One of the most common gynecological surgeries is called a hysterectomy, which is typically the removal of the uterus. There are roughly 600,000 hysterectomies performed annually in the United States, and gynecologists suggest the surgery to women for many reasons. It is estimated that by age 60, one-third of all women have had hysterectomies for different reasons. However, since the surgery removes the uterus, it does prevent a woman from conceiving and having a child, which is an unwanted side effect for many. Read on to learn more about hysterectomies, why they are performed, and what recovery is like.
Why Would I Need a Hysterectomy?
There are several reasons that a hysterectomy may be performed. One of the most common reasons is a problem with the uterus itself. This could be because of uterine fibroids, which can cause moderate-to-severe pain as well as bleeding, or because of uterine prolapse, which is a situation where the uterus slides out of its place and begins to fall in the vaginal canal. Adenomyosis is another uterine problem that involves the thickening of the uterus. Another common reason is cancer, whether it be cancer of the uterus or cervix or ovarian cancer. Endometriosis is another reason for a hysterectomy. Sometimes healthcare providers will suggest hysterectomy if the patient has chronic pelvic pain or abnormal/heavy vaginal bleeding.
Hysterectomy is not the first-line treatment for any type of cancer-it is usually the last resort after other options have been exhausted, such as chemotherapy and radiation. In fact, because hysterectomy is major surgery and prevents pregnancy and conception permanently, physicians will often try numerous other options before suggesting surgical methods.
Types of Hysterectomy
Depending on the reason hysterectomy is suggested, there are different types. Generally speaking, hysterectomy is the removal of the uterus, but doctors may opt only to remove part of it or to remove the cervix as well. Types of hysterectomy include:
- Supracervical hysterectomy. In this type of surgery, the surgeon removes only the top part of the uterus and no part of the cervix.
- Total hysterectomy. This type of hysterectomy removes both the uterus and the cervix.
- Radical hysterectomy. This gynecological surgery is the most comprehensive of the three, where the uterus, uterine tissue, cervix, and the upper part of the vagina are removed. This hysterectomy is typically only performed because of cancer.
Depending on the reasons for surgery, the surgeon may also remove other parts of the reproductive system. During a hysterectomy, the ovaries may be removed as well, which is known as an oophorectomy. The fallopian tubes may also be removed, which is called a salpingectomy. If the surgeon must remove all three (uterus, ovaries, and tubes) due to cancer or other serious condition, this operation is known as a hysterectomy and bilateral salpingectomy-oophorectomy.
What Happens During a Hysterectomy?
There are two different ways that surgeons perform hysterectomies, and the decision to choose either is based on several factors, such as the reason for the surgery, the surgeon’s personal experience with performing gynecological surgeries, and the woman’s state of overall health. The two different types of approaches for hysterectomy include surgery using a minimally invasive procedure (known as MIP) or traditional open surgery.
MIP has different subtype approaches, which surgeons can use to perform a hysterectomy. He or she can perform a laparoscopic hysterectomy. During this procedure, the surgeon makes several small incisions in the stomach and uses a laparoscope and lighted camera to perform the surgery using a minimally invasive method.
A vaginal hysterectomy is also considered an MIP. In this type of surgery, the physician makes an incision in the vagina and removes the uterus using the vaginal canal. This type of procedure leaves no visible scarring.
The surgeon can also opt for laparoscopic-assisted vaginal hysterectomy, where the surgeon will make laparoscopic incisions in the belly to aid with the surgery, but still removes the uterus via the vagina. A robot-assisted laparoscopic hysterectomy is also an option. This is a form of laparoscopic hysterectomy that uses robotic tools and advanced technology to remove the uterus.
Open (or traditional) hysterectomy is the most common type of hysterectomy and is performed in over 50 percent of cases. During this procedure, the surgeon makes a large incision (five to seven inches) across the belly and removes the uterus in this way. This surgery involves more recovery time and is more invasive and also leaves a visible scar post-procedure. However, it remains the primary choice for hysterectomies unrelated to cancer.
MIP is less invasive and has less recovery time, allowing a patient to resume normal activities in just three to four weeks. The average recovery time for an open hysterectomy is four to six weeks. However, MIP is not a viable option for many women, due to current health issues, obesity, and scarring from any previous surgeries (such as a C-section).
Will My Sex Life Change After a Hysterectomy?
It is possible that a patient’s sex life can change after hysterectomy. However, it is not always in a negative way. Patients who had experienced heavy vaginal bleeding or pelvic pain prior to the surgery can often enjoy a better sex life because there is no more bleeding or chronic pain.
Women that have a hysterectomy that also removes the ovaries will immediately begin menopause post-procedure, no matter their age. This can have a negative effect on one’s sex life because of the side effects that are part of menopause, such as vaginal dryness, insomnia, sweats, and hot flashes. Vaginal dryness is most common, and this can be cured by using lubrication during intercourse. You may also have trouble with arousal prior to intercourse, and this is something you can discuss with your physician in order to find treatment options.
Hysterectomy Risks and Recovery Time
Because hysterectomy is a major surgery, there are many risks. There are more risks involved with abdominal hysterectomy than vaginal hysterectomy. There are also emotional side effects that come with any type of surgery.
There is usually a short hospital stay following a hysterectomy. You may need pain medication to manage pain post-surgery. Many women experience bloody vaginal discharge in the weeks following the procedure. Most women are able to resume all normal activities by the six-week marker. Common side effects immediately following hysterectomy include:
- Burning or itching at the incision site
- Numbness in the leg
- Pain or bruising at the incision site
- Swelling or redness at the incision site
There are also long-term side effects post-hysterectomy. One of the most common is organ prolapse, which is the movement of organs out of their placement. For example, the vagina can move after a hysterectomy, and in rare cases, can even move outside of the body. The bowel or bladder can also unexpectedly move. However, these are rare, yet possible, side effects of the surgery.
The emotional side effects are also serious. Hysterectomy will prevent a patient from having a period, but this also means conception and pregnancy are no longer possible. In some women, this can cause a sense of loss and sadness, while other women are relieved they can no longer conceive. Still, it is possible to experience a sense of loss and grief after major surgery.
There are also risks with a hysterectomy that are common to all types of major surgeries, such as:
- Major blood loss
- Bowel blockage
- Damage to surrounding organs (bladder, urethra)
- Blood clots
- Negative reaction to anesthesia
Prior to surgery, your surgeon and anesthesiologist will discuss the risks with you and go over what will happen during the procedure. If you need more information about hysterectomy or would like to be seen by a gynecologist for women’s health issues, request an appointment with The Woman’s Clinic today. We provide a full range of gynecological and obstetric services and offer two clinic locations for your convenience.