Hysterectomy is surgical removal of the uterus. A total hysterectomy is removal of the uterus and cervix, and a subtotal or partial hysterectomy is removal of the uterus while leaving the cervix. The ovaries can be left in or removed during a hysterectomy. Removal of both tubes and ovaries is called bilateral salpingo-oophorectomy or BSO. Hysterectomies can be done through the vagina, the abdomen, or through a laparoscope.
Hysterectomy is the ultimate treatment for vaginal bleeding. Removal of the cervix and uterus will permanently stop vaginal bleeding in essentially all cases. It is a big step. It is major surgery with risk and recovery and permanently removes these structures. Leaving the cervix in and taking out the uterus in some cases reduces the difficulty and some risk of surgery but it is possible to have bleeding from the cervix. If the ovaries are left in there will be no change in the women’s hormones. Removing both ovaries will cause a women to go into menopause. Hysterectomy does not change the way sex feels for a woman. On average a woman’s sex life tends to improve after hysterectomy. This is because whatever the problem was that made hysterectomy necessary usually also negatively impacts sexual relations as well. Curing the problem with a hysterectomy can benefit many aspects of a woman’s life that were negatively affected, including a woman’s sex life.
Abdominal hysterectomy is done by making an incision in the abdomen and removing the uterus through the abdominal incision. This usually requires 2-3 nights stay in the hospital. Recovery is about 6 weeks, with the first two weeks being the most difficult. The cervix can be removed or left, as can the ovaries. The advantage to the abdominal hysterectomy is that it gives the greatest access to the tissues around the uterus. The risk of bleeding or injury to surrounding tissues is the lowest for this form of surgery. The reasons to do an abdominal hysterectomy are for a very large uterus or the possibility of significant scar tissue from previous surgery. Various other factors may also affect the decision.
Vaginal hysterectomy is removal of the uterus through the vagina. This involves no incisions in the abdomen and greatly reduces recovery compared to abdominal hysterectomy. Vaginal hysterectomy involves an overnight stay in the hospital and 2-4 weeks recovery with much less pain than an abdominal hysterectomy. The cervix must be removed with a vaginal hysterectomy. The ovaries are usually left in but sometimes can be removed during a vaginal hysterectomy. In a case where the ovaries need to be removed, this can not always be accomplished with a vaginal hysterectomy. In order to be a candidate for a vaginal hysterectomy the uterus must be small enough to remove safely through the vagina, there must not be scar tissue in the abdomen, and preferably the woman has had at least one vaginal delivery in the past. There is increased risk of bleeding with a vaginal hysterectomy but for the appropriate candidate this can be a very nice way to do a hysterectomy.
Laparoscopic hysterectomy is done through a camera that is placed through the abdomen. Several tiny incisions are made in the abdomen and the uterus is removed through the small holes in pieces. The patient may stay overnight or in some cases go home the same day. Recovery is about 2 weeks. In some cases, the uterus is removed through the vagina after some of the surgery has been completed using the camera. This is called a laparoscopic assisted vaginal hysterectomy. The advantage of the laparoscopic hysterectomy is the decreased recovery time and the minimal incisions. To be a candidate for a laparoscopic hysterectomy there cannot be too much scar tissue and the uterus may be larger than that of a candidate for a vaginal hysterectomy, but not extremely large.
The decision of which approach to use for hysterectomy is complicated and nuanced. There is the balance of risk and recovery. Many factors will play into the decision including the size of the uterus, previous abdominal surgeries, number of children and type of delivery, other medical issues in the patient, and the patients desire and willingness to accept a slight increase of risk for the benefit of decreased recovery time.