A total hysterectomy is a surgery that removes a woman’s uterus. 
The uterus is the organ where a baby grows when a woman is pregnant. Sometimes the ovaries and fallopian tubes are also removed. 
A hysterectomy is an important operation for a woman that is recommended only when other treatment options do not resolve the problem.


When is hysterectomy necessary?

The most frequent reasons for hysterectomy surgery include:

 

Abusive Menstruation

Many women lose a lot of blood during the menstrual phase. Other symptoms such as pain and abdominal cramps may be felt . 
Abusive menstruation can be caused by fibroids, but in many cases there is no obvious cause. 
Removal of the uterus may be the only way to stop bleeding in these cases:

  • Other therapies have been ineffective,
  • Bleeding has a significant impact on the quality of life,
  • The woman no longer wants to have children.

 

Pelvic inflammatory disease

Pelvic inflammatory disease is a bacterial infection of the female reproductive system. 
If diagnosed early, the infection can be treated with antibiotics . However, if it spreads, it can result in damage to the uterus and fallopian tubes, resulting in long-term pain. 
A hysterectomy to remove the uterus and fallopian tubes may be recommended if a woman has pain from pelvic inflammatory disease and does not want to have children.

 

Endometriosis

Endometriosis is a condition in which cells lining the uterus can also be found in other areas of the body such as the ovaries, fallopian tubes, bladder, and rectum. 
If the cells that make up the lining of the uterus are trapped in other areas of the body, they can cause inflammation and injury to surrounding tissues. This can cause pain, abudent and irregular menstruation and sterility (inability to conceive). 
A hysterectomy may remove areas of endometrial tissue that cause pain, but come after attempting all possible therapies.

 

Uterine Prolapse

A uterine prolapse occurs when the tissues and ligaments that support the uterus become weak and so the genital organ slides down from its normal position. 
Possible symptoms include back pain , a feeling of something falling out of the vagina, loss of urine ( urinary incontinence), and difficulty in having sex. 
A prolapse of the uterus can often occur as a consequence of a birth. 
A hysterectomy resolves the symptoms of a prolapse because it completely removes the uterus.

 

Cancer

A hysterectomy may be recommended for the following cancers:

  • Cervical cancer (cancer of the cervix)
  • Ovary cancer
  • Fallopian tube cancer
  • Uterine cancer.

If the cancer has spread and reached an advanced stage, a hysterectomy may be the only recommended treatment option.

 

What are the types of hysterectomy?

Depending on the reason for the hysterectomy, the surgeon may choose to remove all or only part of the uterus. 
Surgery can be performed under spinal or total anesthesia .

Subtotal Hysterectomy
In a subtotal hysterectomy surgical operation, the surgeon removes only the upper part of the uterus, leaving the cervix.

Total
hysterectomy A total hysterectomy removes the entire uterus and cervix.

Radical hysterectomy
During radical hysterectomy, the surgeon removes the uterus, tissues that are located next to the uterus, cervix, and upper part of the vagina, also perform Oophorectomy. 
Radical hysterectomy is usually performed only when you have a tumor.

Oophorectomy
The oophorectomy is a surgical operation where you remove the ovaries.

 

Hysterectomy for women of childbearing age

Once a woman has had a hysterectomy of any kind she can not get pregnant. 
When removing the ovaries from a premenopausal woman, ovulation can not occur. 
This means you will have a drop in sex hormones: estrogen and progesterone. 
This can cause vaginal dryness, heat waves, sweating and other menopause symptoms. 
Women who undergo bilateral oophorectomy (removal of both ovaries) usually take hormone replacement therapy to maintain hormone levels.

 

Alternative cures

Hysterectomy should be the last to be the last therapy to be considered when all other treatment options have failed unless the woman has cancer. 
Other treatments for the disease that resolve with hysterectomy include:

  • Fibroids – the options are surgery to remove them (myomectomy), drugs that temporarily block the action of sex hormones, freezing, cauterization, laser removal (peripheral myolysis) or resection (cut) when inside the uterus (submucous) .
  • Abundant bleeding – the options are the contraceptive pill for regular cycles, other hormonal pharmacological therapies, surgical removal of the endometrium (the lining of the lining of the uterus).
  • Uterine Prolapse – Options include perineal rehabilitation exercises, insertion of a pessary into the vagina to brace the uterus or surgical repair
  • Endometriosis – the options are hormonal medications and surgical removal of endometriosis.

 

How to do a hysterectomy?

There are several ways to perform a hysterectomy.

Abdominal hysterectomy. This procedure is done through a 12/16 cm (cut) incision in the lower abdomen. The cut can be vertical or horizontal just above the junction of pubic hair.

Vaginal hysterectomy. An incision is made through the vagina. The doctor performs the hysterectomy and closes with stitches.

Laparoscopic hysterectomy. 
The laparoscope is an instrument that consists of a thin tube that ends with a light and a camera that allows the doctor to see the pelvic organs. The doctor makes three or four small cuts (less than 1 cm) in the abdomen to insert a laparoscope and other instruments. 
The uterus is then cut into small pieces and removed through the incisions. 
The duration of laparoscopic surgery is about 45-60 minutes.

Laparoscopic assisted vaginal hysterectomy
The doctor removes the uterus through the vagina. The laparoscope is used to guide the procedure.

Robotic-assisted laparoscopy

The doctor uses a special machine (robot) to perform the hysterectomy through small cuts in the belly, the procedure is similar to a laparoscopic hysterectomy (see above). Often the surgeon performs this operation when a patient has a cancer or is very overweight and vaginal surgery is not safe. 
Complications after a hysterectomy

Possible complications of a hysterectomy include:

  • Nausea and vomiting
  • Infection
  • Internal bleeding
  • Blood accumulation below the points ( hematoma )
  • Internal scar tissue
  • Allergic reaction to anesthesia
  • Blood clots
  • Difficulty urinating
  • Decreased sexual desire
  • Constant pelvic pain
  • Bellyache
  • Injury to the bowel, bladder, or ureters (tubes that carry urine from the kidneys to the bladder) – rare
  • Fistula (abnormal bore between internal structures, such as the intestine and vagina) – rare
  • Vaginal prolapse (when the upper vaginal wall loses its shape, descends and protrudes).

Recovery after hysterectomy and consequences

You need to follow your doctor’s advice, but the general tips for the first six weeks after surgery are: 
Maximum possible rest – at least two weeks rest. You better rest in bed. 
Exercises – continue with the exercises taught in the hospital. You should take a walk every day if your doctor is not otherwise. 
Standing – avoid standing for more than a few minutes in the immediate postoperative period. 
Avoid weight lifting . 
Constipation – to avoid constipation , drink lots of fluids and eat fresh vegetables and fruits. 
Medications – if your doctor prescribed antibiotics, you need to complete the treatment, even if you are well after taking some tablets. 
Sexual intercourse – It is recommended to avoid vaginal intercourse until postoperative control (about four to six weeks after the operation) to ensure that the vagina is fully healed. 
If vaginal dryness is a problem, you can use water-based lubricants or almond oil.

 

Hysterectomy and sexual intercourse

Removal of the uterus should not prevent you from having sex after the operation. 
In fact, many women report an improvement in sexual intercourse after a hysterectomy. 
This is because it eliminates the disturbance by which the woman decided to perform the hysterectomy (pain, heavy bleeding, etc.). 
However, some women note that a hysterectomy affects their sex life. 
In particular, some women feel that sexual intercourse is different after a hysterectomy or even has trouble reaching it. 
A hysterectomy does not decrease sexual desire (libido) unless you also remove the ovaries. 
It is usually possible to resume sexual intercourse about six weeks after the operation.

 

How long does it take for healing?

This varies from person to person. Usually recovery is faster if the incision is made through the vagina. 
For a few weeks after the operation, you have to remain at rest. 
Hospitalization (recovery) takes about 10 days in the case of abdominal hysterectomy and is less than for vaginal hysterectomy, about 4 days. 
Your doctor probably recommends mild exercises that increase progressively. Usually full recovery takes about 6-8 weeks, but some women need 3 months. 
You can not drive until you can not do emergency braking. 
It usually takes about six weeks after the operation, but it is best to talk to the insurer. 
The time to return to work depends on the type of work.

Lumbar pain after hysterectomy

After any surgery, especially abdominal surgery, severe spinal pain may occur . 
It usually occurs in the first month after the operation and if you do not do the proper treatment can become chronic. 
The cause of postoperative pain is the scar, although surgery is performed on laparoscopy plus a scar forms within the body. 
Surgery can be successful; in any case, the scar is a fibrous tissue that forms in an area where it should not, so it is not natural and the body can not always adapt. 
The scar is fibrous as a patch on a clothing and creates abnormal stress to muscles, nerves and connective tissue. 
To resolve this issue, you must run:

  • The detachment of the surgical scar in the first month after surgery,
  • The manipulation of the fascia at the level of the lumbar and abdominal muscles for the tissue release for adhesions as a consequence of the intervention.

 

Long-term results after hysterectomy

After hysterectomy, there is no need for contraception. If the ovaries were removed, if menopause enters , the first symptoms begin a few days after the surgery. 
It is normal that with the menopause the weight increases, the abdominal muscles begin to reduce and we have the tendency of weight gain in the belly. 
You need to talk to your doctor about hormone replacement therapy to prevent menopausal symptoms, but there are risks and contraindications. 
Hysterectomy is effective for gynecological conditions such as fibroids, endometriosis and adenomyosis, but some diseases may be present, for example, cancer in advanced stages. 
You need to do regular checkups to make sure you do not have cancer.
Your doctor may recommend regular testing, in which case the cells analyzed originate from the vagina rather than the cervix.

 

Do you need to have a Pap test after hysterectomy?

The Pap test is used to check the uterus if:

  • The woman had cancer of the cervix,
  • The hysterectomy is parisial and the cervix has not been removed.
  • Hysterectomy was done for cancer.

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