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Hysterectomy

Information for Patients

Introduction

Hysterectomy is an operation in which the uterus (‘womb’) is removed.  There are a number of different types of hysterectomy, and this information statement deals with the most common forms.  It is always important to discuss your procedure in detail with your gynaecologist.

Reasons for hysterectomy

There are many possible reasons that the uterus might be removed, and your gynaecologist should discuss these in your particular case.  Some of the more common reasons for the operation are:

Prolapse

Prolapse is a condition where the normal supports of the pelvic organs are damaged, and the uterus comes down through the vagina. 

You can find more information about prolapse here.

Fibroids

Fibroids are benign tumours that arise from the muscle in the uterus.

You can find more information about fibroids here.

Heavy menstrual bleeding

Some women will experience bleeding with their periods that is heavy, prolonged, painful, or all of these.  In some cases, such bleeding is associated with fibroids.  Many women will have tried other treatments for heavy bleeding, and have found these unsatisfactory.

You can find more information about heavy menstrual bleeding here.

Endometriosis

Endometriosis is a condition where tissue that is the same as that which lines the uterus, is present elsewhere in the pelvis.

You can find more information about endometriosis here.

Types of hysterectomy

There are many types of hysterectomy, and the procedure recommended by your gynaecologist will depend upon your personal circumstances.

The first consideration is the amount of tissue to be removed.

Total hysterectomy is removal of both the cervix and the body (corpus) of the uterus.

Subtotal hysterectomy is removal of only the body of the uterus, with the cervix left in place.

Radical hysterectomy is performed when there is cancer in the cervix or uterus, and involves taking additional tissue from the supports and tissues around the uterus.

As well, the ovaries and fallopian tubes may be removed at the same time as the hysterectomy is performed.  In some cases, the tube and ovary on one side are left in place while the uterus and tube and ovary from the other side are removed.

It is important to be absolutely clear as to what your procedure involves, and it is vital that you discuss this in detail with your gynaecologist.

Route of hysterectomy

The second major consideration is how the operation is performed.  There are three ways of performing a hysterectomy:

Abdominal hysterectomy 

This is where a cut (‘incision’) is made on the abdomen and the hysterectomy is performed through that incision

Vaginal hysterectomy

This is where the uterus is removed through the vagina, with no cut on the abdomen.

Laparoscopic hysterectomy

This is where part or all of the hysterectomy is performed with the use of ‘keyholes.’  You can find more information about laparoscopy here.

View a YouTube video clip of a hysterectomy here:

What to expect after hysterectomy

Whatever the type of hysterectomy, and whichever route is used to perform the operation, the recovery will take some time.

Often, a catheter is left in the bladder for a day or more after the operation.  When it is clear that recovery is satisfactory and that the bowel is working, eating food is allowed.  In some cases, women will be treated with antibiotics or agents to reduce the risk of thrombosis (clots) after the procedure.

There is commonly some discharge from the vagina, until the stitches at the top of the vagina (vault) dissolve.

It is normal to feel tired for some weeks after a hysterectomy, but there should be improvement each day, and it is uncommon not to be able to return to work and normal activities within a month to six weeks.

Potential complications of hysterectomy 

Any surgical procedure has the potential for complications.  In general, hysterectomy is safe and effective.  You should discuss potential complications with your gynaecologist before any procedure is undertaken.  Fortunately, complications after this type of surgery are uncommon.

General complications of any surgical procedure include thrombosis (clotting within vessels) and embolus (where a clot breaks off, travels through the circulation, and then lodges in another organ, such as the lungs).  Bleeding, infection, and complications of anaesthesia are also possible.  

Specific complications after hysterectomy

Whenever any major operation is performed, there is a potential for complications.

Because of the anatomical location of the uterus (between the bladder and bowel, and between the tubes that carry urine from the kidney to the bladder) there is potential for damage to other abdominal and pelvic organs:

  • Injury to the bladder
  • Injury to the bowel
  • Injury to the ureter
  • Injury to blood vessels and nerves

Although these potential complications are uncommon, it is important to discuss them with your gynaecologist prior to any surgery.

Frequently asked questions about hysterectomy

Does hysterectomy affect sexual intercourse?

In most cases, hysterectomy does not have any effect on enjoyment of sexual relations.  For many women, when the problem that hysterectomy is treating (heavy periods, prolapsed, pelvic pain) is removed, many women find that their life is more enjoyable.  It is important that you discuss any concerns with your gynaecologist.

Are Pap smears necessary after hysterectomy?

This depends on the type of hysterectomy and the woman’s past history.  If the cervix has been removed, and the woman has no previous history of Pap smear abnormalities, then ongoing Pap smears will probably not be necessary.  If the cervix is left in place, or there is a history of Pap abnormalities in the past, Pap smears will usually still be an important health check.

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