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Vaginal hysterectomy

Key points

  • A vaginal hysterectomy is surgery to remove your womb (uterus) through your vagina.
  • There are different reasons why you may have a vaginal hysterectomy but it’s most commonly done to treat a pelvic prolapse.
  • You will stop having periods after a hysterectomy and you won’t be able to get pregnant.
  • The length of time it takes to recover from a vaginal hysterectomy varies for all women, and may take a couple of months.

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

You will meet the gynaecologist (a doctor who specialises in women’s reproductive health) 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 female reproductive system, these may include the following.

  • Pelvic organ prolapsed. This is when your womb, rectum or bladder drops out of position into your vagina.
  • Irregular or heavy menstrual bleeding, but only if other treatments haven’t worked.
  • Fibroids (non-cancerous growths of muscle and fibrous tissue in your womb) that are painful, cause bleeding or are very enlarged.
  • Cancer of your womb.
  • Endometriosis. A condition in which cells that usually line your womb grow elsewhere in your abdomen.
  • Adenomyosis. This is a benign condition in which cells that usually line your womb grow in the womb muscle causing painful, heavy periods.

A vaginal hysterectomy involves removing your womb through your vagina. You may or may not also have your ovaries removed, depending on why you’re having a hysterectomy. Your ovaries produce oestrogen so if you have them removed, you will immediately go through the menopause. There is some evidence to show that having your fallopian tubes removed during a hysterectomy may reduce your risk of ovarian cancer, even if your ovaries aren’t removed.

After a hysterectomy, you will no longer have periods or be able to become pregnant. It’s important to discuss this with your gynaecologist before the operation.

Depending on what type of hysterectomy you have, you may or may not need to continue having regular smear tests for cervical screening.

Illustration showing the location of the womb and surrounding structures

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 for you. For example, if your gynaecologist thinks that you have a pelvic prolapse that isn’t very severe, you may not need surgery and will be referred to a physiotherapist. Treatment may involve exercises to strengthen your pelvic floor muscles. See our frequently asked questions for more information.

Alternative surgical techniques to a vaginal hysterectomy are as follows.

  • Keyhole hysterectomy. This procedure is done through small cuts in your abdomen. This may be used to help with vaginal hysterectomy.
  • Vaginal repair surgery that doesn't involve removing your womb.
  • Abdominal hysterectomy. This involves removing your womb through a cut in your abdomen (tummy).

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

Preparing for a vaginal hysterectomy

Your gynaecologist 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 may be done under a general anaesthetic, in which case 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 gynaecologist’s advice. You may also be able to have the procedure done under epidural anaesthesia. This injection is given into the space that surrounds your spinal cord and completely blocks pain from your waist downward.

Your gynaecologist 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 one to one and a half hours.

Your gynaecologist will make a cut in the top of your vagina and 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 (known as a pack) in your vagina.

What to expect afterwards

You will 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.

You will have a catheter after your operation – the length of time you need to keep this in will vary depending on what type of surgery you had. You may also need to keep it in for a few days if you have trouble passing urine after this time.

You may 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 and bloating. You may be offered a mild laxative to help ease this. Having a gentle walk around will also help once you feel able to get out of bed.

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. This will include exercises to strengthen your pelvic floor muscles.

The amount of time your dissolvable stitches will take to disappear depends on the type you have. It may be anything from a few days to a few weeks. The cut is done through your vagina so you won’t have any visible cuts or scars, unless you had keyhole surgery to help with the hysterectomy.

You will need to stay in hospital for one to two days. Before you go home, your nurse will give you advice about managing at home over the first few days and may arrange a date for a follow-up appointment.

Recovering from a vaginal hysterectomy

The length of time it takes to recover after a vaginal hysterectomy will be different for every woman, and it can take up to a couple of months to get back to full health. 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.

You may have some pain in your lower abdomen after the procedure. How long this lasts varies for everyone but you should notice an improvement after a week or maybe sooner. 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 and you’re likely to feel more tired than usual. If a physiotherapist has given you exercises to do, try to do these regularly. You can lift light items, such as a kettle, but don't lift anything heavy for about four weeks. 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.

Try to start some gentle exercise such as walking once you’re back at home and steadily increase how much activity you do. You can go swimming about two to three weeks after your hysterectomy as long as you don’t have any vaginal bleeding or discharge. The only reason you will gain weight after a hysterectomy is if you eat too much and don’t do enough physical activity.

You will probably 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 gynaecologist's advice. It’s important that you can comfortably wear a seatbelt and do an emergency stop. 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.

It's usual 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. How much blood there is and how long it lasts will be different for everyone. If you have any concerns or you have a vaginal discharge that is bright red, heavy or smells unpleasant, contact your gynaecologist or hospital as you may have an infection.

You will need to wait until your scar has healed before you start to have sex again. This will take between four and six weeks. How comfortable you feel about sex after a hysterectomy and when you feel ready will vary for every woman. You may feel more sexual pleasure because the problem that meant you had to have a hysterectomy has now gone. However, some women feel a sense of loss after a hysterectomy and may find their libido (sex drive) is reduced.

It’s common to feel emotional or depressed after a hysterectomy and this may take some time to pass. You may find it helps to talk to your partner, a friend or family member about how you’re feeling, and you may also wish to talk to a counsellor.

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 gynaecologist 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:

  • abdominal pain
  • vaginal bleeding

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 can include the following.

  • Blood loss.
  • Damage to other organs and tissues in your abdomen, particularly your bowel, bladder or ureters (tubes that carry urine from your kidneys to your bladder). This can cause incontinence or a need to urinate frequently.
  • A wound or urinary infection. You may need antibiotics to treat this.
  • Premature ovarian failure. There is a risk that if your ovaries aren’t removed, they may not work properly because they receive some of their blood supply through your womb.
  • Prolapse of the vagina where it was cut.
  • Nerve damage.

 

Reviewed by Polly Kerr, Bupa Health Information Team, August 2013.

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

For sources and links to further information, see Resources.


  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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