Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina.
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.
Vaginal hysterectomy involves a shorter time in the hospital, lower cost and faster recovery than an abdominal hysterectomy, which requires an incision in your lower abdomen. However, if your uterus is enlarged, vaginal hysterectomy may not be possible and your doctor will talk to you about other surgical options, such as an abdominal hysterectomy.
Hysterectomy often includes removal of the cervix as well as the uterus. When the surgeon also removes one or both ovaries and fallopian tubes, it's called a total hysterectomy with salpingo-oophorectomy (sal-ping-go-o-of-uh-REK-tuh-me). All these organs are part of your reproductive system and are located in your pelvis.
Vaginal hysterectomy treats many different gynecologic problems, including:
- Fibroids :
Many hysterectomies are done to permanently treat fibroids — benign tumors in your uterus that can cause persistent bleeding, anemia, pelvic pain, pain during intercourse and bladder pressure.
If you have large fibroids, you may need an abdominal hysterectomy — surgery that removes your uterus through an incision in your lower abdomen.
- Endometriosis :
Endometriosis occurs when the tissue lining your uterus (endometrium) grows outside of the uterus, involving the ovaries, fallopian tubes or other organs.
Most women with endometriosis have an abdominal hysterectomy, but sometimes a vaginal hysterectomy is possible.
- Gynecologic cancer :
If you have cancer of the uterus, cervix, endometrium or ovaries, your doctor may recommend a hysterectomy to treat it.
Most of the time, an abdominal hysterectomy is done during treatment for ovarian cancer, but sometimes vaginal hysterectomy may be appropriate for women with cervical cancer or endometrial cancer.
- Uterine prolapse :
When pelvic supporting tissues and ligaments get stretched out or weak, the uterus can lower or sag into the vagina, causing urinary incontinence, pelvic pressure or difficulty with bowel movements. Removing the uterus with hysterectomy and repairing pelvic relaxation may relieve those symptoms.
- Abnormal vaginal bleeding :
When medication or a less invasive surgical procedure doesn't control irregular, heavy or very long periods, hysterectomy can solve the problem.
- Chronic pelvic pain :
If you have chronic pelvic pain clearly caused by a uterine condition, hysterectomy may help, but only as a last report.
Chronic pelvic pain can have several causes, so an accurate diagnosis of the cause is critical before having a hysterectomy for pelvic pain.
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 if your doctor recommends hormonal medications or other less invasive gynecologic procedures that are successful in managing your symptoms.
You cannot become pregnant after you've had a hysterectomy. If you're less than completely sure that you're ready to give up your fertility, explore other treatments.
Although vaginal hysterectomy is generally safe, any surgery has risks. Risks of vaginal hysterectomy include:
- Heavy bleeding
- Blood clots in the legs or lungs
- Damage to surrounding organs
- Adverse reaction to anesthesia
Surgical risks are higher in women who are obese or who have high blood pressure.
There is a risk of injury to other pelvic and abdominal organs during vaginal hysterectomy, including the bladder, ureters or bowel.
Severe endometriosis or scar tissue (pelvic adhesions) may force your surgeon to switch from a vaginal hysterectomy to abdominal hysterectomy during the surgery. Ask your surgeon about this possibility.
Before the surgery, get all the information you need to feel confident about it. Ask your doctor and surgeon questions. Learn about the procedure, including all the steps involved if it makes you feel more comfortable.
- Follow your doctor's instructions about medication:Find out whether you should change your usual medication routine in the days leading up to your hysterectomy.
Be sure to tell your doctor about any over-the-counter medications, dietary supplements or herbal preparations that you're taking.
- Discuss what type of anesthesia you'll have :You may prefer general anesthesia, which makes you unconscious during surgery, but regional anesthesia — also called spinal block or epidural block — may be an option.
If you're having a vaginal hysterectomy, regional anesthesia will block the sensation in the lower half of your body.
- Arrange for help :Although you're likely to recover sooner after a vaginal hysterectomy than after an abdominal one, it still takes time. Ask someone to help you out at home for the first week or so.