Vaginal hysterectomy

Published by Bupa’s Health Information Team, September 2011.

This factsheet is for women who are having a vaginal hysterectomy, or who would like information about it.

A vaginal hysterectomy is an operation to remove the womb (uterus) through the vagina.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About vaginal hysterectomy

A hysterectomy is a treatment option for a number of conditions that affect the reproductive system, including:

• irregular or heavy menstrual bleeding – but only if other treatments haven’t worked
• endometriosis – a condition in which cells that usually line the womb grow outside the womb in other parts of the body
• prolapse – where the womb drops into the vagina
• cancer of the uterus, ovary or cervix (neck of the womb)
  
• fibroids (non-cancerous growths of the womb) that are very enlarged

A vaginal hysterectomy is where your womb is removed through your vagina.

Your ovaries are usually left in place because they produce oestrogen – if you have these removed, you will immediately go through the menopause.

After a hysterectomy, you will no longer have periods or be able to become pregnant. It’s important to discuss this with your gynaecologist (a doctor who specialises in women’s reproductive health) before the operation.

What are the alternatives to a vaginal hysterectomy?

A hysterectomy will usually only be recommended if other treatments, such as medicines or other surgery, are unsuitable or haven't worked.

Alternative surgical techniques to a vaginal hysterectomy are:

• vaginal repair operation not requiring hysterectomy
• abdominal hysterectomy, where the procedure is done through a cut in your abdomen (tummy)
• keyhole hysterectomy, where the procedure is done through small cuts in your abdomen and may be used to assist with vaginal hysterectomy

Ask your surgeon for advice about which surgery will be most suitable for you.

Preparing for a vaginal hysterectomy

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop, as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

The procedure is usually done under a general anaesthetic, so you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form. This process is usually done in the clinic prior to your admission.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of an anticlotting medicine called heparin as well as wearing compression stockings. Usually, you will be given antibiotics before the surgery.

What happens during a vaginal hysterectomy?

The operation usually takes about an hour.

Your surgeon will pass specially designed instruments through your vagina to remove your cervix and womb. He or she will then close the top of your vagina using dissolvable stitches and may place a tampon-shaped dressing (sometimes known as a pack) in your vagina.

You won’t have any visible cuts or scars.

What to expect afterwards

You may need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

It's usual to feel some initial discomfort when you pass urine, but you should let your nurse or surgeon know if you are finding it difficult to pass urine or are having problems with bladder control. This should be temporary, but if it continues you may need to use a catheter for about two to three weeks.

A nurse will usually check that your bladder is emptying properly after you’ve had the catheter removed. This is done with a bladder scan and uses a small ultrasound device to check how much urine is left in your bladder.

You may also find that you don't have any bowel movements for a few days after the procedure and this can cause you to have painful wind. Taking laxatives will help you to avoid straining and stop you getting constipation.

Your nurse will give you advice about getting out of bed, bathing and your diet. You may see a physiotherapist who can explain some exercises that you can do to help your recovery.

The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about two weeks.

You will need to stay in hospital for one to two days. Before you go home, your nurse will advise you about your initial few days at homes and may arrange a date for a follow-up appointment.

Recovering from a vaginal hysterectomy

It usually takes about four to six weeks to make a full recovery from a vaginal hysterectomy, but this varies between individuals. Most women are able to return to work between two and six weeks after the operation but it will depend on the type of job you have and how physical it is.

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards.

You will need to take it easy for a few days. If a physiotherapist has given you exercises to do, try to continue with these. You can lift light items, such as a kettle, but don't lift anything heavy. If you live on your own, it may be helpful to ask a friend or relative to stay with you for the first few days while you recover.

You should be able to drive two to four weeks after the operation but if you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice. If you need to travel, consider how you feel and if you will be comfortable. Also bear in mind access to medical facilities if you need to go abroad. Discuss your plans with your surgeon or GP.

It's normal to have some bleeding from your vagina for about one to two weeks after the procedure. Use sanitary towels rather than tampons to help reduce the risk of infection. The bleeding may be heavier at around seven to 10 days after surgery. If you have any concerns or you have a vaginal discharge that’s bright red, heavy or smells unpleasant, contact your GP as you may have an infection.

You will need to wait around six weeks before having sex to allow your wound to heal.

What are the risks?

As with every procedure, there are some risks associated with a vaginal hysterectomy. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of a vaginal hysterectomy include:

• pain, swelling and bruising
• blood-stained vaginal discharge
• feeling emotional

If your ovaries have been removed during the procedure, you will have menopausal symptoms such as hot flushes and vaginal dryness.

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of a vaginal hysterectomy include:

• an infection, such as a urinary tract infection or an abscess in your pelvis
• blood loss – you may need further treatment, such as a transfusion or, rarely, a second operation to stop the bleeding
• damage to other organs and tissues in your abdomen, particularly your bladder and ureters (tubes that carry urine from your kidneys to your bladder) – this can cause incontinence or a frequent need to urinate
• damage to your bowel
• ovarian failure – there is a chance your ovaries won’t function properly because they receive some of their blood supply through the uterus, which is removed during the operation
• problems at the top of your vagina where the cervix is removed, such as slow wound healing in the short term or prolapse in later years

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.