What is a Vaginal Hysterectomy?
Your doctor has recommended a procedure, vaginal hysterectomy, to remove your uterus.
This video is intended to help you understand this surgical treatment option.
To start let’s review some information about your body.
The uterus is in the lowest part of the abdomen, between the hips.
It is where a baby grows in a pregnant woman. The cervix is the bottom of the uterus and connects it to the vagina. The cervix is also called the neck of the uterus.
The ovaries and fallopian tubes attach to the top of the uterus. These structures are all are part of the female reproductive system, and are needed for a woman to naturally make a baby.
To better understand some of the risks of this surgery, notice that the bladder is directly in front of the cervix and vagina.
Looking at a side view of the body you can see that the uterus is behind the bladder and at the top of the vagina.
Ureters, are also next to the uterus. They are delicate tubes that fill the bladder with urine.
The rectum is behind the vagina, it is the lowest part of your bowel.
A supracervical or partial hysterectomy is surgery to remove the uterus above the cervix.
A total hysterectomy removes the whole uterus and cervix. After, the ovaries and tubes are held in place by their own ligaments.
Removing an ovary is called an oophorectomy, and removing a tube is called a salpingectomy.
One or both ovaries and tubes can be removed during a hysterectomy procedure.
About 1 of 3 women have had a hysterectomy by age 60.
This number is dropping because of conservative treatment options available today.
Most conditions that can lead to a hysterectomy are not cancer, they include,
•painful and/or heavy vaginal bleeding that is disrupting daily life
•uterine fibroids, benign tumors of the uterus and
•endometriosis, a serious cause of pelvic pain in women.
Non-invasive treatment options that may be recommended for some problems are
•watch and wait, also called expectant management,
•changes to diet and exercise to improve overall health
•and medications to control pain, or to stop or lighten periods.
Less invasive procedures than a hysterectomy may be considered for some problems and include
•endometrial ablation to treat heavy periods, a procedure that destroys the lining of the uterus
•uterine artery embolization (say em-bow-liz-A-shun), used to shrink large fibroids
•myomectomy to cut out fibroids and save the uterus, and
•laparoscopy to look, find and treat the reason for the pain.
Removing one or both of your ovaries and tubes can be planned as part of your procedure if you have endometriosis, a known cyst or mass on your ovary, or to lower your future risk of ovarian cancer.
Unplanned removal of a tube and ovary may be necessary during surgery because
•an ovary has an unexpected cyst or mass
•there are adhesions making it stuck to the uterus
•or there is bleeding that makes it impossible to save.
After a hysterectomy
•pregnancy is not possible
•you may have less estrogen, even if you keep your ovaries
•you will be in menopause if the ovaries are removed.
There are three types of minimally invasive hysterectomy procedures:
vaginal,...laparoscopic,.... and laparoscopic assisted vaginal hysterectomy also known as LAVH ( say letters L-A-V-H).
All of these options use smaller incisions, not a classic large incision.
A vaginal hysterectomy removes the uterus and cervix through an incision in the vagina.
There are no skin incisions so recovery can be faster. There tends to be less bleeding and fewer complications than with other procedures to remove the uterus.
Sometimes a larger, open incision in your abdomen is needed for unexpected bleeding or other findings.
If this happens your hospital stay and recovery will be longer than originally planned.
Each way of removing the uterus has its own risks and benefits.
With all minimally invasive surgery the recovery is typically shorter with less pain than if an open surgery is needed.
Now let’s talk about what happens during a Vaginal Hysterectomy.
General anesthesia and medications to make you asleep and pain-free during your procedure are given.
You are positioned carefully and prepared for the start of surgery.
A thin soft tube, called a Foley is placed in your bladder.
Tools called retractors are used to see the cervix. The cervix is held with a grasper and a circle cut, also called an incision, is made where it connects to the vagina.
The cervix is pulled toward the surgeon and step... by step... the blood vessels and attachments are sealed and then cut.
The uterus is then delivered through the vagina…..
The tubes and ovaries are delivered with the uterus if removing them was part of your procedure.
The surgeon checks for bleeding then closes the top of the vagina with stitches.
These dissolve in about 7-8 weeks, which means they don’t need to be taken out.
You are then awakened from anesthesia and taken to the recovery room.
After surgery “speak-up” and tell your care-team if you have more than expected pain or problems.
You may be able to go home the same day, but many patients stay overnight.
You may have a foley, a soft tube to drain your urine, this is usually taken out the morning after surgery.
You will have some pain and soreness.
At home, follow your doctor’s instructions for the best results.
The first week rest as much as possible and do not lift anything heavy. Use Tylenol, Motrin, Aleve or other pain medication as recommended by your physician.
You will be given a prescription for narcotic pain medicine for the first few days. This type of medication can cause nausea and constipation.
Constipation is a very common side effect of anesthesia and pain medication.
To keep your stool soft drink plenty of fluids throughout the day.
If you are having a problem with constipation and cannot have a bowel movement your surgeon may recommend a stool softener or Miralax, 1 capful mixed in a cup of water once a day.
The first 6-8 weeks after the procedure do shower to stay clean but do not swim or use a hot tub. Do not have sex, exercise or do any heavy lifting until your surgeon tells you that it is safe to do so.
There is a very small risk of serious problems. This can include internal bleeding, infection, blood clot or problems from injury to the bladder, bowel or ureter.
Call your doctor if you: cannot urinate or have a bowel movement,...
if you have a fever, worsening pain, unusual leg swelling or bright red bleeding that does not stop.
Hospital admission, medication or surgery may be needed to fix some problems.
To help your body heal eat healthy foods. Avoid junk food, sugary drinks and snacks. If you are a smoker, don’t smoke. And if you have diabetes, keep your blood sugar under control. Both smoking and high blood sugar slow healing.
To avoid cancellation or complications from anesthesia or your procedure,
your Job as the Patient is to
•not eat, drink or chew gum after midnight, the night before the procedure unless you are given different instructions
•take medications you were told to on the morning of the procedure with a sip of water
•stop your aspirin or blood thinners before surgery as you are instructed
•and arrive on time.
You should be ready to verify or confirm your list of medical problems and surgeries, all of your medications, including vitamins and supplements, your current smoking, alcohol and drug use and all allergies, especially to medications, latex and tape.
The procedure recommended for you depends on your surgeon’s experience and training, and your individual situation. No one type of hysterectomy is considered the best.
All surgery and anesthesia have a small but possible risk of serious injury, even some problems very rarely leading to death.
It is your job to speak up and ask your surgeon if you still have questions about why this surgery is being recommended for you, the risks and alternatives.
