One of the big questions for most women who consider the option of a radical hysterectomy is: How will this impact my sex life? What can I do about it? To figure that out, we first need to establish what a radical hysterectomy is. We’ll also cover who really needs it, the various types of radical hysterectomies, risks involved, how patients recover, and alternatives to this procedure.
What Is a Radical Hysterectomy?
A radical hysterectomy is used to treat cancers of the cervix. The surgeon removes the uterus and the ligaments (tissue fibers) that hold it in place. The cervix and 1 to 2 inches of the vagina around the cervix are also removed. A hysterectomy surgery for uterine or ovarian cancer actually removes less tissue.
Once the cervix is removed, the vagina is stitched closed at the top. This on the inside, 1-2 inches down from where the cervix used to be located. The vagina then will have a closed end inside and will not become an open tunnel to the pelvis, as some women fear it will.
If a woman is under the age of 40, the surgeon will try to leave an ovary or part of one in. Even one ovary makes enough hormones to stop early menopause. Since the uterus is gone, the woman will not be able to have a menstrual cycle or carry a child.
If the woman is between the ages of 40 and 50, the surgeon will advise whether or not removing both ovaries to prevent ovarian cancer and allowing the woman to enter early menopause is the best decision.
The surgeon will most likely remove both ovaries if the woman is over the age of 50.
Types of Radical Hysterectomies
There are four types of radical hysterectomies. The type used will depend on the stage of cervical cancer.
The type I radical hysterectomy, which is also known as the extrafascial or simple hysterectomy, removes the cervix along with the uterine corpus. This does not require the mobilization of the ureter or removal of a significant amount of parametria. Because the type 1 is the same as a simple hysterectomy, the radical terminology is not utilized 99% of the time
A type II (modified) radical hysterectomy, also known as the Wertheim operation, requires more of a dissection than type I. The central portion of the parametrial tissue is removed while minimizing disruption to the ureteral and vesical vasculature. Removal of a 1 to 2 cm portion of the upper vagina, pelvic and para-aortic lymphadenectomy is almost always performed with type II.
The type III radical hysterectomy removes as much parametrial tissue as possible. Care is taken to preserve the superior vesical artery. Removal of 2 to 3 cm of the upper vagina, pelvic, and para-aortic lymphadenectomy is also performed with the type III radical vasectomy.
A type IV radical vasectomy is rarely used and is known as the extended version of the radical hysterectomy. This procedure involves the complete dissection of the ureter from the pubovesical ligament and the removal of up to 75% of the vagina.
Who Needs a Radical Hysterectomy?
A woman may need a radical hysterectomy if she is diagnosed with:
- Cancer of the uterus, cervix, or ovaries.
A woman may need a standard hysterectomy if she is experiencing any of the following symptoms:
- Uterine fibroids that cause pain, bleeding, and other problems.
- Uterine prolapse, which is the sliding of the uterus from the normal position into the vaginal canal.
- Abnormal vaginal bleeding.
- Chronic pelvic pain.
- Adenomyosis, which refers to the painful glands in the wall of the uterus.
Risks Involving Radical Hysterectomies
Complications that can occur after a radical hysterectomy can include:
- Heavy blood loss.
- Bladder or bowel injury.
- A blood clot in the lungs.
The risk of infection is lowest when the doctor gives you an antibiotic immediately during and sometimes also after surgery. Other ongoing complications that can occur after this surgery can include:
- Difficulty urinating.
- The weakness of pelvic muscles and ligaments supporting the vagina, bladder, and rectum.
- Continued heavy bleeding.
- Some women may experience early menopause.
- Adhesions, or the formation of scar tissue, in the pelvic area.
Each woman’s body will react differently in how long it takes her to recover. Some will be able to go home the next. day; some will have to stay in the hospital 1 – 2 days for post-surgery care.
Once the patient feels up to it, she should start walking and moving around. This way, you will avoid complications such as blood clots, pneumonia, and gas pains. During the first 2 – 3 weeks, get plenty of rest. Avoid lifting more than 20 pounds during the first 4 – 6 weeks after surgery. At this time, you should also avoid vaginal intercourse.
Vaginal dryness from low estrogen levels may make intercourse painful. If so, use a vaginal lubricant, purchased from the store or even coconut oil works well. You could also use a low-dose estrogen cream, ring, or tablet which will reverse vaginal dryness. Estrogen therapy can help as well if you’re experiencing other menopausal symptoms.
If you can’t take hormones or simply want to avoid taking hormones there are a couple other options. One is a oral pill called ospemifene that will make the vagina softer, have more elasticity, and have more moisture similar to when a woman is in her 30s or 40s. There are some other non-hormonal pills for helping with menopausal hot flashes, night sweats, and mood changes as well.
Pain during intercourse could occur if your vagina was shortened during the surgery. Pelvic physical therapy and vaginal dilators are common solutions that will help. The ospemifene or estrogen cream work extremely well also. Changing positions may help to limit the depth of penetration. Many women find that the disruption to their sex life after a radical hysterectomy can be only temporary. Remember to talk to your doctor if you continue to have difficulty on this matter.
Alternatives to Radical Hysterectomies
If the patient has been diagnosed with a form of cancer, then the options are limited. Other cancer treatments include chemotherapy and radiation. Many times the radical hysterectomy is an alternative to both of those. Sometimes it is used in conjunction with chemo or radiation in order to increase the patient’s survival and successful cure rate.
If you have a non-cancerous condition, then there are other non-surgical options that should be attempted first. Drugs like contraceptive pills can reduce bleeding, along with tranexamic acid and mefenamic acid. Uterine artery embolization can block blood flow to fibroids and shrink or destroy them, reducing bleeding. The Mirena IUD can also reduce bleeding.
Below are examples of other types of surgery that can be done in the place of a standard abdominal hysterectomy:
- Endometrial Ablation.
- Hydro-thermal Ablation
- Balloon Thermoablation.
- Laparoscopically Assisted Hysterectomy.
- Robotic Hysterectomy
- Vaginal Hysterectomy
A radical hysterectomy is used for cancers of the cervix. There are several types. There are many risks associated with this procedure, and recovery can be tedious which is why it is reserved only to treat cancer. So be sure to speak with your doctor if you feel you may need the surgery or are considering it.
If you or anyone you know has had a radical hysterectomy or has had any of the alternative treatments, please leave a comment if you would like to share your experience and help others out. Take care and stay healthy!