Vaginal Hysterectomy Procedure
Overview
Vaginal hysterectomy is a type of surgery where the surgeon removes the uterus through the vagina. This procedure often includes removal of the cervix as well. Doctors may recommend this approach when it is safe and suits the patient’s health needs.
One major benefit is that patients usually recover faster, spend less time in the hospital, and face lower costs compared to surgeries that require a cut in the belly. In some cases, vaginal hysterectomy is not possible. Factors such as the size or shape of the uterus, along with the underlying medical condition, can influence the surgical approach.
Your doctor might discuss other options, such as laparoscopic or robotic-assisted surgeries, which use small cuts in the belly, or traditional abdominal hysterectomy, which involves a larger incision. The table below shows key types of hysterectomy:
| Type | Organs Removed | Surgical Approach |
|---|---|---|
| Vaginal Hysterectomy | Uterus ± Cervix | Through the vagina |
| Total Hysterectomy | Uterus + Cervix | Vagina, laparoscopy, or abdomen |
| Radical Hysterectomy | Uterus + Cervix + nearby tissue | Usually abdominal or laparoscopic |
Sometimes, the surgeon also removes the ovaries and fallopian tubes. This is called hysterectomy with salpingo-oophorectomy. All of these organs are found in the pelvic area and play key roles in menstruation, hormone production, and fertility.
Reasons for Performing the Procedure
Surgeons most often perform vaginal removal of the uterus and cervix to treat various conditions affecting the female reproductive system. The procedure can address both non-cancerous and certain cancerous problems. Below are some main reasons for choosing this surgery:
- Uterine Fibroids: Non-cancerous growths in the uterus which may bring on heavy bleeding, anemia, pelvic pressure, pain during sex, and frequent urination.
- Endometriosis: When tissue similar to the uterine lining grows outside the uterus, often involving the ovaries or fallopian tubes, causing pain and other symptoms.
- Adenomyosis: A situation where the uterine lining grows deep into the muscle of the uterus, often causing an enlarged uterus with heavy, painful periods.
- Gynecologic Cancers or Precancer: Cancer and precancerous changes, especially in the uterus, cervix, or the lining of the uterus, may sometimes be managed by this type of surgery.
- Prolapsed Uterus: The uterus slips into the vagina because of weakened pelvic support, leading to urinary leakage, pelvic heaviness, or issues with bowel movements.
- Abnormal Uterine Bleeding: Regular, unusually heavy, or long-lasting menstrual periods that do not improve with medication or other treatments.
- Chronic Pelvic Pain: Ongoing pain tied to the uterus for which other treatments have not provided relief.
Surgeons may pair a vaginal procedure with removal of the ovaries (oophorectomy), the fallopian tubes (salpingectomy), or both (salpingo-oophorectomy), especially if there is a higher risk for ovarian cancer or other related health concerns.
Pregnancy and Fertility Considerations
After this operation, pregnancy is not possible. People who wish to have children in the future should talk with a provider about other choices before deciding to have this surgery.
When Medicines or Other Procedures Don’t Work
Doctors usually suggest vaginal uterus removal only after other options, like medication or less invasive procedures, have not provided enough relief.
| Condition | Possible companion procedure |
|---|---|
| Endometriosis | Removal of ovaries/fallopian tubes |
| Ovarian Cancer Risk | Oophorectomy, salpingo-oophorectomy |
| Chronic Infections | Salpingectomy, oophorectomy |
Treatments and procedure choices may change based on a person’s age, overall health, and desire for future fertility.
Possible Problems
Vaginal hysterectomy, like any major surgery, carries some risks. The most common issues include:
- Bleeding, which might need extra medical care.
- Infection at the surgical area.
- Blood clots that may form in the legs or lungs.
- Heavy discharge that lasts longer than expected.
- Abdominal pain after the operation.
- Complications such as harm to other organs or a reaction to anesthesia.
Close monitoring helps manage these problems if they arise.
How to Get Ready
People preparing for a vaginal hysterectomy can take several steps to help the process go smoothly. The first step is to ask questions and gather details about the surgery. Speaking with a healthcare professional or provider can help clear up any concerns.
Patients should follow all instructions about medications. It’s important to tell the healthcare provider about any medicines they take, including over-the-counter drugs, herbal supplements, and vitamins. The provider may advise whether to stop, adjust, or continue certain medicines before the operation.
Discussing anesthesia options with the medical team is another important step. Many people receive general anesthesia, which puts them to sleep. Others may get regional anesthesia, such as a spinal block or epidural, which numbs the lower part of the body while they stay awake.
Before surgery, patients should arrange for support at home. A friend or family member should be available to help with daily tasks during the first week after leaving the hospital.
What You Might Experience
During this type of surgery, the patient lies flat on their back, similar to how someone is positioned for a routine pelvic exam. Before starting, the medical team may insert a thin tube (urinary catheter) to empty the bladder and clean the area with a special solution to lower the chance of infection.
The surgeon makes a small cut inside the vagina to reach the uterus. Using long surgical tools, the surgeon clamps the blood vessels, gently separates the uterus from surrounding tissues, and removes it through the vaginal opening. Dissolvable stitches are used to close the cut and control bleeding.
If the uterus is larger, the surgeon may divide it into smaller pieces and remove it in sections. This technique is used only when it is safe and there is no concern about cancer.
| Tool / Method | Purpose |
|---|---|
| Urinary catheter | Keep bladder empty during surgery |
| Surgical instruments | Clamp blood vessels, separate tissues |
| Dissolvable stitches | Close incision, stop bleeding |
| Morcellation | Break up large uterus for easier removal |
Laparoscopic or Robotic Approaches
For some, minimally invasive surgeries might be used instead of traditional methods. Laparoscope-assisted or robotic procedures use small incisions in the belly. The surgeon places a thin camera (laparoscope) and other slim instruments through these cuts and removes the uterus through the vagina.
These methods may be suggested if someone has scar tissue from past surgeries or endometriosis. Laparoscopic or robotic surgeries can also be helpful for certain vaginal repairs.
Right After Surgery
After the procedure, the medical team moves the patient to a recovery area. Most patients stay there for 1-2 hours. Many go home the same day, but some might need to stay overnight.
The care team gives pain medicine to make the patient comfortable. They encourage moving around as soon as it is safe. For a few days or even weeks, light bleeding or mild discharge is normal. Using sanitary pads is recommended.
Physical Changes and Healing
Most people heal faster after this surgery compared with an abdominal hysterectomy. Recovery usually takes three to four weeks. Patients should avoid heavy lifting (anything more than 15 pounds) and vaginal intercourse for six weeks.
Short, gentle walks are safe and encouraged. If pain grows stronger, or if there is nausea, vomiting, or bleeding heavier than a typical period, the healthcare team should be contacted right away.
Recovery Timeline at a Glance
| Activity | When to Resume |
|---|---|
| Light activity/walking | As soon as possible |
| Heavy lifting | After 6 weeks |
| Vaginal intercourse | After 6 weeks |
Emotional Well-Being After Surgery
Many people feel better emotionally once heavy bleeding or pain is gone. Some feel relief, while others may feel sad or experience a sense of loss because they cannot have children anymore. Sex life may not change for most; however, those who had their ovaries removed might experience vaginal dryness or reduced sexual interest.
Others may find their sex life improves due to less pain. Feeling down or having trouble enjoying life can happen, too. Talking with professionals can help if feelings of sadness or grief continue.
Findings
After a hysterectomy, the patient will not have menstrual periods anymore, and pregnancy is not possible. If the surgeon removes the ovaries during the surgery, menopause starts right away, which can cause symptoms like vaginal dryness, hot flashes, and night sweats.
There are several medicine options, including hormone therapy, to manage these symptoms. If the ovaries stay in place, they continue to make hormones and eggs until the person naturally reaches menopause. Recovery may also include tiredness, light vaginal bleeding, and the need for rest. Most people get stronger each day during recovery.
