Vaginal hysterectomy has been a wonderful breakthrough in the field of gynaecology. This hysterectomy procedure involves the removal of the uterus and cervix (or parts of the two, depending on the requirement of the surgery) using a laparoscope, by taking a vaginal approach. It helps to completely do away with surgical cuts that were earlier required to be made in the abdominal region, during abdominal hysterectomies. Those often led to scarring, increased risk of complications and a longer time for surgery and recovery from hysterectomy. Conversely, vaginal hysterectomies require minimum invasion, the sutures given are self absorbing and there is practically no scarring seen, thus, reducing the overall recovery period. Normally, an abdominal hysterectomy recovery would require up to twelve weeks, whereas the vaginal hysterectomy recovery period can be as short as three weeks, as it is a laparoscopic hysterectomy procedure.
During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it. The uterus is then removed through the vagina.
Hysterectomy often includes removal of the cervix as well as the uterus. When the surgeon also removes one or both ovaries and fallopian tubes, it's called a total hysterectomy with salpingo-oophorectomy. All these organs are part of your reproductive system and are located in your pelvis.
Why vaginal hysterectomy is performed?
Vaginal hysterectomy treats many different women health conditions such as:
- Fibroids: Many hysterectomies are done to permanently treat fibroids- benign tumours in your uterus that can cause persistent bleeding, anaemia, pelvic pain, pain during intercourse and bladder pressure. If you have large fibroids, you may need an abdominal hysterectomy- surgery that removes your uterus through an incision in your lower abdomen.
- Endometriosis: Endometriosis occurs when the tissue lining your uterus (endometrium) grows outside of the uterus, involving the ovaries, fallopian tubes or other organs. Most women with endometriosis have an abdominal hysterectomy, but sometimes a vaginal hysterectomy is possible.
- Gynaecologic Cancer: If you have cancer of the uterus, cervix, endometrium or ovaries, your gynaecologist may recommend a hysterectomy to treat it. Most of the time, an abdominal hysterectomy is done during treatment for ovarian cancer, but sometimes vaginal hysterectomy may be appropriate for women with cervical cancer or endometrial cancer.
- Uterine Prolapse: When pelvic supporting tissues and ligaments get stretched out or become weak, the uterus can lower or sag into the vagina, causing urinary incontinence, pelvic pressure or difficulty with bowel movements. Removing the uterus with hysterectomy and repairing pelvic relaxation may relieve those symptoms.
- Irregular vaginal bleeding: When medication or a less invasive surgical procedure doesn't control abnormal, heavy or very long periods, a vaginal hysterectomy can solve the problem.
- Chronic pelvic pain: If you have chronic pelvic pain clearly caused by a uterine condition, a vaginal hysterectomy may help, but only as a last resort. Chronic pelvic pain can have several causes, so an accurate diagnosis of the cause is critical before having a hysterectomy for pelvic pain.
Risks associated with a vaginal hysterectomy
Although vaginal hysterectomy is generally safe, any surgery has risks. Risks of vaginal hysterectomy include:
Surgical risks are higher in women who are obese or who have high blood pressure. There is a risk of injury to other pelvic and abdominal organs
during vaginal hysterectomy, including the bladder
, ureters or bowel.
Severe endometriosis or scar tissue (pelvic adhesions) may force your surgeon to switch from a vaginal hysterectomy to abdominal hysterectomy during the surgery. Consult with your gynaecologist
in detail before the surgery.
What to expect during a vaginal hysterectomy?
You may have general anaesthesia
, so you won't be awake for a vaginal hysterectomy. Alternatively, you may choose a spinal block (regional anaesthesia) with a medication that makes you drowsy, or you may remain awake during your surgery.
In order to perform a vaginal hysterectomy:
- Your surgeon makes a cut 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
What to expect after a 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 doctor 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 vaginal hysterectomy, so you'll need to wear sanitary pads.
How you will feel physically after a vaginal hysterectomy?
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 9 kilograms or have vaginal intercourse
until six weeks after surgery. Inform your doctor immediately if pain worsens or if you develop nausea, vomiting or bleeding that's heavier than a menstrual period
How you will feel emotionally after a vaginal hysterectomy?
After a vaginal 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 a vaginal 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
Results of a vaginal hysterectomy
After a vaginal hysterectomy, you'll no longer have periods or be able to get pregnant.
If you had your ovaries removed, you'll begin menopause immediately after surgery. You may experience symptoms such as vaginal dryness
, hot flashes
and night sweats
. Your doctor can recommend medications for these symptoms, if you need treatment.
If your ovaries weren't removed during surgery - and you still had periods before your surgery - your ovaries continue producing hormones and eggs until you reach menopause