Overview
A hysterectomy is the surgical removal of a woman’s uterus. A vaginal hysterectomy is performed by making an incision inside the vagina. The uterus is then removed through the vagina.
A vaginal hysterectomy may be performed if the uterus is not too large, or if it has dropped down into the vaginal canal. Occasionally, additional procedures will be done at the time of the hysterectomy to correct areas of tissue weakness or prolapse.
Why It Is Done
Hysterectomy may be needed if you have one of the following conditions:
- Fibroids. Hysterectomy is the only certain, permanent solution for fibroids — benign uterine tumors that often cause persistent bleeding, anemia, pelvic pain or bladder pressure. Nonsurgical treatments of fibroids are a possibility, depending on your discomfort level and tumor size. Many women with fibroids have minimal symptoms and require no treatment.
- Endometriosis. In endometriosis, the tissue lining the inside of your uterus (endometrium) grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication or conservative surgery doesn’t improve endometriosis, you might need a hysterectomy along with removal of your ovaries and fallopian tubes (bilateral salpingo-oophorectomy).
- Uterine prolapse. Descent of the uterus into your vagina can happen when the supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. Hysterectomy may be necessary to achieve satisfactory repair of these conditions.
- Persistent vaginal bleeding. If your periods are heavy, irregular or prolonged each cycle, a hysterectomy may bring relief when the bleeding can’t be controlled by other methods.
- Chronic pelvic pain. Occasionally, surgery is a necessary last resort for women who experience chronic pelvic pain that clearly arises in the uterus. However, hysterectomy provides no relief from many forms of pelvic pain, and an unnecessary hysterectomy creates new problems. Seek careful evaluation before proceeding with such major surgery.
- Gynecologic cancer. If you have a gynecologic cancer — such as cancer of the uterus or cervix — a hysterectomy may be your best treatment option. Depending on the specific cancer you have and how advanced it is, your other options might include radiation or chemotherapy.
Hysterectomy ends your ability to become pregnant. If you think you might want to become pregnant, ask your medical provider about alternatives to this surgery. In the case of cancer, hysterectomy might be the only option. But other conditions — including fibroids, endometriosis and uterine prolapse — have alternative treatments that you can try first.
During hysterectomy surgery, your surgeon might also perform a related procedure that removes your ovaries and fallopian tubes (bilateral salpingo-oophorectomy). You and your medical provider will discuss ahead of time whether you should have this procedure done.
Risks
Most women do not have complications after a hysterectomy. But complications that may occur include:
- Fever. A slight fever is common after any surgery.
- Difficulty urinating.
- Urinary incontinence.
- Continued heavy bleeding. Some vaginal bleeding within 4 to 6 weeks following a hysterectomy is expected. But call your medical provider if bleeding continues to be heavy.
- The formation of scar tissue (adhesions).
Rare complications include:
- Infection.
- Blood clots in the legs (thrombophlebitis) or lungs (pulmonary embolus).
- Injury to other organs, such as the bladder or bowel.
- A collection of blood at the surgical site (hematoma).
You may have other physical problems after a hysterectomy. In some women, the pelvic muscles and ligaments that support the vagina, bladder, and rectum may become weak. The weakness may cause bladder or bowel problems, such ascystocele, urinary incontinence, or rectocele. Kegel exercises may help strengthen the pelvic muscles and ligaments. But some women need other treatments, including additional surgery.
Your medical provider will tell you how long you should wait after surgery before engaging in sexual intercourse. Pain during intercourse (dyspareunia) may occur if your vagina was shortened during your hysterectomy. Changing positions may help make intercourse less painful. If you continue to have difficulty with intercourse after a hysterectomy, talk with your medical provider.
What To Expect After Surgery
Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. Usually the stay in the recovery area is for 1 to 4 hours. You will then be moved to a hospital room. In addition to any special instructions from your medical provider, your nurse will explain information to help you during your recovery.
You will likely stay in the hospital 1 to 4 days after a hysterectomy. About 4 to 6 weeks after the hysterectomy, your medical provider will examine you in his or her office. You should be able to return to all of your normal activities, including having sexual intercourse, in about 6 to 8 weeks. Some light bleeding or spotting is expected for up to 6 weeks following a hysterectomy. If your vaginal bleeding is heavier or different than what you were told to expect, call your medical provider.
After you have a hysterectomy, you will not be able to become pregnant.
After a hysterectomy, call your medical provider if you have:
Chest pain, a cough, or trouble breathing.
Bright red vaginal bleeding that soaks two or more pads in an hour or forms large or painful clots.
Pain or tenderness, swelling, or redness in your legs.
A fever of 100°F (37.8°C) or higher.
Pain that is not relieved by your pain medicine or pain that is getting worse.
Pus coming from your incision.
Trouble passing a stool, especially if you have not had a normal bowel movement for 3 to 5 days, or if you have mild pain or swelling in your lower abdomen.
Trouble passing urine, pain or burning when you urinate, blood in your urine, or cloudy urine.
Pain, discomfort, or bleeding during intercourse.
Hot flashes, sweating, flushing, or a fast or pounding heartbeat.
What To Think About
It is normal to feel a variety of emotions about having a hysterectomy. These are often based on beliefs about the importance of your uterus, fears about your health or personal relationships, and concerns about your enjoyment of sexual activities after surgery. If you do have sexual problems after your surgery, talk with your medical provider. He or she will be able to help you or direct you to a specialist who can help.
The hospital or surgery center may send you instructions on how to get ready for your surgery or a nurse may call you with instructions before your surgery.