In 2008, like around 500,000 other women in the U.S., I had a hysterectomy.
And just like probably every single one of those women did, I had a lot of questions: Is this the right decision? Will I regret it? Will I be able to handle the pain? What will the recovery be like?
I was still in my long season of avoiding sex. Even so, my biggest questions were about how this would affect my sex life. Specifically, I wondered if I would ever again experience an orgasm.
Because hysterectomy is the second-most common surgery for women (second only to caesarean sections), I thought it might be helpful to spend some time talking here about hysterectomy, recovery, and sex after a hysterectomy.
I’ve split this into three posts. Today’s post will give an overview of hysterectomy basics. I’ll cover what a hysterectomy actually is and how it is done.
Friday’s post will include some general recovery information and will address hormonal changes and the emotions that sometimes result from a hysterectomy. Next Tuesday, the post will be all about sex after a hysterectomy: both the early post-hysterectomy sexual experiences while you’re getting back into the swing of things and the long-term effects on your sex life.
Let’s get started!
The very first thing I want to say is that is you are facing a hysterectomy, do yourself a favor and visit HysterSisters.com. With over 450,000 members, the wealth of information and support is incomparable. You’ll find articles, videos, discussion forums, and more. While you won’t get medical advice in the discussion forums, what you will find is women ready to share their experiences with you to help you navigate the hysterectomy experience.
In the interest of full disclosure, I have done work for HysterSisters for quite a few years. I am not receiving anything in exchange for mentioning the site here. HysterSisters saved my sanity (and probably my family’s as well) as I prepared for my own hysterectomy experience. I am referring you to it because I know what an amazing resource it is.
My relationship with HysterSisters has helped me learn a great deal about hysterectomies. I’ve ended up reading a lot of medical resources. I consider myself fairly knowledgeable about hysterectomies. However, I am not a medical professional Everything I say here is my personal opinion and understanding and does not constitute medical advice. Please consult your own doctor for information and advice.
Two years before my hysterectomy, I had a small fibroid that was causing me intense pain. I was also experiencing an increase in heavy bleeding. My doctor recommended an ablation (a destruction of the uterine lining in order to minimize bleeding) and a myomectomy (a removal of the fibroid). Both these procedures were done vaginally. The ablation worked wonderfully for me. I had no more bleeding at all each month, and my fibroid pain disappeared.
A year later, I had a cancer scare. While it turned out to not be cancer, my doctor and I did begin to discuss the possibility of a hysterectomy. The following year I began to grow another fibroid. This time the pain was even more intense, causing me to nearly faint while driving, pushing a shopping cart, and even while teaching. Furthermore, the fibroid was a bit trickier for the doctor to access. Between the possibility of cancer and the recurrence of fibroids, I decided to have a hysterectomy.
Although going through two gynecological surgeries within two years was not fun, I’m glad I did it the way that it did. After my ablation and myomectomy, I had time to learn about a hysterectomy so when I was faced with one, I was able to make a fully informed decision. Most women do quite well with a hysterectomy, but some don’t. I wanted to be sure that if I ended up not doing so well, I wasn’t in a position to regret a decision made in haste and without accurate information.
It was a big decision. A hysterectomy is a major surgery, and recovery is not easy or speedy. I was afraid I would lose the ability to experience an orgasm.
I had a vaginal hysterectomy, meaning that the doctor removed my uterus through the vagina. I kept my ovaries.
I’ll say more about my recovery later, but I do want to say up front that I had a very good outcome from my surgery. My recovery was slow but with no complications. My sexual function did not suffer, and my sex life is far better than it was before.
Why a Hysterectomy?
Doctors recommend hysterectomy for a variety of conditions: uterine fibroids, gynecological cancer, heavy bleeding, uterine prolapse, endometriosis, and adenomyosis. Many of these conditions have alternative treatments that can be effective and far less invasive. Be sure you talk with your doctor about all your options. Get a second opinion. Make a decision based on what is best for you—regardless of what your relative, friend, or neighbor had done.
Some women want to just get everything taken out and be done with it. However, the uterus does serve a purpose other than growing babies. It helps support internal organs and it is part of a woman’s sexual response. It is important to be sure that a hysterectomy is truly the best option for you. If you have endometriosis, I encourage you to consult an endometriosis specialist. A hysterectomy is not a cure for endometriosis, and it is important for you to work with someone with expertise in your condition.
What Is a Hysterectomy?
A hysterectomy is the surgical removal of the uterus. If you have ovaries and fallopian tubes removed, that is a salpingo-oophorectomy. If you have only your uterus removed, it is a hysterectomy. If you have your uterus, tubes, and ovaries removed, you are having a hysterectomy with bilateral salpingo-oophorectomy.
A total hysterectomy is the surgical removal of the entire uterus, including the cervix.
If the upper part of the uterus is removed but you keep your cervix, it is referred to as a partial, subtotal, or supracervical hysterectomy.
A radical hysterectomy is the removal of the uterus, cervix, tissue surround the cervix, and some vaginal tissue. This is typically done to treat certain types of gynecological cancer.
Any of these types of hysterectomies may include a salpingo-oophorectomy. Many women talk about them as if they are all part of the same procedure. For many women, they are—but it isn’t a given. Approximately 325,000 women in the U.S. have a salpingo-oophorectomy each year, many in conjunction with a hysterectomy.
Many women are able to choose whether to keep or remove the cervix and ovaries.
The cervix does provide a bit of internal support and can make recovery a bit easier. Also, it plays a role in sexual response for some women. If this is the case for you and your medical situation does not require its removal, you may want to ask to keep your cervix.
The other decision many women have is whether ovaries are removed. Many doctors recommend keeping your ovaries unless you are at risk for ovarian cancer. Even after menopause, the ovaries continue to produce low levels of hormones that help with sexual and heart health. However, if you are approaching or are past menopause, your doctor may recommend removal.
If your doctor leaves the choice up to you, do your own research on reputable websites. If you find that a source is either trying to stir up fear or is telling you you’re worrying too much about nothing, it probably isn’t the best resource for you. There are pros and cons with keeping or removing the cervix and the ovaries, and it is best to make an informed decision.
How Is a Hysterectomy Performed?
Hysterectomies can be done in one of four ways:
- Abdominal hysterectomy – The doctor removes the uterus through an incision in the abdomen. This used to be the most common type of hysterectomy. It is less common now due to a preference for minimally invasive procedures.
- Vaginal hysterectomy – An incision is made at the top end of the vagina, and everything is removed that way. A woman who has not given vaginal birth may find that she is not a good candidate for a vaginal hysterectomy.
- Laparoscopic-assisted hysterectomy – Small incisions are made in several locations in the abdomen and sometimes at the top end of the vagina as well. Doctors use laparoscopic tools to remove the uterus through the small incisions.
- Robotic-assisted hysterectomy – This is a laparoscopic-assisted surgery that uses a robotic tool rather than traditional laparoscopic instruments. Because of the way the tools can move, it can access behind organs to effectively remove cancer and endometriosis. (Check out this fun video to see how the instrument works.)
What Happens to the Vagina?
If you keep your cervix, nothing at all happens to your vagina. It stays attached to your cervix. If your cervix is removed, however, the top end of the vagina is usually stitched back together to create a vaginal cuff. (This doesn’t actually shorten the vagina, as the tissue that is stitched is where the cervix has previously taken up space. A radical hysterectomy does shorten the vagina somewhat.) My doctor told me that he attached the top end of the vagina to the ligaments that had previously supported my uterus.
Some hysterectomies are often done as outpatient procedures. You stay in the hospital overnight and return home the next day. I thought there was no way I would feel up to it. Surprisingly, I really did feel ready. My surgery was at 7:30 am, and I was in my recovery room around 11. By 9 am the next day, I’d showered, eaten breakfast, and was dressed.
My surgery was minimally invasive and pretty straightforward. More involved hysterectomies often involve a stay of several days.
Stay tuned for Friday’s post on recovery, hormones, and emotions. Meanwhile, if you have questions you’d like me to try to answer in the next couple posts, feel free to ask them here and I’ll try to add them in.
Image courtesy of dream designs at FreeDigitalPhotos.net