What is vaginal hysterectomy?
This is a surgical procedure to remove the uterus through the vagina. This procedure is performed through an incision made right above the vagina. The incision is small and leaves no visible scar. During a vaginal hysterectomy procedure, the surgeon detaches the uterus from the ovaries, the fallopian tubes, and the upper vagina and also separates the blood vessels and connective tissue supporting it. He then removes the uterus through the vagina. This is the least invasive of all the hysterectomy procedures. Depending on the patient’s condition, a vaginal hysterectomy can last anywhere between 60 - 90 minutes.
How is vaginal hysterectomy performed?
The following steps are involved in the vaginal hysterectomy procedure:
At the outset, general anesthesia is administered by an anesthetist to keep you free from pain during surgery.
Once the anesthesia takes effect, the surgeon makes an incision right above the vagina.
He reaches through the incision to cut and tie off the ligaments, blood vessels, and fallopian tubes connected to the uterus with two thin instruments.
Once the uterus is free, the surgeon removes it through the vagina.
Please Note:If the uterus is enlarged, the surgeon may cut it into smaller pieces and remove it in sections.
He then sutures the incision.
Am I eligible for a vaginal hysterectomy?
You are eligible for a vaginal hysterectomy if you suffer from:
Abnormal vaginal bleeding
Gynecologic cancer (cancer in the neck of the womb, or the womb)
Chronic pelvic pain
Precancerous or cancerous cells or tissue on the cervix.
Do not have adhesions from previous surgery
What risks will I face while undergoing the vaginal hysterectomy procedure?
The risks of vaginal hysterectomy include:
Blood clots in legs or lungs
Adverse reaction to anesthesia
Risk of injury to your urinary tract, bladder, ureter, bowels, rectum during surgery, which may require further surgical repair
Earlier onset of menopause even if the ovaries aren't removed
You may develop a hernia just above your vagina
Post the surgery you may face difficulty emptying your bladder
The risk of complications occurring in the bladder, bowel, ureter escalates if the patient has earlier undergone a cesarean section or pelvic surgery. These surgeries cause scar tissue which may make the surgery more difficult to accomplish.
What are the disadvantages of vaginal hysterectomy?
There are a few disadvantages of vaginal hysterectomy such as:
It is not the best option for patients who have not had children vaginally, because a vaginal delivery results in increased “room” in the vagina, which is needed to perform a vaginal hysterectomy.
Large uteri can be difficult to remove vaginally.
Patients with large ovarian masses may be difficult to treat with the vaginal approach.
It is not possible for a surgeon to see and treat other pelvic problems, such as endometriosis, scar tissue, ovarian masses, cancers, etc while performing a vaginal hysterectomy. It is also difficult for the surgeon to see the uterus and surrounding tissue in this surgery. This makes complications more common in vaginal hysterectomy.
The ability to assess for bleeding or other complications after a vaginal hysterectomy is highly constrained.
It is very difficult to remove the ovaries during a vaginal hysterectomy, so this approach may not be possible if the ovaries are involved.
What are the complications of vaginal hysterectomy?
The complications of vaginal hysterectomy include:
Heavy blood loss requiring blood transfusion
Blood clot in the lung (Any pelvic surgery increases the risk of developing blood clots in the large veins of the leg or lung. The risk is increased for approximately six weeks after surgery.)
Anesthesia problems (such as breathing or heart problems)
Need to change to abdominal incision during surgery
Wound pulling open
Hematoma or localized collection of blood outside blood vessels leading to swelling at the surgery site, which will need surgical drainage
What are the side effects of undergoing a vaginal hysterectomy?
Some side effects of vaginal hysterectomy include:
Formation of scar tissue in the pelvic area.
Earlier onset of menopause even if the ovaries aren't removed.
You’ll no longer have menstrual periods.
Occasional spotting or pink discharge for up to about 6 weeks after the surgery.
You will never be pregnant since your uterus will be removed.
Relief from the symptoms you suffered from prior to the surgery.
If your cervix remains in place, you're still at risk of cervical cancer, and therefore, will need regular Pap tests to screen for cervical cancer.
Some women may experience a better sex life after hysterectomy as their painful symptoms subside after the surgery. While, some others may experience a drop in testosterone levels and thus possible sexual dysfunction.
How will I benefit from undergoing a vaginal hysterectomy procedure?
There are quite a few benefits of vaginal hysterectomy such as:
The procedure enables the removal of small uterine fibroids
Very short hospital stay required compared to abdominal hysterectomy
Shorter recovery period for the patient compared to someone who undergoes abdominal hysterectomy
Less pain is experienced by patients who undergo vaginal hysterectomy compared to patients who undergo an abdominal hysterectomy.
This procedure is highly cost-effective
It is excellent for prolapse procedures to correct “drop down” of the uterus, vagina, bladder, and rectum.
It leaves no visible scar and is less painful.
What are my alternatives to vaginal hysterectomy?
The alternatives to vaginal hysterectomy include:
Using vaginal pessaries which are good for treating the symptoms of prolapse.
MRI-guided focused ultrasound (MRgFUS)
Uterine artery embolization (UAE)
What are the pre-procedure guidelines I should follow for a vaginal hysterectomy?
Preparation for a vaginal hysterectomy typically involves several steps:
Physical examination to determine overall health
Blood and urine tests
Complete medical history discussion with your surgeon
You will be advised to quit smoking, if you smoke, for at least 6 weeks prior to the surgery since smoking can cause problems during the operation and can also delay the healing process
You will be advised to not drink and eat anything at least 12 hours prior to the procedure.
Your doctor may prescribe an enema or a laxative to empty your bowels thoroughly before the surgery
The doctor may prescribe some medicines prior to the surgery, which can reduce the risk of heavy bleeding during the surgery
You need to inform the doctor about any over-the-counter medications, dietary supplements or herbal preparations that you're taking.
What are post-operative guidelines I need to follow after undergoing a vaginal hysterectomy procedure?
The post-operative guidelines for vaginal hysterectomy include:
Overnight stay at the hospital is required immediately after the hysterectomy procedure. In fact, after a vaginal hysterectomy procedure, a hospital stay from 2 to 5 days is generally required depending on your condition. You will be monitored for discomfort and given medications to prevent pain and infection.
Post the surgery you should avoid lifting heavy weights or any form of strenuous physical activity for at least upto 6 weeks.
You need to avoid tub baths for at least 6 weeks after the surgery.
You may have to take a liquid diet temporarily.
Depending on your health condition, the doctor will advise you to abstain from sexual intercourse for 6 to 8 weeks after the surgery.
You will need to use sanitary napkins since vaginal bleeding may occur after a hysterectomy procedure and last for a few weeks.
After 6 weeks depending on the rate of your recovery, the doctor may advise you to return to work, perform light chores and drive short distances.
After any surgery, constipation is a common problem due to the number of medicines and inactivity. Eating fruits and vegetables which are rich in fiber content and drinking lots of fluids may help you avoid constipation. And if that is not helpful or if constipation worsens the doctor may prescribe a stool softener or a laxative.
What is the recovery period after undergoing a vaginal hysterectomy procedure?
The recovery period of vaginal hysterectomy is 3 weeks – 6 weeks depending on overall health conditions.
Are the results of vaginal hysterectomy permanent?
There is no definite answer to this question, as the results of the surgery can vary from person to person. Some people may experience complete relief from their symptoms, while others may suffer from side-effects. It will be wise to discuss your complete medical history with the doctor and also get to know the risks involved for you personally, before taking a decision to undergo the procedure.
How do I know if the vaginal hysterectomy procedure I underwent is a success?
Here again, the results vary from person to person. Ideally, if you are free from the earlier painful and discomforting symptoms, then quite obviously, the procedure has been a success for you. If you experience side effects after the procedure for prolonged periods, then you may need to consult with your doctor once again to understand the situation and opt for further treatments.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.