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By Mayo Clinic staffDuring 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.
During vaginal hysterectomy
You may be put under general anesthesia, so you won't be awake for the surgery. If you choose a spinal block (regional anesthesia), you may opt for a medication that makes you drowsy (intravenous sedative) or you may remain awake during your surgery.
Your legs will be placed in stirrups, similar to the position you're in for a Pap smear. Sometimes, a urinary catheter is passed through your urethra to empty your bladder. Your vagina is cleansed with a sterile solution prior to the surgery.
To perform the hysterectomy, the surgeon makes an incision inside your vagina to access the uterus. Using long instruments, the surgeon clamps the uterine blood vessels and separates your uterus from the connective tissue, ovaries and fallopian tubes. The uterus is removed through the vaginal opening, and absorbable stitches are used to control any bleeding inside the pelvis. Except in cases of suspected uterine cancer, the surgeon may cut an enlarged uterus into smaller pieces and remove it in sections (morcellation).
In some cases, your doctor may recommend a laparoscopic-assisted vaginal hysterectomy (LAVH) or robotic hysterectomy. Both procedures allow your doctor to remove the uterus vaginally but also make it possible for your doctor to view your pelvic organs through a laparoscope. Most of the procedure is performed through small abdominal incisions with the use of long, thin surgical instruments inserted through the incisions. The uterus is then removed through an incision made in your vagina. Your doctor might recommend LAVH or robotic hysterectomy if he or she suspects you may have scar tissue (adhesions) on your pelvic organs from prior surgeries or from endometriosis.
There is always a risk that severe endometriosis or pelvic adhesions may force your surgeon to switch from a vaginal to abdominal hysterectomy during the surgery. Your doctor should discuss this possibility with you before the surgery begins.
After the vaginal hysterectomy
After surgery, you'll be in a recovery room for a few hours and in the hospital for one to three days. You'll take medication for pain and to prevent infection. Your health care team will encourage you to get up and move as soon as you're able.
It's normal to have bloody vaginal discharge for several days to weeks after a hysterectomy, so you'll need to wear sanitary pads.
Physical aftereffects
After a hysterectomy, you'll no longer have periods or be able to get pregnant.
If you were still having periods before the surgery and your ovaries were not removed, they will continue producing hormones and eggs until you reach menopause. If your ovaries and fallopian tubes were removed with your uterus, you'll begin menopause immediately after surgery and may experience symptoms such as vaginal dryness and hot flashes. Your doctor may prescribe medications to treat the symptoms.
Recovery after a vaginal hysterectomy is shorter and less painful than after an abdominal hysterectomy. Most women feel better within a week and make a full recovery in one to two weeks. Even if you feel like you're back to normal, don't lift anything over 20 pounds or have vaginal intercourse until six weeks after surgery. Contact your doctor if your pain worsens instead of letting up or if you develop nausea, vomiting or bleeding heavier than a menstrual period.
Emotional aftereffects
After hysterectomy, many women report improved mood and increased sense of well-being. Others enjoy life more because they're no longer experiencing symptoms such as bleeding or pelvic pain. Many report an increase in sexual satisfaction as well — perhaps because they're not afraid of becoming pregnant, or perhaps because, before the hysterectomy, a condition such as uterine fibroids was causing pain during intercourse.
Some women feel a sense of loss and grief after hysterectomy, which is normal. Others may experience depression related to losing the ability to become pregnant. If sadness or negative feelings begin to interfere with your enjoyment of everyday life, talk to your doctor.
- About hysterectomy: Surgical removal of the uterus, or womb. American College of Surgeons. http://www.facs.org/public_info/operation/hysterectomy.pdf. Accessed May 10, 2010.
- Falcone T, et al. Overview of hysterectomy. http://www.uptodate.com/home/index.html. Accessed May 10, 2010.
- Hysterectomy. The National Women's Health Information Center. http://womenshealth.gov/faq/hysterectomy.cfm. Accessed May 10, 2010.
- Stovall TG, et al. Vaginal hysterectomy. http://www.uptodate.com/home/index.html. Accessed May 10, 2010.
- Hysterectomy. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp008.cfm. Accessed May 10, 2010.
- Cain J, et al. Gynecology. In: Brunicardi FC, et al. Schwartz's Principles of Surgery. 9th ed. New York, N.Y.; McGraw-Hill Medical; 2010. http://www.accessmedicine.com/content.aspx?aid=5025391. Accessed May 10, 2010.
- Wieslander CK, et al. Therapeutic gynecologic procedures. In: DeCherney AH, et al. Current Diagnosis & Treatment Obstetrics & Gynecology. 10th ed. New York, N.Y.: McGraw-Hill Medical; 2007. http://www.accessmedicine.com/content.aspx?aID=2391554. Accessed May 10, 2010.
- Lyons T. Laparoscopic approach to hysterectomy. http://www.uptodate.com/home/index.html. Accessed May 10, 2010.
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