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What is a hysterectomy?

A hysterectomy is the surgical removal of the uterus, and most likely, the cervix. Depending on the reason for the surgery, a hysterectomy may involve removing surrounding organs and tissues, such as the fallopian tubes and ovaries. The uterus is where a baby grows during pregnancy. It’s lining is the blood you shed during your menstrual period. You lose the ability to get pregnant and you will not get your period after a hysterectomy.

What are the different kinds of hysterectomy?
1. Total hysterectomy: Removing the uterus and cervix, but leaving the ovaries.
2. Supracervical hysterectomy: Removing just the upper part of the uterus while leaving the cervix.
3. Total hysterectomy with bilateral salpingo-oophorectomy: Removing the uterus, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy). If you haven’t experienced menopause, removing the ovaries will start menopausal symptoms.
4. Radical hysterectomy with bilateral salpingo-oophorectomy: The removal of the uterus, cervix, fallopian tubes, ovaries, the upper portion of the vagina and some surrounding tissue and lymph nodes. This type of hysterectomy is performed when cancer is involved.

Why is a hysterectomy performed?
It is done to treat:
1. Abnormal or heavy vaginal bleeding that is not controlled by other treatment methods.
2. Severe pain with menses that is not controlled by other treatment methods.
3. Leiomyomas or uterine fibroids (noncancerous tumors).
4. Increased pelvic pain related to the uterus but not controlled by other treatment.
5. Uterine prolapse (uterus that has “dropped” into the vaginal canal due to weakened support muscles) that can lead to urinary incontinence or difficulty with bowel movements.
6. Cervical or uterine cancer or abnormalities that may lead to cancer for cancer prevention.
7. Conditions with the lining of your uterus like hyperplasia, recurrent uterine polyps or adenomyosis.
8. General anesthesia in which you will not be awake during the procedure; or
9. Regional anesthesia (also called epidural or spinal anesthesia) in which medications are placed near the nerves in your lower back to “block” pain while you stay awake.

There are several different surgical approaches to perform a hysterectomy:

Vaginal hysterectomy:
1. Your uterus is removed through an incision at the top of your vagina. There is no external incision.
2. Dissolvable stitches are placed inside the vagina.
3. Most commonly used in cases of uterine prolapse and other non-malignant (or noncancerous) conditions.
4. Fewest complications and fastest recovery (up to four weeks) and is considered the preferred approach.
5. Patients often go home in 2 days of surgery.

Laparoscopic hysterectomy :
1. A laparoscope (a thin tube with a video camera on the end) is inserted in the lower abdomen through a small incision in the belly button.
2. Surgical tools are inserted through several other small incisions.
3. Your uterus can be removed in small pieces through the incisions in your abdomen or through your vagina.
4. Usually people go home after 2 days.
5. Full recovery is shorter and less painful than an abdominal hysterectomy.

Abdominal hysterectomy :
1. Your uterus is removed through a six- to eight-inch-long incision in your abdomen.
2. The incision is made either from your belly button to your pubic bone, or across the top of your public hairline.
3. Most commonly used when cancer is involves, when the uterus is enlarged or when disease spreads to other pelvic areas.
4. It generally requires a longer hospital stay (three days) and a longer recovery time.

Will I enter menopause after a hysterectomy?
This depends on whether the ovaries were removed. If your ovaries remain after a hysterectomy, you will not enter menopause right away. If both of your ovaries were removed during the hysterectomy, you might enter menopause immediately.

Do I still need a Pap test if I have had a hysterectomy?
Generally, no and especially if you are deemed to be at low risk for developing cervical cancer. You should continue to have a Pap test if you had a hysterectomy because of cancer.

Does a hysterectomy affect my sex life?
Your sexual function is usually not affected by a hysterectomy. If the ovaries were removed with the uterus, this could start symptoms of menopause. Symptoms such as low sex drive and vaginal dryness may occur. Using a water-based lubricant can help with dryness.

A note from Manasi Clinic
A hysterectomy can offer relief from many conditions of the uterus like irregular bleeding or painful periods. Remember, talk openly and honestly with us about your symptoms so we can recommend the best treatment. We are able to offer Total Laparoscopic hysterectomy to our patients where the entire procedure can be done laparoscopically thereby reducing post op pain dramatically and allows for shorter hospital stay and faster recovery.


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