Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina. Vaginal hysterectomy involves a shorter time in the hospital, lower cost and faster recovery than does the most common alternative, abdominal hysterectomy. However, if your uterus is enlarged, vaginal hysterectomy may not be possible.
Any type of hysterectomy usually includes removal of the cervix as well as the uterus, often along with one or both ovaries and fallopian tubes (salpingo-oophorectomy). All these organs are located in your pelvis and are part of your reproductive system.
Female reproductive system
The ovaries, fallopian tubes, uterus, cervix and vagina make up the female reproductive system. ...
Why it's done
Vaginal hysterectomy treats many different gynecologic problems, including:
For most of these conditions — with the possible exception of cancer — hysterectomy is just one of several treatment options. You may not even need to consider hysterectomy unless medications and less invasive gynecologic procedures have failed.
You cannot get pregnant after you've had a hysterectomy. If you're less than completely sure you're ready to give up your fertility, explore other treatments.
Although vaginal hysterectomy is generally safe, any surgery has risks. These include blood loss or clots, infection, damage to surrounding organs or reaction to anesthesia. Surgical risks are higher in women who are obese or who have diabetes or high blood pressure.
The location of the uterus in the pelvis means there is a risk of injury to other pelvic and abdominal organs during vaginal hysterectomy, including the bladder, ureters or bowel. The risk of organ injury is greater if large fibroids, severe endometriosis or cancer obstructs the surgeon's view or otherwise makes the surgery difficult.
How you prepare
What you can expect
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.
During vaginal hysterectomy
Your legs will be placed in stirrups, similar to the position you're in for a Pap smear. Sometimes, a urinary catheter is passed through your urethra to empty your bladder. Your vagina is cleansed with a sterile solution prior to the surgery.
To perform the hysterectomy, the surgeon makes an incision inside your vagina to access the uterus. Using long instruments, the surgeon clamps the uterine blood vessels and separates your uterus from the connective tissue, ovaries and fallopian tubes. The uterus is removed through the vaginal opening, and absorbable stitches are used to control any bleeding inside the pelvis. Except in cases of suspected uterine cancer, the surgeon may cut an enlarged uterus into smaller pieces and remove it in sections (morcellation).
In some cases, your doctor may recommend a laparoscopic-assisted vaginal hysterectomy (LAVH) or robotic hysterectomy. Both procedures allow your doctor to remove the uterus vaginally but also make it possible for your doctor to view your pelvic organs through a laparoscope. Most of the procedure is performed through small abdominal incisions with the use of long, thin surgical instruments inserted through the incisions. The uterus is then removed through an incision made in your vagina. Your doctor might recommend LAVH or robotic hysterectomy if he or she suspects you may have scar tissue (adhesions) on your pelvic organs from prior surgeries or from endometriosis.
There is always a risk that severe endometriosis or pelvic adhesions may force your surgeon to switch from a vaginal to abdominal hysterectomy during the surgery. Your doctor should discuss this possibility with you before the surgery begins.
After the vaginal hysterectomy
It's normal to have bloody vaginal discharge for several days to weeks after a hysterectomy, so you'll need to wear sanitary pads.
If you were still having periods before the surgery and your ovaries were not removed, they will continue producing hormones and eggs until you reach menopause. If your ovaries and fallopian tubes were removed with your uterus, you'll begin menopause immediately after surgery and may experience symptoms such as vaginal dryness and hot flashes. Your doctor may prescribe medications to treat the symptoms.
Recovery after a vaginal hysterectomy is shorter and less painful than after an abdominal hysterectomy. Most women feel better within a week and make a full recovery in one to two weeks. Even if you feel like you're back to normal, don't lift anything over 20 pounds or have vaginal intercourse until six weeks after surgery. Contact your doctor if your pain worsens instead of letting up or if you develop nausea, vomiting or bleeding heavier than a menstrual period.
Some women feel a sense of loss and grief after hysterectomy, which is normal. Others may experience depression related to losing the ability to become pregnant. If sadness or negative feelings begin to interfere with your enjoyment of everyday life, talk to your doctor.
Last Updated: 2010-06-22
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