Having Sex After a Hysterectomy

Overview

A hysterectomy is surgery to remove the uterus (womb) — the hollow organ where babies grow and develop during pregnancy.

Having this procedure can relieve pain and other symptoms from conditions like fibroids or endometriosis. And if you have uterine or cervical cancer, it could save your life.

Any surgery can have both short-term and long-term side effects. A hysterectomy can cause side effects like pain and bleeding. Once you have this procedure, you won’t be able to carry a child.

A hysterectomy can also impact your sex life in the weeks following the procedure. Yet it shouldn’t prevent you from having sex — and enjoying it — once you’re healed.

Here’s a look at how a hysterectomy can affect your sexuality and what you can do to ensure you don’t lose this important part of your life.

Most of the surgery-related side effects should go away and your body should heal within two months.

The American College of Obstetricians and Gynecologists and U. S. Department of Health and Human Services recommend that you not insert anything in your vagina for the first six weeks after your surgery.

Doctors can perform different types of hysterectomy:

• Total hysterectomy. This is the most common type. It removes the whole uterus, including the bottom part, the cervix. The surgeon might also remove your ovaries and fallopian tubes.
• Partial (also called subtotal or supracervical) hysterectomy. Only the top part of the uterus is removed. The cervix is left in place.
• Radical hysterectomy. The surgeon removes the uterus, cervix, tissue on either side of the cervix, and the top part of the vagina. This type is often used to treat cancer of the cervix or uterus.

You might have some light bleeding and discharge after your surgery, and you’ll no longer get regular menstrual periods.

Pain, burning, and itching around the incision site are also normal. If your ovaries were removed, you’ll likely have menopause-like side effects like hot flashes and night sweats.

A hysterectomy will put your sex life on pause for a few weeks, but it shouldn’t end it.

According to one review of studies, most women said their sex life either stayed the same or improved after the procedure. They were finally free from the pain or heavy bleeding that caused them to have the surgery.

Having your ovaries removed during the procedure could dampen your desire for sex, though. That’s because your ovaries produce testosterone and estrogen — hormones that are integral to your libido.

Can I still have an orgasm?

Some women do report that they have less intense orgasms or no orgasms at all after surgery. This is because removing the uterus can cut nerves that enable you to climax.

Also, the cervix contains nerves that are stimulated during sex. If your cervix was removed during the procedure, the surgeon may have cut these nerves. This is rare and not the norm for most people who have the surgery, though.

Will sex still feel the same?

A hysterectomy shouldn’t affect sensation in your vagina. However, removing your ovaries will put you into menopause, which can dry out the tissues of the vagina and make sex more painful.

What’s the safest way to start having sex again?

First, make sure you wait at least six weeks — or as long as your doctor recommends — before you start having sex again. Take your time easing back into sex.

If vaginal dryness is making sex too painful, ask your doctor about using vaginal estrogen creams, rings, or tablets. Or, try a water-based or silicone-based lubricant like K-Y or Astroglide when you have sex.

If you’re having difficulty getting back to your normal sex life after a hysterectomy, try these tips to get back on track:

1. Take your time

When you have sex, don’t rush. Give yourself time to get aroused.

2. Experiment

Try different positions until you find one that’s most comfortable. Explore options other than vaginal sex, like oral or manual stimulation.

3. Be honest

Be open with your partner about what feels good and what hurts.

If these tips don’t work, consider seeing a sex therapist or counselor with your partner.

Once you pass the six-week mark after your surgery, you should be able to go back to a normal sex life. If you’re still having problems with arousal, orgasm, or comfort during sex, don’t just accept it. See your doctor.

Here are a few questions to ask your doctor:

• What’s the safest way to ease back into sex after my surgery?
• What should I do if sex is painful?
• How can I overcome a lack of desire?
• What should I do if my partner is getting frustrated or isn’t helping?

Together, you and your doctor can strategize ways to make your sex life as good as — or even better than it was — before your surgery.

Considerations and What to Expect

People may have a hysterectomy due to health conditions like fibroids, endometriosis, or cancer. It may also be part of gender-affirming care.

A hysterectomy is a surgery to remove your uterus. Sometimes, doctors will also remove your fallopian tubes and ovaries during a hysterectomy. After a hysterectomy, you won’t have periods and won’t be able to get pregnant.

A hysterectomy is the second most common surgery performed on women in the United States after cesarean delivery. Each year, nearly 600,000 hysterectomies are done. There are many reasons your doctor may recommend a hysterectomy. Read on to learn more about why you might need a hysterectomy and what risks are involved.

Uterine fibroids are noncancerous growths that form in the uterus. They’re one of the most common reasons for a hysterectomy.

Fibroids can cause heavy bleeding, pain, or stomach distention. They may also affect fertility.

Your doctor may first recommend medications, such as oral birth control pills, or other less-invasive procedures, such as a myomectomy, to treat fibroids. A myomectomy removes only the fibroids and leaves the uterus intact.

If other measures aren’t effective or fibroids continue to regrow and produce symptoms, a hysterectomy may be an option.

Cancer is the reason for about 10 percent of all hysterectomies.

Your doctor may recommend a hysterectomy if you have cancer of the:

• uterus
• ovary
• cervix
• endometrium

Your treatment approach will depend on the type of cancer you have, how advanced it is, and your overall health. Other options may include chemotherapy and radiation.

Sometimes, doctors recommend surgery if you have precancerous conditions or if they suspect cancer. In some cases, removing the uterus may be a safer way to diagnose cancer than through a biopsy on an intact uterus.

You may also opt to have a hysterectomy to reduce your risk of developing cancer in the future if you have Lynch syndrome. This is an inherited condition that can increase your risk of colon, uterine, and other cancers.

If you test positive for the BRCA gene, you don’t necessarily need a hysterectomy. People with this gene may have an increased risk for ovarian and breast cancers, so doctors may just recommend the removal of ovaries and fallopian tubes.

Endometriosis is a condition where tissue that normally lines the uterus grows outside of it. Endometriosis can cause extreme pain and irregular periods. It can also lead to infertility.

Doctors usually recommend hormone therapy or medical procedures to remove endometrial tissue before a hysterectomy.

A hysterectomy can often reduce or eliminate symptoms from endometriosis, but it’s still possible for endometriosis to recur following hysterectomy. It’s important to discuss the pros and cons of this treatment option with your doctor before having surgery.

Adenomyosis happens when the lining of the uterus grows into the muscle of the uterus. This causes the uterine wall to thicken, which leads to pain and heavy bleeding.

This condition often goes away after menopause, but if your symptoms are severe, you may require treatment sooner.

Hormone therapies and pain medication are usually tried first. If they don’t work, a hysterectomy may be an option.

Pelvic Inflammatory disease (PID) is a bacterial infection that can lead to severe pelvic pain.

When found early, PID can usually be treated with antibiotics. But it can damage the uterus if it spreads.

Your doctor may recommend a hysterectomy if you have severe PID.

Hyperplasia means the lining of your uterus is too thick. This condition may be caused by having too much estrogen.

In some cases, hyperplasia can lead to uterine cancer.

Hyperplasia can cause heavy, irregular menstrual bleeding.

Typically, treatment options include different types of hormone therapies. If your hyperplasia is severe or your doctor suspects it may develop into cancer, they may recommend a hysterectomy.

You might benefit from a hysterectomy if you regularly experience heavy or irregular menstrual bleeding.

Irregular bleeding can be caused by:

• fibroids
• infection
• hormone changes
• cancer
• other conditions

It can be accompanied by stomach cramps and pain.

Removing the uterus is sometimes the only way to find relief from heavy bleeding. Other treatments, such as hormone therapy, are usually tried first.

Uterine prolapse happens when your uterus slips from its usual place and falls into the vagina. This condition is more common in those who’ve had multiple vaginal births. It can also affect people with obesity or who have gone through menopause.

Common symptoms with uterine prolapse are:

• pelvic pressure
• urinary issues
• bowel problems

Treatment options often depend on how severe the prolapse is. Certain exercises and devices can be used at home. In some cases, doctors can repair the weakened pelvic tissues with minimally invasive surgery.

If these measures don’t work or aren’t good options, a hysterectomy may be the treatment of choice.

Sometimes, a hysterectomy is performed within 24 hours after vaginal or cesarean delivery. Certain complications, such as severe bleeding, may mean your doctor has to take out your uterus.

This outcome is very rare, but it can be lifesaving.

Placenta accreta happens during pregnancy when the placenta grows too deeply into the uterine wall. This condition can be very serious, but it often doesn’t cause symptoms.

In almost all cases of placenta accreta, the doctor will perform a cesarean delivery followed by a hysterectomy to prevent blood loss that happens when the placenta separates.

A transgender person may choose to have a hysterectomy. They may decide to only remove the uterus or to remove the uterus and ovaries.

Your doctor can help walk you through the different procedures and possible complications.

Some insurance providers will cover gender affirming hysterectomies. If you have insurance, it’s a good idea to review your policy and confirm your coverage with your provider. They can help you understand if and when hysterectomies are covered.

There are several types of hysterectomy. The type your doctor recommends will depend a lot on the reason you’re having a hysterectomy.

Types of hysterectomy include:

• Partial hysterectomy. With this type, a portion of your uterus is removed, and your cervix, ovaries, and fallopian tubes are left intact.
• Total hysterectomy. Your doctor will remove your entire uterus and your cervix. They may also remove your fallopian tube while leaving your ovaries intact. Removing your fallopian tubes and cervix may reduce your risk for certain cancers.
• Hysterectomy and salpingo-oophorectomy. With this procedure, your doctor will remove your uterus and one or both ovaries along with your fallopian tubes. You may require hormone treatment following this type of hysterectomy.

In addition to different types of hysterectomy, there are also different surgical procedures or methods to remove the uterus. The actual procedure your doctor recommends will depend on your reason for having a hysterectomy.

Your doctor might go through your abdomen or your vagina to get to your uterus. The procedure can be done as a laparoscopic, robotic, or open surgery. If you have open surgery, your doctor may do either a vertical or a horizontal incision.

Discuss all of your surgical options with your doctor ahead of time. Depending on the type of surgery, you may have an increased risk of some side effects or complications.

While a hysterectomy is considered one of the safest surgeries, there are risks involved with any procedure.

Potential side effects or complications may include:

• infection
• heavy bleeding during or after the procedure
• injury to other organs
• blood clots
• breathing or heart complications from anesthesia
• bowel blockage
• trouble urinating
• death

Serious complications are more common in abdominal hysterectomies compared to other, less invasive types. Remember, after a hysterectomy, you won’t get your period again.

Some people experience a loss of interest in sex or become depressed after a hysterectomy. Talk with your doctor or healthcare professional if this happens to you.

If you have your ovaries removed as part of the procedure and you haven’t gone through menopause yet, the surgery could cause you to experience menopause symptoms, such as:

• hot flashes
• vaginal dryness
• mood swings

Ovary removal also puts you at risk for developing other medical conditions like bone loss, heart disease, and urinary incontinence.

A hysterectomy can improve your quality of life.

For people living with fibroids, adenomyosis, endometriosis, or abnormal periods, a hysterectomy can help reduce or eliminate chronic pain. It can also help avoid unexpected and heavy bleeding.

For people having the surgery due to cancer, hysterectomy can be an important part of your treatment plan.

Talk with your doctor about how a hysterectomy might improve your symptoms or quality of life.

Having a hysterectomy is a big decision. It’s a major surgery that can change your body forever. You cannot become pregnant following a hysterectomy. You may also go into early menopause.

You might want to ask your doctor the following questions before considering a hysterectomy:

• Do I need a hysterectomy? Why?
• What are the benefits and downsides of having a hysterectomy for my particular condition?
• What other options are available?
• If I don’t have a hysterectomy, what will happen?
• How can a hysterectomy relieve my symptoms?
• What kind of hysterectomy will I have?
• What are the symptoms of menopause?
• Will I need medications after surgery?
• What changes to my mood will it have?
• What will my recovery be like?

If you need a hysterectomy but still want to have children, make sure you discuss your options with a healthcare professional. Adoption and surrogacy are two potential options you may consider.

A hysterectomy is a common procedure that can improve symptoms caused by many different medical conditions. In some cases, the surgery can be lifesaving.

You won’t be able to get pregnant following the surgery and you may go into early menopause. But, the procedure can relieve heavy or irregular bleeding and pelvic pain.

Talk with your doctor if you think you might benefit from having a hysterectomy. There are lots of factors to consider before deciding to have this surgery.

procedure, recovery after surgery and consequences for the woman

10/16/2016

Contents

• Purpose of hysterectomy
• Indications for surgery
• Preparation
• Contraindications
• Procedure
• Rehabilitation
• Benefits of contacting MEDSI

Removal of the uterus (hysterectomy) is one of the most frequently performed operations in gynecology. Intervention is a real test for a woman. Not surprisingly, patients experience not only the fear of the operation itself, but also depression and vulnerability, confusion and inferiority. We will try to answer all the questions that women have. We will understand how the removal of the uterus is carried out, and how life can change after such an intervention.

Purpose of hysterectomy

Surgery is performed when other treatments have failed or are inappropriate. Emergency interventions often help save the patient’s life.

Interestingly, in a number of European countries and the United States, the operation is common among women after 40–45 years of age. This is due to the fact that it makes it possible to reduce the risks of developing fibroids and tissue growth, if any, and also avoids the appearance of malignant tumors.

Indications for surgery

Hysterectomy is performed in the following pathological conditions and diseases:

• Uterine cancer. After surgery, chemotherapy and radiation therapy are also carried out
• Multiple nodules of fibroids
• Internal bleeding with risk of anemia and other life-threatening conditions
• Acute pain syndrome
• Vaginal bleeding
• Growth of uterine lining tissue in ovaries and fallopian tubes

Preparation

Before the removal of the uterus, the woman undergoes a comprehensive examination. It allows you to assess the patient’s health status and identify possible contraindications.

The following diagnostic tests are usually performed:

• Pelvic ultrasound or MRI with contrast agent
• Vaginal swab
• Endometrial biopsy

The so-called hospital complex is obligatory.

It includes:

• general and biochemical blood test
• urinalysis
• blood test for group and Rh factor, as well as infections, clotting disorders, HIV and other diseases
• fluorography
• ECG

The patient consults with a gynecologist, internist and anesthetist.

Important! If temporary (relative) contraindications to the intervention are identified, the necessary treatment is carried out. If, for example, infectious diseases are detected, the doctor prescribes antibiotics and anti-inflammatory drugs. It is very important to achieve complete recovery or remission. Otherwise, there will be a high risk of surgical and postoperative complications. In addition, existing diseases negatively affect the rehabilitation process, lengthening it.

If a cervicalectomy or other operation is performed to remove a malignant tumor, hormonal and other drugs are prescribed. They help stop tumor growth. The therapy can make it possible to reduce the size of the formation, which will positively affect the course of the intervention, reducing tissue trauma.

Contraindications

Surgery to remove the uterus is not performed if there are the following contraindications:

• low blood clotting
• arterial hypertension
• acute infectious diseases (including small pelvis)
• angina pectoris
• anemia
• diabetes mellitus
• liver failure
• kidney failure
• allergic reactions to anesthetics

Important! There are both absolute and relative contraindications to intervention. In this case, the doctor makes the final decision on the operation. If necessary, the patient is consulted by specialists of narrow profiles.

Procedure

Hysterectomy of the uterus (including appendages) is performed under general anesthesia. The intervention usually takes 1-1.5 hours.

3 methods are used to access organs:

• Laparoscopic. The intervention is carried out through punctures in the area of ​​the abdominal wall. The technique allows to reduce tissue injuries and shorten the rehabilitation period. Usually only 4 small punctures and a specialized tool are required. It is inserted into the cervical canal. First, the ligaments of the uterus are excised, and then it is removed. After that, the walls of the vagina are coagulated and sutured
• Abdominal. This operation is traditional and the most traumatic. It requires a large incision in the abdominal wall. Mandatory for standard intervention is the fixation of intestinal loops. This avoids damage to them. The cervix is ​​cut off in the inner zone of the pharynx. After that, her stump and vaginal vaults are sutured. Then drain pipes are installed. They are removed after a few days
• Transvaginal. Access is provided through an incision in the vaginal area. After that, the surgeon peels off the bladder. Then the vessels and fallopian tubes, as well as ligaments, are separated and cut. After that, the uterus is cut off. The stumps of the pipes are sewn together

There are also 3 types of hysterectomy.

Radical

It involves the removal of the uterus, fallopian tubes, ovaries, regional lymph nodes and fatty tissue. The operation is performed for endometriosis and cancer.

Total

This hysterectomy involves the removal of the uterus with the cervix and appendages. It is prescribed for oncological diseases. The technique allows to reduce the risks of the spread of the tumor process. It is often combined with other methods of cancer therapy (chemotherapy, etc.). Total hysterectomy can also be performed in emergency situations.

Subtotal

The cervix is ​​not removed during this operation. This intervention eliminates the risk of damage to the ureters and large vessels. It is prescribed for adhesions, pelvic endometriosis and some other pathologies.

Rehabilitation

Recovery after a hysterectomy is a lengthy process. Conventionally, rehabilitation is divided into 2 periods:

1. Early. 3-4 days after the intervention, the woman is under the control of medical personnel. The therapy is aimed at eliminating pain, preventing bleeding, restoring the body, reducing the risk of developing anemia and inflammation. The doctor also monitors the work of the intestines, the condition of the suture and the amount of discharge from the genitals. To remove fluid from the body, a urinary catheter is installed on the first day. During this time, the patient only drinks and does not eat anything. Then, low-fat broths and yogurts are gradually introduced into the diet. Eat light foods that are quickly digested. Chocolate, cabbage, legumes, corn are completely excluded, i.e. products that can cause increased gas formation and constipation. A woman should eat in small portions and at least 4-5 times a day
2. Late. With the classical method of the operation, it lasts about 1.5 months, with laparoscopic – no more than 30 days. The late rehabilitation period begins after discharge from the hospital. At this time, a woman should be attentive to her health and direct all actions towards its full recovery

There are certain recommendations that the patient should follow during rehabilitation:

• Mandatory intake of medicines prescribed by the doctor. Painkillers, anti-inflammatory, hormonal, enzymatic and general tonic agents are usually recommended
• Restriction of physical activity. It is especially important to avoid excessive pressure on the muscles of the abdomen and pelvic floor
• Do simple exercises (if recommended by a doctor)
• Refusal of sexual life. Return to it is carried out with caution. If a woman experiences discomfort, you need to contact a gynecologist. Perhaps it will prolong the period of sexual dormancy
• Healthy eating. Even after discharge from the clinic, you need to adhere to the correct diet with the restriction of alcohol, pastries, fatty foods, smoked meats, marinades
• Proper drinking regimen. A woman should drink about 1.5-2 liters of water per day. This will allow the natural detoxification of the body

Of course, the main consequence of the removal of the uterus is that the woman loses her childbearing function. Otherwise, life can remain as fulfilling as it was before.

Over time, the menstrual cycle is restored, the level of hormones returns to normal. After the removal of the uterus, even the libido can remain the same. At the same time, the ability to lead an active sex life fully returns.

Benefits of contacting MEDSI

• Experienced doctors. Our specialists are not only professionally trained to solve women’s problems, but also provide patients with an attentive and delicate approach
• Comprehensive surveys. They are carried out using modern equipment and ensure the accuracy of diagnosis and the identification of all pathologies
• Possibilities of using sparing techniques for hysterectomy of the uterus and ovaries. Operations are performed using minimally invasive methods, which increases their safety and shortens the rehabilitation period
• New high-tech equipment. It minimizes the risk of bleeding and the occurrence of complications and relapses
• Comfortable hospital stay before and after hysterectomy
• Outpatient rehabilitation and monitoring facilities

To clarify information or make an appointment, just call +7 (812) 336-33-33. Our specialist will answer all questions. Recording is also possible through the SmartMed application.

Do not delay treatment, see a doctor right now:

• Gastroenterologist appointment
• General practitioner appointment
• Gynecological appointment

Hysterectomy (extirpation of the uterus) – prices in Moscow

Uterine extirpation is a surgical operation that is a type of hysterectomy. This is the name of the operation to remove the uterus. This is a total hysterectomy, in which the body of the organ is removed along with the neck. Appendages in the form of fallopian (fallopian) tubes and ovaries are preserved. The operation is performed as a radical method of treating certain diseases in which the preservation of the uterus is not possible due to the high risk to the health of the woman.

Purpose of surgery

The main goal of the operation is to restore the patient’s health and improve her well-being by getting rid of the signs of the disease that bothers her. After removal of diseased tissues, the symptoms of pathology disappear completely. These can be uterine bleeding, the uterus falling out of the vagina and other conditions that significantly complicate the life of a woman.

In oncological diseases, hysterectomy allows you to eradicate the malignant process, if it has not yet had time to spread to other organs and tissues. In this case, the risk of oncology recurrence is reduced, the woman’s well-being improves, and her life expectancy increases.

When uterine amputation is indicated

Hysterectomy is indicated for the following pathologies of this organ:

• Neoplasms of the body and cervical part of the organ, appendages – benign or malignant. Benign tumors (myomas, fibromyomas) are an indication if they rapidly increase in size. cause violations of the menstrual cycle according to the type of bleeding. In malignant processes, removal of the uterus is indicated regardless of the size of the formation.
• Adenomyosis is a type of endometriosis in which the mucous membrane lining the cavity from the inside grows into the muscle wall. The disease is dangerous because it does not cause symptoms in the early stages of development. But as the endometrium grows in the muscle layer, scarring of the walls occurs. They lose their elasticity and ability to stretch. Adenomyosis can cause severe uterine bleeding, leading to the development of anemia.
• Prolapse or prolapse of the uterus. If conservative methods of correcting the position of the organ are ineffective, it is removed.
• Severe inflammation, covering the body, appendages. Hysterectomy is performed if conservative treatment is ineffective and impractical, and the preservation of the woman’s reproductive function is not required.

Preoperative preparation

Extirpation of the uterus requires special preparation. Before the operation, the patient is prescribed an examination, during which the diagnosis is clarified and possible contraindications are identified. The preoperative examination includes the following procedures:

• General urine and blood tests.
• Blood test for coagulability, sugar level, latent infections, tumor markers, determination of the group and Rh factor.
• Fluorography – X-ray examination of the respiratory organs.
• ECG (electrocardiography) to assess the bioelectrical activity of the heart.
• Ultrasound, CT or MRI of the pelvic organs.
• Colposcopy – examination of the cervix using an optical device that magnifies the image many times over.
• Cytological smear from the intracervical canal.
• Consultation of a general practitioner, anesthesiologist, and, if necessary, other narrow specialists.

If no contraindications are identified, the woman is prescribed preparation for surgery. It includes:

• Cancellation of blood thinners (Aspirin, anticoagulants) 7 days before the procedure.
• Refusal to eat 8-10 hours before surgery. You should refrain from drinking for 4-6 hours. The last meal should be in the evening. A light dinner is recommended.
• A cleansing enema the day before the procedure.
• Hygienic shower and hair removal from the pubis, perineum.

Before surgery, the bladder must be emptied. If the patient was unable to do this on her own, a bladder catheterization is performed to remove the accumulated urine.

Types of hysterectomy according to the volume of intervention

Depending on which structures are to be removed, the following types of hysterectomy are distinguished:

• Subtotal (supravaginal). During the operation, only the body of the uterus is removed, preserving its appendages and cervix. All manipulations are performed over the vagina. This is where the name of the procedure comes from.
• Total (extirpation of the uterus). Together with the body, the neck of the organ is amputated. In terms of the degree of intervention, this type of operation is superior to subtotal hysterectomy.
• Radical (full). The surgeon removes the body and neck, as well as adnexal structures – the ovaries, fallopian tubes.

The volume of surgical intervention is determined by the attending physician, taking into account the age of the patient, the presence of concomitant pathologies of the reproductive system and other organs. In malignant tumors, preservation of the cervix is ​​usually impractical, since it increases the risk of recurrence of oncology – in this case, hysterectomy is indicated.

The main advantage of the total technique before radical hysterectomy is that the ovaries continue to function. They produce hormones that are responsible for shaping a female figure, regulating the menstrual cycle, sexual desire and cell renewal throughout the body. This is especially important if the patient is a woman of childbearing age. In this case, the extinction of the functions of the reproductive system occurs naturally with the onset of menopause. To maintain a normal hormonal background after a radical hysterectomy, lifelong use of drugs containing female sex hormones is indicated.

Classification of the operation according to the type of access to the removed organ

To remove the uterus along with its cervix, the surgeon must have convenient access to the removed organs. You can approach the uterus through the vagina and the anterior abdominal wall. In the latter case, surgical manipulations are performed through a long incision or small punctures about 1 cm long. Each method of hysterectomy has its own characteristics, pros and cons.

Abdominal

Abdominal hysterectomy is an operation to remove the uterus with access through the abdomen. It is also called laparotomy. This means that access to the operated organ is provided through a large vertical or horizontal incision made with a scalpel on the anterior abdominal wall. The benefits of laparotomy include:

• Easy access to structures to be removed – the surgeon can visually control the manipulation directly through the incision.
• Versatility – all types of hysterectomy (subtotal, total, radical) can be performed with access through the abdomen.
• Efficiency – sometimes laparotomy is the only possible way to amputate the uterus. This happens, for example, with very large tumors, when it is not possible to extract it through small incisions on the abdominal wall or vagina.

The disadvantages of the method include the extensiveness of the surgical intervention. Due to the high morbidity, the risk of postoperative complications significantly increases. The recovery period after surgery also increases, the patient has to stay in the hospital longer.

The operation is performed under epidural or general anesthesia (narcosis). Its duration is from 1 to 2 hours. During the procedure, the surgeon cuts the skin, subcutaneous fat, muscle layer with a scalpel and exposes the uterus. Then he fixes it and brings it out. Then he bandages the uterine ligaments and tubes, blood vessels. After that, he cuts off the body of the uterus along with the cervix and forms the stump of the vagina. At the end, the surgeon performs stitches and applies a sterile dressing.

Laparoscopic

With the laparoscopic method of removing the uterus, access to the organ is also carried out through the abdominal wall. The method differs in that the surgeon performs not one large incision, but 3-4 small ones. Their length does not exceed 10–15 mm.

Advantages of the method:

• Versatility. Laparoscopy can be used for total, total, and supravaginal hysterectomy.
• Minimally invasive. Surrounding tissues are injured to a lesser extent.
• Low risk of serious complications. Since the surrounding organs and tissues are less damaged during laparoscopy, postoperative complications develop less frequently.
• Fast recovery period and short stay in stationary conditions.

The main disadvantage of laparoscopic hysterectomy is the impossibility of using the method for large tumors.

The operation is performed under anesthesia or epidural anesthesia, lasts from 1.5 to 3.5 hours. The surgeon monitors the progress of the procedure using an endoscope, a long flexible tube with a light and a video camera at the end. He introduces her into one of the holes. The endoscope transmits an image to a computer monitor. Otherwise, a hysterectomy resembles a laparotomy – with the help of special instruments inserted through punctures, the surgeon selects and fixes the uterus, bandages the vessels, ligaments, and tubes. Then he cuts off the organ and brings it out. At the end, stitches and a sterile bandage are applied.

Attention! A variation of laparoscopic hysterectomy is robot-assisted hysterectomy. It differs from conventional laparoscopy in that all manipulations are performed by a robot controlled by the surgeon using a console.

Vaginal

The uterus can be accessed through the vagina. In this case, a hysterectomy is called a vaginal hysterectomy. Advantages of the method:

• Minimally invasive. Access to the amputated uterus is through the vagina. Therefore, it is not necessary to dissect the abdomen.
• Low risk of complications. The less tissue damage, the lower the likelihood of serious consequences for the patient’s health.
• Possibility of simultaneous plastic surgery of the vagina, correction of the muscles of the pelvic floor.
• Fast rehabilitation period. After a vaginal hysterectomy, patients recover the fastest.

There are also disadvantages to the vaginal amputation method. Thus, the method does not allow the body of the uterus to be removed through the vagina while preserving the cervix. With its help, it is also impossible to remove tumor formations of very large sizes. Vaginal extirpation of the uterus is most often performed when it is prolapsed or prolapsed.

Despite the low trauma, the operation requires the use of general anesthesia or epidural anesthesia. It takes from 1 to 1.5 hours. Using a scalpel, the surgeon cuts the wall of the vagina. Through the incision, he cuts off the ligaments that hold the uterus in the pelvis. Then he seals the vessels through which blood enters the removed organ, and completely cuts it off. At the end, the doctor sutures the vagina, if necessary, performing plastic surgery (colporrhaphy).

What are the contraindications

Contraindications for all types of operations considered are:

• Acute inflammation of the reproductive system. First, the inflammatory process is stopped with medication, then amputation is performed.
• Severe pathologies of the liver, kidneys, heart, in which surgical intervention threatens the life of the patient.

Possible postoperative complications

During or after amputation of the uterus, the following complications may develop:

• Intra-abdominal bleeding. May develop during and after surgery.
• Hematomas of the parametrial structure surrounding the uterus.
• Injury to the ureters, bladder – the risk increases during surgery if adhesions occur in the abdominal cavity and small pelvis.
• Peritonitis, sepsis – infectious complications caused by the penetration of pathogenic microflora into an open wound.
• Formation of blood clots – the blood thickens, clots form, which can move through the blood vessels.
• Pelvic prolapse – after the intervention, the vault may descend along with the bladder, rectum.
• Difficulties with urination – occur after vaginal hysterectomy.

Within 6-8 days after the operation, the patient is in the hospital, where she is monitored by medical workers. Every day, a woman’s blood pressure, body temperature are measured, urine and blood tests are taken several times, and ultrasound of the small pelvis is done. All this helps to timely identify possible complications and carry out treatment. After being discharged home, it is important to continue to monitor your well-being on your own. With the appearance of severe pain, fever, general malaise, you should call an ambulance – these symptoms indicate the occurrence of complications.

Rehabilitation after hysterectomy

The rehabilitation time for a woman after amputation of the uterus depends on the method of the operation. After laparotomy, the recovery period lasts about 2-3 months. Minimally invasive techniques can reduce it to 6-8 weeks.

Features of recovery after hysterectomy:

• The patient is in the intensive care unit for 24 hours after the operation. At this time, you can not get out of bed.
• Dressings are changed daily after laparotomy.
• The load should be increased gradually.
• It is recommended to wear a compression bandage for the first 2-4 weeks. It prevents the formation of blood clots, promotes the outflow of lymph.

Return to the previous way of life is possible after full recovery, which occurs in 1.5-2 months. During this time, it is necessary to refuse to take hot baths, visit the bath, sauna. Until full recovery, it is important to observe sexual rest, to exclude heavy physical exertion.

Within 7-10 days, a woman is recommended to take antibacterial drugs to prevent infectious complications. She is also shown painkillers. If necessary, drugs are prescribed for the treatment of iron deficiency anemia. Their reception is best combined with ascorbic (vitamin C) and folic acid (B9). They significantly increase the absorption of iron.

Attention! If the uterus has been removed along with the uterus, the woman is given hormone replacement therapy.

Hysterectomy in Moscow can be performed at the multidisciplinary medical center “Clinical Hospital on Yauza”. Our clinic employs experienced surgeons who constantly improve their skills. Before surgery, we carefully examine the condition of the woman, which reduces the likelihood of severe postoperative consequences. See the prices for operations on the clinic’s website or find out by phone. To make an appointment for an initial appointment, call us or request a call back.

Sources

1

Bazarova Z.Z., Sobirova S.E. Hysterectomy as an effective method of therapy for severe obstetric complications // Science and Education. 2018..

2

Kostyakhin A.E., Gutikova L.V. Laparoscopic hysterectomy – fifteen years of experience // Educational Institution “Grodno State Medical University”. 2019..

3

Iozefson S.A., Khaven T.V., Golygin E.V., Kuklin S.I., Shalneva E.V., Kargina D.S., Efimtseva I.P., Triputin A.A. Hysterectomy in women of reproductive age // Editorial and Publishing Center of the Chita State Medical Academy.