WOMEN: GYNAECOLOGICAL OPERATIONS. HYSTERECTOMY

Surgical removal of the uterus is the second most common gynaecological operation after D&C. The word ‘hysterectomy’ comes from the Greek hysterikos meaning suffering in the womb’. There are several types of hysterectomy.

Total hysterectomy The entire uterus (body plus cervix) is removed.

Subtotal hysterectomy

The body of the uterus is removed, leaving the cervix. This operation was popular in the past; the cervix was believed to be important in sexual function and the enjoyment of sex. We still don’t know the function of the cervix in sexual pleasure, but because most women who’ve had total hysterectomies notice no change in the sensations of sexual arousal and orgasm, total hysterectomy is recommended these days because it is a less difficult and safer operation.

Radical hysterectomy

The uterus and associated lymph glands in the pelvis are removed.

Hysterosalpingo-oöphorectomy

This is also called hysterectomy and bilateral salpingo-oöphorectomy. The uterus, the ovaries and tubes on both sides are moved. The vault (uterine end) of the vagina may also need to be removed. If a woman needs a hysterectomy before the menopause, the ovaries are preserved unless they are damaged or diseased beyond salvage. If no ovarian tissue can be saved, hormone replacement must be started at once.

After the menopause, when ovarian production of oestrogen has ceased, saving the ovaries is not so important. However, there is no justification for removing healthy ovaries as a routine when hysterectomy is performed in postmenopausal women. As far as we know, postmenopausal ovaries continue to produce androgens that may be important in maintaining libido in older women. Perhaps they have ‘ other undiscovered functions.

When is hysterectomy necessary?

Reasons for hysterectomy include:

• cancer of the body or cervix of the uterus, or cancer of the ovaries

• benign tumours (such as large fibroids) that cause symptoms and can’t be removed without removing the uterus

• endometriosis that can’t be controlled by other means and is causing severe symptoms

• excessive menstrual blood loss and pain that hasn’t improved with other treatment

• severe prolapse that can’t be corrected otherwise

• rarely, to relieve symptoms due to severe chronic pelvic infection that can’t be controlled by antibiotics

• very rarely, as a life-saving emergency if the uterus is severely injured during childbirth or other gynaecological surgery.

The operation

Hysterectomy involves cutting the uterus away from the ligaments that hold it in the pelvis and separating the cervix from the inner end of the vagina. The uterus can be removed through the vagina or through an incision in the lower abdominal wall.

Vaginal hysterectomy is usually performed with laparoscopic assistance. It has the advantage of less post-operative pain and a shorter average hospital stay (two to three days) and convalescence (about the weeks), and is now the most common method of hysterectomy for benign (non-cancerous) uterine disease. However, vaginal hysterectomy is unsuitable if the uterus is very enlarged or if adhesions or other disease have attached the uterus to other organs and tissues in the pelvis. Abdominal hysterectomy surgery, so you’ll be in hospital for about a week. As with any abdominal surgery, you’ll have some abdominal pain and pain around the wound, for which you’ll be given painkillers as required. The pain rarely lasts more than a few days. You’ll be encouraged to be up and moving a little more each day – early movement reduces the risk of some complications. Convalescence after abdominal hysterectomy is usually complete within six weeks.

After either type of hysterectomy there will be a decreasing amount of bloodstained discharge from the vaginal wound for about two weeks. Any bright red vaginal bleeding should be reported to your doctor without delay. For the first couple of weeks after you get home you’ll need to take things easily. Aim to do a little more each day.

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