Hysterectomy – How Does Removing the Uterus Affect Life?

What is a hysterectomy?

Hysterectomy is a surgical procedure to remove the uterus (sometimes combined with the removal of the ovaries and fallopian tubes). The procedure is irreversible, so the decision to undergo it must be based on specific health indications and confirmed by the informed consent of the patient.

Hysterectomy - reasons for surgery

Hysterectomy – apart from diagnosed cancer – is performed in the following cases (if the patient has no further reproductive plans):

• uterine fibroids – cause painful, heavy and long menstrual bleeding;
• endometriosis – is characterized by the presence of cells of the uterine lining outside its cavity, which causes inflammation and extremely severe pain during menstruation. You can read more about this disease in our articles: what is endometriosis, its diagnosis and treatment , endometriosis surgery and endometriosis and pregnancy and infertility ;
• disorders of reproductive organ statics – i.e. lowering and sometimes even prolapse of the uterus; may be caused by numerous deliveries, weakening of the pelvic floor muscles, physical work or advanced age.

Four Types of Hysterectomy

• Total – removal of the entire uterus (i.e. both the body of the uterus and the cervix).
• Partial – In a partial hysterectomy, only the body of the uterus is removed.
• Total ovarian salpingo-oophorectomy – in addition to the uterus, the ovaries and fallopian tubes are also removed during the surgery.
• Radical – removal of the uterus along with the upper part of the vagina and surrounding lymph nodes.

In what cases are the ovaries and fallopian tubes removed?

How radical the hysterectomy should be depends on the condition and the patient's general health. Most often, this most extensive hysterectomy is performed in the case of diagnosed uterine or adnexal cancers. In the absence of such indications, the ovaries are left. The fallopian tubes are removed because they are no longer needed as structures (they constitute a tunnel connecting the ovary with the uterine cavity) - additionally, their removal reduces the risk of ovarian cancer (which may originate from the fallopian tube, specifically from its infundibulum). The removal of the adnexa is often preventive for people genetically burdened with such diseases.

Methods of surgical removal of the uterus

Thanks to the development of surgery, hysterectomy can be performed in the following 3 ways:

Laparoscopic

It is performed under general anesthesia. During the operation, the gynecologist inserts a laparoscope, a device that allows viewing the interior of the abdominal cavity, through small incisions around the navel. Then, laparoscopic instruments are used to cut the uterus. If the procedure involves the entire uterus, it is removed through the vagina, and if only its body is removed, it is cut from the cervix and, after fragmenting it in the abdominal cavity, removed in pieces through an abdominal incision.

Transabdominal (laparotomy)

This method is also called classical. It is performed under general anesthesia. The abdominal incision can be transverse or longitudinal. The doctor orders laparotomy if it is technically impossible to perform laparoscopy (for example, in the case of very large lesions, widespread neoplastic disease or if the patient has had numerous abdominal surgeries and adhesions may occur because of this). Laparotomy is also chosen by those surgeons who have no experience in laparoscopic surgeries. The nature of the transabdominal surgery is associated with a worse cosmetic effect and long healing of postoperative wounds.

Transvaginal

It is the least invasive method of removing the uterus. Laparotomy (opening the abdominal wall) leaves a large wound, so recovery can take a long time; laparoscopy, on the other hand, requires a smaller incision, but wounds remain after the procedure. Transvaginal surgery is associated with less pain and the risk of postoperative complications. In addition, it does not leave visible scars.

Recovery after uterine removal

A hysterectomy is a serious procedure that involves a lot of stress, anxiety, and fear.

The hospital stay after the procedure usually lasts from 1 to 5 days, and full recovery occurs after about 2 months. Of course, this is average information - how quickly and in what way the recovery will proceed after the removal of the uterus depends on several factors:

• fitness and health condition before surgery,
• due to a hysterectomy,
• type and method of performing the procedure,
• course of the operation.

After the hysterectomy, the gynecologist usually issues a 30-day sick leave. The check-up should take place every year, and in the case of people whose hysterectomy was caused by oncological issues - from 2 to 3 times a year. After such operations caused by cancer, further chemotherapy or radiotherapy may still be necessary.

For about half a year after the surgery, it is a good idea to refrain from straining the body, lifting and excessive fatigue. You should gradually return to physical activity and the "old" lifestyle. And when it comes to sex - it is worth waiting a few weeks to start having sex. During intercourse after the surgery, discomfort and slight pain may appear, but these should pass with time. Of course, if the recovery period is accompanied by other disturbing symptoms, you should immediately consult them with your doctor.

Hysterectomy – side effects

Possible complications after a hysterectomy are not much different from those that can occur after any gynecological procedure. During hospitalization, but also for some time after leaving the hospital, the person should remain under the close care of a doctor.

During the first 2 weeks after the procedure, the following may occur:

• genital bleeding,
• thromboembolic complications,
• urinary incontinence (most often due to lowering of the vaginal walls),
• urethral and bladder infections.

If the uterus was removed during the procedure, there was no indication or necessity to remove the ovaries as well, and the patient is premenopausal, they will continue to produce sex hormones. The situation is different in cases where a more radical procedure was necessary and the uterus and its adnexa were removed.

Side effects of salpingo-oophorectomy

Removal of the ovaries in premenopausal women leads to a very rapid drop in the level of sex hormones (estrogens) in the body. This is most often the cause of symptoms characteristic of menopause, such as:

• hot flashes and sweating at night,
• sleep disorders,
• mood swings.

This condition is called surgical menopause , which is the kind that occurs as a result of medical interventions. The occurrence of symptoms of premature menopause means that the hospital stay may be longer, and the quality of recovery itself - worse.

(Estrogen) hormone replacement therapy

The aim of hormone therapy after hysterectomy is to eliminate the above-mentioned negative effects of gonadal function cessation.

Chronic sex hormone deficiency can significantly affect quality of life and have serious health repercussions, including:

• Cardiovascular diseases – such as coronary heart disease, heart rhythm disorders.
• Osteoporosis – a decrease in bone mass and bone structure. This can lead to so-called osteoporotic fractures, which take a long time to heal, are ineffective, and can lead to permanent disability.
• Psychological problems, often related to the sexual sphere – surgery to remove the uterus and adnexa and the associated surgical menopause can cause vaginal dryness (due to reduced mucus production), decreased libido, urinary incontinence or weight gain. For many people, this is associated with a lot of stress, shame and embarrassment, and such a large emotional load can lead to the development of depression and body image disorders and lowered self-esteem.

The level of estradiol, or basic estrogen, drops rapidly already on the first day after surgery. The doctor should regularly verify the effects of the therapy, and also strive to establish the optimal dose and form of its administration. Although the use of hormone replacement therapy may be necessary and beneficial for health and well-being, it is associated with the risk of complications. Hence such a wide discourse on this form of supporting the body - the doctor should discuss all its aspects with the patient, both positive and negative.

The effects of taking hormone replacement therapy depend on, among other things:

• age,
• comorbidities,
• age of occurrence of surgical menopause.

The main component of hormone replacement therapy is estrogen . To prevent the development of endometrial cancer, progesterone is also added and it is this that is responsible for most of the adverse effects of this type of treatment (possibility of developing breast cancer, thromboembolic complications, and so on).

In postmenopausal people who have had their uterus removed, the use of ERT:

• does not significantly affect the risk of coronary events, invasive breast cancer and general condition,
• increases the risk of stroke,
• reduces the risk of fractures associated with osteoporosis.

If the patient has been previously diagnosed with any of these conditions, the doctor may suggest transdermal therapy instead of oral supplementation. After surgery to remove the adnexa, hormone therapy is also sometimes administered intranasally.

Hysterectomy and sexual intercourse

Almost every procedure, even the least invasive, carries the possibility of side effects and complications. However, they do not always concern only the physical sphere - hysterectomy is an extremely difficult experience for many people, requiring psychological support.

People who undergo hysterectomy often fear losing their "femininity". Many of them feel less attractive after the surgery, and sex with a partner - instead of joy and satisfaction - brings more stress and anxiety (and not only because of post-procedure discomfort).

The uterus is associated by many with the attribute of femininity, the cradle of the superpower of being able to give birth to children. Of course, the perception of the role and significance of this organ is an individual matter, but it also depends on the culture and society in which we live. Not every person wants to have children - but what if the surgery to remove the uterus affects the quality of sexual life? Regardless of desires and aspirations, hysterectomy in both cases raises similar fears and doubts.

On the other hand, gynecological surgeries (such as hysterectomy) can have a positive impact on the quality of sexual life by eliminating pain (caused, for example, by the presence of uterine fibroids). The external genitalia and their appropriate stimulation are also responsible for the sensation of sexual stimuli. The issue of the impact of hysterectomy on sexual intercourse is therefore controversial and depends on individual conditions.

Also check out our articles on masturbation: " Is masturbation healthy? " and " Female masturbation ".

The purpose of uterine removal surgery is primarily the necessary improvement and protection of health. Radical procedures, during which the uterus and adnexa are removed, are often a form of saving lives in the course of cancer.