uterus. There are several reasons why this may be required. These include benign conditions such as fibroids, endometriosis, excessive menstrual bleeding, prolapse and malignant ones such as cancer of the ovaries, uterus or cervix.
To remove the uterus the surgeon needs to tie or ligate all the vessels and ligaments that provide blood supply and support to the organ. This is done following precise surgical technique.
Once all the vessels and ligaments have been ligated, the uterus is removed. In most cases, the cervix is also removed (“total hysterectomy”).
There are three possible routes through which the operation can be performed: vaginal, abdominal or laparoscopic. Sometimes a combination of routes can be used.
Laparoscopic hysterectomies follow the same principles and surgical technique as the open abdominal procedure. The instruments used and the way the vessels and pedicles are secured are different but the surgical steps are virtually the same. Instead of an incision of about 10 to 15 cm similar to the one used for a Caesarean Section, the whole operation is performed through 4 small incisions of 0.5 to 1 cm. After a laparoscopic hysterectomy, most women go home after 1 or 2 days and return to work within 3 weeks.
Frequently Asked Questions
How do I know if I really need the hysterectomy recommended by my doctor?
If you have been diagnosed with ovarian or uterine cancer, your treatment will most certainly include a hysterectomy and possibly removal of both ovaries. If a hysterectomy has been recommended for benign conditions, you need to make sure other alternatives have been considered and explained to you. As in most cases in medicine, you need to be convinced that the potential complications or side effects of treatment outweigh the symptoms or risks of the disease.
How urgently do I need the hysterectomy done?
Again, if it is necessary because of cancer, the sooner the better. All other conditions are not urgent and most times a hysterectomy can be delayed if necessary. The most important question to ask yourself is: 'Am I having a hysterectomy because I understand the reasons and agree it is the best treatment for me or because my doctor told me I need a hysterectomy and I don't understand why?'
If I have a hysterectomy will I enter menopause?
After a hysterectomy you will no longer have periods. Nevertheless, if your ovaries have not been removed you will continue to ovulate, produce hormones and experience hormonal cycles. Some studies showed that a hysterectomy can bring hormonal menopause one or two years earlier, but on average you should expect to reach menopause, i.e., reduction in ovarian hormones and discontinuation of ovulation, around the same age you would have if you did not have the hysterectomy.
Will the hysterectomy affect my sexual pleasure?
This in an uncertain area because of the different reasons for which hysterectomies are performed, different ways it is performed, the large role played by emotions and culture over sex and women's attitudes towards the uterus. Sexual pleasure and orgasm should remain by and large the same as before. Most sexual stimulation happens on the lower (most external) third of the vagina and the clitoris and these are not altered by a hysterectomy. There are cases of women who report changes in their sexual life after a hysterectomy. These can be for the worse or the better.
Improvements tend to happen when the hysterectomy was performed for reasons that were interfering with sex in the first place such as pain or bleeding. Some women also report becoming more confident knowing that they are no longer at risk of falling pregnant. Studies that looked into the effect of hysterectomies on sexual life found that the most satisfied women are the ones that have good pre-operative discussion, counselling and expectations.
A few physiological considerations include:
Some women experience short repeated uterine contractions after orgasm and these tend to disappear after the hysterectomy. Some women experience short repeated vaginal contractions after orgasm and these tend to remain the same. Vaginal lubrication is mostly secretions from the vaginal wall during arousal and it also remains the same.
Will the hysterectomy change my desire for sex?
Your sexual desire (libido) should stay the same as before the hysterectomy. In some women, the removal of pain and heavy bleeding may increase sexual desire. The most common causes of reduction in libido are stress, fatigue, and fear of pain with intercourse. A hysterectomy may interfere with sexual desire to the extent that it interferes with those factors. In most cases there is no change.
What is the difference between a vaginal, abdominal and laparoscopic hysterectomy?
The main steps of all three procedures are similar and involve ligation of the arteries that bring blood to the uterus and ligaments that hold it in place. The terminology relates to the route of access of the operation. As the names suggest, a vaginal hysterectomy is done through the vagina with no abdominal incisions, an abdominal hysterectomy is done through a cut on the abdomen similar to a caesarean section and a laparoscopic hysterectomy, also called keyhole surgery, is done through four 0.5 cm incisions on the abdomen. The large incision on the abdomen for an abdominal hysterectomy usually means more post-operative pain and a longer recovery period compared with laparoscopic or vaginal hysterectomy.
What are the risks involved with a hysterectomy?
As with most operations there is risk of excessive bleeding which in extreme cases may require a blood transfusion. There is risk of infection to the operation site (pelvis) or surgical wounds. These are usually not serious in healthy women and can be treated with antibiotics. Lastly there is the risk of damage to other organs adjacent to the uterus namely the bladder, bowel, large vessels and ureters (the tubes that bring urine from the kidneys to the bladder). These are rare and if diagnosed during the operation can be fixed and do not cause long term issues. Discussion of surgical risks and complications are part of the informed consent you will sign before your hysterectomy and you should take the opportunity to discuss them with your doctor.
Is a laparoscopic hysterectomy riskier than an open abdominal hysterectomy?
No. When the operation was first performed a higher incidence of organ damage and bleeding was reported. This is now believed to have occurred mainly because of surgeon's inexperience and introduction of the new method. Nowadays, in experienced hands, when compared to an open procedure, a laparoscopic hysterectomy generally means less bleeding, faster recovery, faster return to physical activities and to work, better cosmetic results and comparable rates of overall complications.
Will I put on weight after a hysterectomy?
No. There is no relationship between a hysterectomy and weight gain.
What are the benefits of having a hysterectomy?
The main benefits depend on the disease being treated and relate to treating the symptoms of pain, heavy bleeding, and genital prolapse in women where other treatment modalities have failed to produce results. Overall, operations performed for a good indication on well prepared and informed women show high success and post-operative satisfaction rates.