Vaginal hysterectomy

About vaginal hysterectomy

A hysterectomy is a treatment option for a number of conditions that affect the reproductive system, including:

  • irregular or heavy menstrual bleeding – but only if other treatments haven’t worked
  • endometriosis – a condition in which cells that usually line the womb grow outside the womb in other parts of the body
  • prolapse – where the womb drops into the vagina
  • cancer of the uterus, ovary or cervix (neck of the womb)
  • fibroids (non-cancerous growths of the womb) that are very enlarged

A vaginal hysterectomy is where your womb is removed through your vagina.

Your ovaries are usually left in place because they produce oestrogen – if you have these removed, you will immediately go through the menopause.

After a hysterectomy, you will no longer have periods or be able to become pregnant. It’s important to discuss this with your gynaecologist (a doctor who specialises in women’s reproductive health) before the operation.

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.

Alternative surgical techniques to a vaginal hysterectomy are:

  • vaginal repair operation not requiring hysterectomy
  • abdominal hysterectomy, where the procedure is done through a cut in your abdomen (tummy)
  • keyhole hysterectomy, where the procedure is done through small cuts in your abdomen and may be used to assist with vaginal hysterectomy

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

Preparing for a vaginal hysterectomy

Your surgeon 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 is usually done under a general anaesthetic, so 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 surgeon’s advice.

Your surgeon 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 an hour.

Your surgeon will pass specially designed instruments through your vagina to 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 (sometimes known as a pack) in your vagina.

You won’t have any visible cuts or scars.

What to expect afterwards

You may 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.

It's usual to feel some initial discomfort when you pass urine, but you should let your nurse or surgeon know if you are finding it difficult to pass urine or are having problems with bladder control. This should be temporary, but if it continues you may need to use a catheter for about two to three weeks.

A nurse will usually check that your bladder is emptying properly after you’ve had the catheter removed. This is done with a bladder scan and uses a small ultrasound device to check how much urine is left in your bladder.

You may also 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. Taking laxatives will help you to avoid straining and stop you getting constipation.

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.

The amount of time your dissolvable stitches will take to disappear depends on the type of stitches you have. However, for this procedure, they should usually disappear in about two weeks.

You will need to stay in hospital for one to two days. Before you go home, your nurse will advise you about your initial few days at homes and may arrange a date for a follow-up appointment.

Recovering from a vaginal hysterectomy

It usually takes about four to six weeks to make a full recovery from a vaginal hysterectomy, but this varies between individuals. 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.

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. If a physiotherapist has given you exercises to do, try to continue with these. You can lift light items, such as a kettle, but don't lift anything heavy. 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.

You should 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 surgeon's advice. 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. Discuss your plans with your surgeon or GP.

It's normal 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. The bleeding may be heavier at around seven to 10 days after surgery. If you have any concerns or you have a vaginal discharge that’s bright red, heavy or smells unpleasant, contact your GP as you may have an infection.

You will need to wait around six weeks before having sex to allow your wound to heal.

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 surgeon 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:

  • pain, swelling and bruising
  • blood-stained vaginal discharge
  • feeling emotional

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 include:

  • an infection, such as a urinary tract infection or an abscess in your pelvis
  • blood loss – you may need further treatment, such as a transfusion or, rarely, a second operation to stop the bleeding
  • damage to other organs and tissues in your abdomen, particularly your bladder and ureters (tubes that carry urine from your kidneys to your bladder) – this can cause incontinence or a frequent need to urinate
  • damage to your bowel
  • ovarian failure – there is a chance your ovaries won’t function properly because they receive some of their blood supply through the uterus, which is removed during the operation
  • problems at the top of your vagina where the cervix is removed, such as slow wound healing in the short term or prolapse in later years

Will I need to take hormone replacement therapy (HRT) after my hysterectomy?

Answer

If your ovaries are removed, you may consider HRT if you haven't already been through the menopause.

Explanation

HRT replaces the hormones that are usually produced naturally by your ovaries.

If you have your ovaries removed in your hysterectomy operation and you haven't been through the menopause yet, you may be advised to start HRT soon after your operation. This is because as well as producing eggs, your ovaries also produce hormones including oestrogen. Without ovaries to produce these hormones your body won't have the oestrogen it needs and you will enter the menopause early. The menopause causes symptoms such as hot flushes and night sweats. These symptoms can be treated with HRT, which replaces the oestrogen that your body has stopped making.

HRT is available as an implant, skin patches, a skin gel or tablets. You may need to try different doses and forms of HRT before you find the one that suits you best.

HRT may cause some side-effects. These include tender breasts, headaches, nausea, bloating and fluid retention. The side-effects usually decrease over time and can often be relieved by lowering your dose of HRT.

If you have previously had breast cancer, heart disease, stroke or blood clots, HRT may not be suitable for you. Make sure that your GP or surgeon knows if you have had any of these conditions in the past. This will help both of you to decide whether HRT is suitable for you.

If you need more information about having HRT after a hysterectomy, speak to your surgeon or GP.

Are there any advantages to having a vaginal hysterectomy rather than an abdominal hysterectomy?

Answer

Yes, there are some advantages to having a vaginal hysterectomy rather than an abdominal hysterectomy. The main advantage is a faster recovery. However, vaginal hysterectomy isn't appropriate for all conditions. Your surgeon will discuss the advantages and disadvantages of each procedure and which will be most suitable for you.

Explanation

A hysterectomy can either be done through your vagina (vaginal hysterectomy) or through a cut in your lower abdomen (abdominal hysterectomy).

If you have a vaginal hysterectomy, your recovery will be faster than it would be following an abdominal hysterectomy. This will mean a shorter stay in hospital and you may be able to return to work sooner. Another advantage of this type of hysterectomy is that it doesn't leave a visible scar.

A vaginal hysterectomy may also have fewer complications than an abdominal hysterectomy, but it may not be suitable if you have large fibroids, endometriosis or if you have suspected ovarian cancer.

I’ve just had a vaginal hysterectomy and have heard pelvic floor exercises will help me recover - what do these involve?

Answer

You may see a physiotherapist after a vaginal hysterectomy who will explain some pelvic floor exercises that you can do to help your recovery. It’s important for you to get these muscles working properly after your operation.

Explanation

Pelvic floor muscles span the base of your pelvis. They help keep your pelvic organs in the correct position and help you control your bladder and bowel function, and prevent incontinence. They also help to improve sexual pleasure.

You can exercise your pelvic floor muscles by tightening them and then relaxing. Start with what is comfortable for you – for example by tightening them for a second – and then gradually increase the number of squeezes you do and for how long (aim to get to about 10 seconds). Try to get into a routine of doing 10 long squeezes for up to 10 seconds each and follow these with 10 short squeezes. Do these exercises at least three times a day and try to breathe normally when you do them.

To begin with, you may find it more comfortable to do the exercises when you lie down or sit, but as your muscles improve, try to do them standing up. It’s important to tighten your pelvic-floor muscles before you do anything that may put them under pressure (wherever possible), such as lifting, coughing or sneezing.

Try to make these exercises part of your daily routine to help keep your muscles strong. You might find it helpful to always do them at a certain point in your day, such as when you brush your teeth or when watching television, for example.

If you have any difficulty doing the exercises or have any questions, ask your physiotherapist or GP for advice.