Talk with your doctor about what to expect during and after surgery, including physical and emotional effects.
During vaginal hysterectomy
You may have general anesthesia, so you won't be awake for the surgery. Alternatively, you may choose a spinal block (regional anesthesia) with a medication that makes you drowsy, or you may remain awake during your surgery.
You'll lie on your back, in a position similar to the one you're in for a Pap smear. You may have a urinary catheter inserted to empty your bladder. A member of your surgical team cleans the surgical area with a sterile solution before surgery.
To perform the hysterectomy:
- Your surgeon makes an incision inside your vagina to get to the uterus
- Using long instruments, your surgeon clamps the uterine blood vessels and separates your uterus from the connective tissue, ovaries and fallopian tubes
- Your uterus is removed through the vaginal opening, and absorbable stitches are used to control any bleeding inside the pelvis
Except in cases of suspected uterine cancer, the surgeon may cut an enlarged uterus into smaller pieces and remove it in sections (morcellation).
There's always a risk that severe endometriosis or pelvic adhesions may force your surgeon to switch from a vaginal to abdominal hysterectomy during the surgery. Ask your surgeon about this possibility.
Laparoscopic or robotic hysterectomy
You may be a candidate for a laparoscopically-assisted vaginal hysterectomy (LAVH) or robotic hysterectomy. Both procedures allow your surgeon to remove the uterus vaginally while being able to see your pelvic organs through a laparoscope, a slender viewing instrument. Your surgeon performs most of the procedure through small abdominal incisions aided by long, thin surgical instruments inserted through the incisions. Your surgeon then removes the uterus through an incision made in your vagina.
Your surgeon might recommend LAVH or robotic hysterectomy if you have scar tissue (adhesions) on your pelvic organs from prior surgeries or from endometriosis.
After the vaginal hysterectomy
After surgery, you'll be in a recovery room for a few hours and in the hospital for one to two days, possibly longer. You'll take medication for pain and to prevent infection. Your health care team will encourage you to get up and move as soon as you're able.
It's normal to have bloody vaginal discharge for several days to weeks after a hysterectomy, so you'll need to wear sanitary pads.
Physical effects after a hysterectomy
After a hysterectomy, you'll no longer have periods or be able to get pregnant.
If your ovaries weren't removed and you still had periods before the surgery, your ovaries continue producing hormones and eggs until you reach menopause. If you had your ovaries removed, you'll begin menopause immediately after surgery. You may experience symptoms such as vaginal dryness and hot flashes — your doctor can recommend treatment for these symptoms, if you need it.
Recovery after vaginal hysterectomy is shorter and less painful than after an abdominal hysterectomy. A full recovery may take three to four weeks. Even if you feel like you're back to normal, don't lift anything heavy — more than 20 pounds (9.1 kilograms) — or have vaginal intercourse until six weeks after surgery. Contact your doctor if pain worsens or if you develop nausea, vomiting or bleeding that's heavier than a menstrual period.
Emotional effects after a hysterectomy
After a hysterectomy, you may have an improved mood and increased sense of well-being. You may be relieved to no longer experience signs and symptoms such as heavy bleeding or pelvic pain. For most women, there's no change in sexual function after hysterectomy. But for some women, heightened sexual satisfaction occurs after hysterectomy — perhaps because they no longer fear becoming pregnant or no longer have pain during intercourse.
You may feel a sense of loss and grief after hysterectomy, which is normal. Or you may experience depression related to the loss of your fertility, especially if you're young and hoped for a future pregnancy. If sadness or negative feelings begin to interfere with your enjoyment of everyday life, talk to your doctor.
Dec. 11, 2012
- About hysterectomy: Surgical removal of the uterus, or womb. American College of Surgeons. http://www.facs.org/public_info/operation/brochures/hysterectomy.pdf. Accessed Nov. 6, 2012.
- Falcone T. Overview of hysterectomy. http://www.uptodate.com/index. Accessed Nov. 6, 2012.
- Hysterectomy fact sheet. U.S. Department of Health and Human Services Office on Women's Health. http://womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.cfm. Accessed Nov. 6, 2012.
- Stovall TG, et al. Vaginal hysterectomy. http://www.uptodate.com/index. Accessed Nov. 6, 2012.
- Frequently asked questions. Special procedures FAQ008. Hysterectomy. American College of Obstetricians and Gynecologists. http://www.acog.org/~/media/For%20Patients/faq008.pdf?dmc=1&ts=20121106T1337303494. Accessed Nov. 6, 2012.
- Muralidhar MM, et al. Vaginal hysterectomy for benign disease without prolapse. Clinical Obstetrics and Gynecology. 2010;53:5.
- Hoffman BL, et al. Williams Gynecology. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.com/resourceTOC.aspx?resourceID=768. Accessed Nov. 6, 2012.
- Lyons T. Laparoscopic approach to hysterectomy. http://www.uptodate.com/index. Accessed Nov. 6, 2012.