Hysterectomy – the removal of the uterus – is one of the most common types of surgery performed in women. A hysterectomy is one way of treating problems affecting the uterus. Because it is major surgery, your doctor may suggest trying other treatments before hysterectomy. For severe conditions – and those that have not responded to other treatment – a hysterectomy may be the best choice. The choice depends to some extent on the effect of the condition, and the surgery, on your life. You should be fully informed of all options before you decide.
This article explains the types of hysterectomy and why it might be needed. It discusses other options you may have for treatment. The physical effects and risks of treatment are covered, too. If you choose to have a hysterectomy, this article can help prepare you for what’s involved.
About the Uterus
The uterus is a muscular organ in the pelvis. The opening of the uterus is the cervix. In pregnancy, the uterus holds and nourishes the fetus. In labor, it contracts to deliver the baby. When a woman is not pregnant, the lining of the uterus (the endometrium) is shed each month in her menstrual period.
Sometimes, there are problems with the uterus. A woman may have pain or heavy bleeding. Growths or cancer can also occur. These problems require treatment.
Conditions Affecting the Uterus
Hysterectomy may be performed to treat conditions that can affect the uterus. Some are benign (not caner), and others are cancer. Some have symptoms that cause discomfort, while others can threaten your life.
Your condition may be treated with medicine or various types of surgery, including hysterectomy. The choice of treatment depends on the nature and extent of your condition as well as personal factors. These factors include your plans to have children in the future, the amount of discomfort you are having, and other options available. Other forms of treatment often are tried first. If they don’t work, hysterectomy may be considered. Following are some of the conditions for which hysterectomy may be performed:
There are three types of hysterectomy:
- Partial (or subtotal), in which the upper part of the uterus is removed but the cervix is left in place
- Complete (or total), in which the entire uterus, including the cervix is removed
- Radical, in which the entire uterus, lymph nodes, and support structures around the uterus are removed. This is done when the cancer is extensive.
The ovaries and fallopian tubes may be removed at the same time.
The uterus may be removed through a cut in the abdomen or through the vagina. The method used depends on the reason for the surgery and the findings of a pelvic exam. During a vaginal hysterectomy, some doctors use a laparoscope to help them see inside the abdomen and do part of the surgery.
Tests are needed before the surgery. Your blood and urine will be tested. You may be given one or more enemas. Your abdominal and pelvic areas may be shaved. Antibiotics usually are given to prevent infection. A needle may be placed in your armor wrist. It is attached to a tube that will supply your body with fluids, medication, or blood. This is called an IV line. Monitors will be attached to your body before anesthesia is given. You may be given a general anesthesia, which makes you unconscious, or a regional one, which blocks out feeling in the lower part of your body.
As with any surgery, problems may occur. These could include theombophlebitis (blood clots in the veins or lungs), severe infection, bleeding after surgery, bowel blockage, injury to the urinary tract, problems related to anesthesia, or even death. Even though the risks of hysterectomy are among the lowest of any major surgery, you and your doctor must weigh the benefits and risks.
The length of stay in the hospital after surgery varies by type of surgery. You can expect to have some pain for the first few days. Normal activities, including sex, usually can be resumed in about 6 weeks. Meanwhile, don’t douche or put anything in the vagina.
As you recover, activities such as driving, sports, and light physical work may be increased gradually. You and your doctor can plan your return to normal activities, including your return to work, at a rate best suited to your own recovery. If you can do an activity without pain and fatigue, it should be okay. If activity causes pain, discuss it with your doctor.
The surgery can have other effects that are both physical and emotional. Some last briefly, and others are long term. You should be aware of these effects before having a hysterectomy.
After hysterectomy, a woman’s periods will stop. She can no longer get pregnant. If the ovaries are left in place, though, they still produce hormones. A woman who still has her ovaries will not have the symptoms that often occur with menopause, such as hot flashes. The ovaries still produce eggs, too, but because the eggs are not fertilized, they dissolve in the abdomen.
If the ovaries also are removed with the uterus before menopause, there are hormone-related effects. It is as though the body goes through menopause all at once, rather than over a few years as is normal. Symptoms can usually be treated with the hormone estrogen.
Many women have a brief emotional reaction to the loss of the uterus. This response depends on a number of factors: how well they were prepared for the surgery, its timing, the reason for having it, and whether the problem is cured. Women who are affected by the early loss of their ability to have children may feel depressed. If problems persist, discuss them with your doctor.
Hysterectomy and Sex
Some women may notice a change in their sexual response after a hysterectomy. Because the uterus has been removed, uterine contractions that may have been felt during orgasm will no longer occur. Some women have a heightened response, however. In part, this is because they no longer have to worry about getting pregnant and may be relieved of discomfort.
If the ovaries have not been removed, the outer genitals and the vagina are not affected. In this case, a woman’s sexual activity is usually not impaired. If the ovaries are removed with the uterus, vaginal dryness may be a problem during sex. Use of estrogen can relieve dryness.
If the procedure required making the vagina shorter, deep thrusting during sex may be painful. Being on top during sex or bringing your legs together may help.
Hysterectomy is just one way to treat uterine problems. It is major surgery. Before you decide whether it is right for you, get as much information as you can:
- About your condition
- About other treatment options
- How hysterectomy may affect you
Some conditions can be treated without this procedure. For others, it is the best choice. Please call our office to discuss your options.