Understanding Hysterectomy: A Complete Guide

A hysterectomy is a surgery whereby part or all of the uterus and ligaments that hold it in place are removed, possibly along with the cervix, lymph nodes, fallopian tubes, ovaries, and one or two inches of the upper vagina.

Which parts are taken or left will depend on what’s wrong and what tissue is damaged or diseased. Newer surgical techniques leave fewer visible scars; however, some scarring should be expected.

Many women who finally undergo a hysterectomy are very happy with the procedure because they no longer suffer from pain, discomfort, or other uncomfortable symptoms.

The relief from no longer experiencing these symptoms may, however, come with many other feelings relating to the loss of parts of one’s body, particularly those parts which may be deeply involved in our sense of identity.

A hysterectomy is a reasonably straightforward surgery; however, as with any surgery, there are risks involved. Make sure you have a very experienced surgeon who uses the most up-to-date techniques and equipment.

If you have a hysterectomy coming up, prepare yourself with the tips in our hysterectomy survival kit.

There are three types of hysterectomy:

Supracervical or partial hysterectomy – that is, keeping everything except the uterus itself
Total hysterectomy – removing the uterus and cervix, keeping the ovaries
Total hysterectomy with removal of one or both of the ovaries (oophorectomy)

Reasons for a hysterectomy

Cervical cancer, uterine cancer, ovarian cancer
Uterine fibroids
Severe endometriosis
Uterine prolapse
Adenomyosis
Heavy menstrual periods
Discomfort or mysterious pelvic issues that do not respond to treatments

The radical or total hysterectomy surgery

The surgeon will remove the cervix, which is attached to the top of the vagina, and stitch up the hole left at the top of the vagina. This closes off the vagina completely from the upper reproductive organs and, once they are removed, the pelvic cavity.

Ovary removal options

Ovaries may remain or be removed, which matters a great deal since the ovaries produce oestrogen. Oestrogen keeps vaginal and vulvar cells plump and juicy, so without ovaries, we lack oestrogen and can develop atrophic vaginitis or other genitourinary signs of menopause (GSM).

Atrophy of vulvovaginal tissue can mean a dry, irritated, easily-damaged vulva and/or vagina. When under the age of 40, at least one ovary may be kept if possible to avoid premature menopause. New research shows that those with hysterectomies who retained one or both ovaries still experienced menopause earlier than their counterparts by about four years¹.

In menopause, ovaries are no longer needed and naturally atrophy.

Fertility after a hysterectomy

During a hysterectomy, the uterus is removed, so there are no more menstrual periods and no ability to carry a baby, creating infertility. If at least one ovary remains, eggs can be harvested and used in a surrogate.

Options will be discussed with you by your doctor, with the general idea that you will keep your normal ovarian function so long as it is safe and beneficial for you to do so. Retaining ovarian function is likely to be the goal.

Bladder function after a hysterectomy

Due to nerve interruptions, bladder function can be affected immediately after surgery during recovery. A urinary catheter may remain for a few days post-surgery.

Long-term damage can occur during surgery, so if normal bladder function isn’t restored after a few weeks, speak to your doctor.

Sex and hysterectomies

Hysterectomies are generally sparing of your sexual pleasure, though sometimes interruptions can occur to nerves that supply the clitoris with sensation.

The vagina is shortened, so pleasurable cervical sensations disappear, but sexual pleasure in the remaining vaginal tissue and clitoris tends to remain as before.

Physical comfort during sex

Cancer, endometriosis or fibroids can be the cause of discomfort and bleeding during sex, so having the uterus removed can actually free many women up from annoying, painful, or debilitating symptoms that were interfering with their sex lives.

Once the surgery is complete, the shortness of the vagina is usually work-around-able, with a little bit of adjusting. Dilators can help lengthen the vagina.

Some techniques can help give the illusion of a longer vagina, including putting the thighs together during penetrative sex or the use of a hand gripped around a penis.

Orgasm after hysterectomy

A Danish study examined the sexual function of women who had undergone radical hysterectomies and those who hadn’t, with the following results:

One in 10 women who had a hysterectomy noticed problems with lubrication and pain during sex
Eight in 10 women reported little or no interest in sex
Compared with those who didn’t have the surgery, twice as many said they had problems reaching orgasm
One in five said they felt like their vaginas were too small
Most of those who had the surgery reported problems were gone six months post-surgery
After two years, nine out of 10 women reported they were having sex again
Then, the number of women who reported orgasming during sex was the same as those who hadn’t had the hysterectomy

Atrophic vaginitis after hysterectomy

A dry, irritated vagina due to low oestrogen can be remedied with oestrogen creams and other natural phytoestrogens or hormone therapy as provided by your healthcare professional. Fennel pessaries can improve vaginal dryness and function.

Atrophic vaginitis is solvable, though it may require regular sexual activity to keep the cells plump and juicy, alongside oestrogen cream. Generally, the sexual prognosis is very good for women who have undergone a hysterectomy.

When you feel psychologically (un)sexy

A lack of self-confidence after a major surgery like a hysterectomy can really put the brakes on sex, with some people feeling complicated without all or some of their reproductive organs.

Losing a sometimes important part of our identity can be difficult to overcome; therefore, it can be useful to focus on what you do have (including your life), not what you don’t.

But, take your time and grieve. You are dealing with a loss. Find a counsellor and seek out support groups – you are not alone.

Are there natural alternatives to a hysterectomy?

A hysterectomy is a surgical solution to many female reproductive health problems. It is the most final of procedures since you can’t get the removed tissue back.

Natural medicine can support healing; however, there is no equivalent natural medicine option for a hysterectomy. The process you go through with your health prior to undergoing a hysterectomy may include various types of practitioners, with many educated, qualified opinions advisable (for non-cancer issues that may be unpleasant but will not kill you).

Do not try to treat cancer with natural medicine. If you are having issues that may be hormonal in nature and not specifically an issue with your uterine tissue per se, there are many options that a naturopath, herbalist, acupuncturist, osteopath or pelvic physiotherapist may be able to help you to correct.

Alternative therapies may provide some pain relief and help manage uncomfortable symptoms, and in some cases, entirely remove the need for a hysterectomy. This is particularly true when it comes to heavy bleeding and hormonal conditions.

Cancers and other serious diseases in reproductive organs may mean the only reasonable option is to remove the tissue. Other treatments may be required, such as chemotherapy and radiation therapy, and you can use as many natural and support therapies as you need.

Make sure that all your practitioners are aware of what you are being treated with so they can keep you safe. Not all treatments are safe because they are ‘natural’.

References²

1.
Moorman PG, Myers ER, Schildkraut JM, Iversen ES, Wang F, Warren N. Effect of Hysterectomy With Ovarian Preservation on Ovarian Function. Obstetrics & Gynecology. Published online December 2011:1271-1279. doi:10.1097/aog.0b013e318236fd12
2.
Kaiser R, Kusche M, W�rz H. Hormone levels in women after hysterectomy. Arch Gynecol Obstet. Published online 1989:169-173. doi:10.1007/bf00931295