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What is a hysterectomy?

A hysterectomy is an operation in which the uterus is removed. It is also called ablation of the uterus. Depending on the case, the cervix, ovaries and/or Fallopian tubes might also be removed.

Why is this operation done?

Hysterectomy is performed to relieve different pain and/or discomfort from illnesses or diseases. Hysterectomy has long been considered the first and only solution for treating women with certain gynaecological problems. However, today, there may be other options available.

Since hysterectomy is a major surgical and permanent procedure, it is important to ask any questions you may have and make sure you receive clear answers so you can make the choice that best meets your needs.

What are the different types of hysterectomies?

There are four types of hysterectomies. The type of hysterectomy performed depends on the problem being treated:

  • Subtotal hysterectomy (partial) involves removing the body of the uterus, but leaving the cervix in place.
  • Total hysterectomy involves removing the body of the uterus as well as the cervix.
  • Total hysterectomy with salipingo-oophorectomy (bilateral if both ovaries are removed) involves removing the body of the uterus, the cervix, as well as the ovaries and Fallopian tubes.
  • Radical hysterectomy is done specifically in the case of invasive gynaecological cancer, is the same procedure as a total hysterectomy but also involves the removal of the upper part of the vagina as well as the pelvic lymphatic ganglions.

How are hysterectomies done?

The removal of the uterus is done through the vagina, through the vagina assisted by laparoscopy or through the abdomen:

  • Abdominal hysterectomy. The operation is done through a 10-to-15-centimetre incision in the abdomen. This incision could be horizontal (under the pubic hair line) or vertical (between the pubis and the navel). This procedure allows the surgeon to easily reach the uterus and Fallopian tubes, in particular, in the case of a radical hysterectomy. This also makes it easier to extract a uterus or large fibroma. However, it requires several days' hospital stay and leaves a visible scar.
  • Vaginal hysterectomy. This operation involves a small incision in the rear of the vagina. The uterus is then removed through this incision. This procedure is chiefly used in the case of uterine prolapse (descended uterus) when the uterus has already descended towards the vagina. This approach only requires a short hospital stay and does not leave any visible scar.
  • Vaginal Hysterectomy with Laparoscopy. This involves small incisions (between 2 and 4) in the abdomen into which a laparoscope* is inserted. Using this instrument, the surgeon "disconnects" the uterus and then removes it following the same procedure as in vaginal hysterectomy. This procedure has the same advantages as vaginal hysterectomy.

*Laparoscope: an instrument the size and shape of a pencil and has a light and various accessories on one end used to "disconnect" the uterus.

What are the short-term risks and complications of a hysterectomy?

All surgery is not without its risks. Therefore, a list of the main risks and complications that could occur following hysterectomy includes:

  • serious infections that may require a woman to return to the hospital and be treated with antibiotics;
  • urinary problems, from a kidney or bladder infection to urinary incontinence (this risk is greater for radical hysterectomies);
  • hemorrhaging that may require blood transfusions;
  • severe reactions to the anaesthesia; and
  • intestinal problems if the intestines were damaged during surgery–some women may have to undergo another operation to remove any adherence* obstructing (blocking) their intestines.

*Adherence: Scar tissue that attaches organs together or can end up in an organ, blocking it and disturbing its function.

Regardless of the type of surgery you will undergo, make sure that you are aware of all the possible risks and complications. You have the right to clear answers to your questions.

What are the long-term risks and complications of a hysterectomy?

The main risks and complications that may occur after hysterectomy are:

  • Prolapse, which means the descent of an organ downwards. When the uterus is removed, other organs, such as the intestines and bladder can descend towards the bottom and lead to problems of constipation and/or urinary incontinence (problems or inability to control one's bladder). These types of prolapse can also lead to pain during penetration with a penis, finger or object into the vagina.
  • Menopause. When the ovaries are removed during hysterectomy, the quantity of hormones circulating in the blood drops sharply. Following this type of surgery, women who are not menopausal will become so. It is what is known as “surgical” or “sudden” menopause. Menopausal symptoms are then felt. The main symptoms of menopause are:
  • heat flashes;
  • vaginal dryness (lubrication problems);
  • fatigue;
  • night sweats;
  • irritability;
  • insomnia;
  • migraines, and
  • increased risk of osteoporosis and heart disease.

Even if the ovaries are not removed, some women may be menopausal following the operation. In these cases, menopause is caused by a decrease in the amount of blood being fed to the ovaries. This prevents the ovaries from producing enough hormones.

  • Sadness/mourning. To some women, losing their uterus is a sad and upsetting event. Their self-image as women may be affected following the operation. Some women may become depressed and experience a period of mourning, especially if they had wanted to become pregnant one day.

The emotions experienced after a hysterectomy can also have a physiological cause. Removing the ovaries causes a drop in the hormone levels, which can provoke behavioural changes: irritability, crying fits, insomnia, etc. If this is your case, support from friends, family, a health professional or a support group can help you go through this period of change and adaptation.

It is important to mention that, for some women hysterectomy will be a positive experience since the benefits far outweigh the complications from the operation.

I had a hysterectomy and my ovaries were removed. Would hormone therapy be a good solution for me?

Following removal of the ovaries, in particular, you will experience menopausal symptoms. Some women will opt for hormone therapy, whereas others will turn to alternative medicine. Deciding whether or not to follow hormone therapy may not be an easy choice. Some researchers recommend this therapy to relieve menopausal symptoms as well as prevent osteoporosis, whereas others issue warnings about the increased risk of breast cancer and heart disease related to its use.

Given that each woman has a different medical history, it is important to discuss with your doctor the advantages and disadvantages that hormone therapy has in your particular case.

Will my sexuality change after a hysterectomy?

It is difficult to say how hysterectomy will impact your sexuality. Each case is unique. In fact, some women feel that hysterectomy has no impact on their sexuality. Others find that their sexuality is renewed, since they are finally relieved of the problems they had before hysterectomy, which made sexual relations painful or even impossible. Others experience certain changes to their sexuality. The following are the most common changes:

  • The feeling of having lost one's femininity. For some women, losing their uterus means losing their femininity. The post-operative process could therefore include discussion on their self-image as a woman and sexual attraction. If this is your case, talking to your partner and gaining her or his support can help you throughout this time of questioning and adapting.
  • Fear of pain. Following the operation, some women may fear feeling pain once they resume having sex, especially penetration. Their partner may also feel this way, and therefore it is important to talk about these fears.
  • Problems in reaching orgasm. For physiological reasons, some women may experience difficulties in reaching orgasm after losing their uterus. Some women find feeling their partner's penis or finger pushing against the cervix can create contractions in the uterus, resulting in excitement and pleasure. For these women, hysterectomy could adversely affect their ability to reach orgasm. Talking with your partner and discovering new ways of producing can help increase your level of sexual satisfaction.
  • Problems during penetration. Some women who have had their cervix removed and the length of their vagina shortened may find penetration uncomfortable. Exploring new ways of touching and new positions with your partner can help you reach more satisfaction.
  • Lubrication problems and loss of sexual desire (libido). Women who undergo a hysterectomy with ablation of the ovaries may experience a drop in sexual desire and problems with lubrication. In order to compensate for the hormonal imbalance caused by ovary removal, some women choose to follow hormone therapy. Others focus instead on the presence of a partner, the experience of a stimulating sex life and the use of lubricant in order to deal with these problems.

Regardless of the type of problems encountered, meeting with a sexologist or therapist, with your partner or alone, can help you reactivate and take back your sexuality.

Where can I go for more information?

Revised June 2006