Hysterectomy is among the most commonly performed surgical procedures in the United States. Even with the increased popularity of conservative therapies, hysterectomies are still preferred due to their effectiveness and relatively quick recovery.  Hysterectomy could be performed abdominally, vaginally or laparoscopically. The selected method is determined by the reason for the surgery, among other health considerations. In this article, we are focusing on vaginal hysterectomy.

What Is Vaginal Hysterectomy?

This is a procedure that features the surgical removal of the uterus through the vagina. During this operation, the fallopian tubes and one or both ovaries may be removed. The removal of just the fallopian tubes is referred to as bilateral salpingectomy. On the other hand, the removal of both the fallopian tubes and the ovaries is called bilateral salpingo-oophorectomy. Vaginal, as opposed to abdominal approach, is often employed if the uterus is not significantly enlarged.

What are the Reasons for Vaginal Hysterectomy?

Maybe you are wondering why you would need to have this procedure performed on you. Well, vaginal hysterectomy is commonly advised due to the following reasons:

  • Abnormal uterine bleeding. Excessive uterine bleeding, also known as menorrhagia, could easily cause anemia and fatigue, thus contributing to prolonged abscence from work or school and difficulty with family and home responsibilities or activities. Irregular uterine bleeding should first be treated with medication and other non surgical alternatives, resorting to hysterectomy if the condition doesn’t improve following such treatments.
  • Pelvic organ prolapse. Following excessive weakening and stretching of the pelvic muscles, your pelvic organs, including the uterus, cervix, rectum, bladder or a combination of these could drop down, bulging into the vagina. Pelvic organ prolapse is normally associated with vaginal childbirth, chronic constipation, pregnancy, genetic factors, and lifestyle; for example, repeated heavy lifting. Although a prolapse does not affect the uterus, removal of the uterus most of the time is necessary to correct the prolapse and to prevent a recurrence.
  • Fibroids. Also known as leiomyoma, fibroids are non-cancerous tumors of the uterine muscle that often enlarge during pregnancy while shrinking after menopause. This could lead to excessive and irregular uterine bleeding, difficult bowel movements, pain while emptying the bladder and lower abdominal pressure or pain.

Discussed above are just a few among the many conditions that can be rectified through vaginal hysterectomy. Other conditions that could use this procedure include treatment of cervical abnormalities, endometrial hyperplasia, and chronic pelvic pain.

What Is the Procedure for Vaginal Hysterectomy?

In preparation for the surgery, a few procedures are executed, including enema as well as blood and urine tests.  In regards to hygeine and the surgery, you should clean your pubic area using an antiseptic solution before shaving it on the day before the surgery.  Fluids and medications will be delivered into your body intravenously.  While this procedure does not include abdominal incision, you will nevertheless require anesthesia, whether epidural or general.

To protect your breathing and oxygen levels during this surgery, an endotracheal tube (ET tube) will be positioned down your throat after you are asleep.  A catheter will also be inserted into your bladder after you are asleep to keep the bladders deflated and safely away from the surgery area.  Another safety procedure is to use compression stockings to prevent the formation of blood clots in your legs during the surgery.

Through a vaginal incision at the top of the vagina and just outside of the cervix, the surgeon will detach your uterus from the vagina.   This is done with long instruments so the surgeon can reach the uterus.  Additionally, the long instruments will allow the surgeon to reach your ovaries, fallopian tubes, blood vessels, and connective tissues.  Dissolvable sutures are used internally to prevent bleeding each time a part of the uterine attachments are clamped and cut.  To maintain your pelvic support and prevent prolapse your uterosacral ligments will be re-attached to the top of the vagina.  Finally, the incision at the top of the vagina will be closed using dissolvable stitches. This procedure lasts for 1-3 hours.

Recovery

After the successful completion of the surgery, you will want to stay in the recovery room for about one to two hours to allow the surgeon to monitor your vital signs while giving you pain reliever and medication to prevent infection. Following a hysterectomy, you might experience a little bloating, a few cramps and more likely than not, a small amount of bloody vaginal discharge that is normally brown in color with a slight odor. This could go on for a few days or even weeks.

Fortunately, vaginal hysterectomy involves a shorter recovery time as compared to abdominal hysterectomy. In fact, you can leave the hospital the next day; you will be provided with instructions pertaining to bathing, showering, and driving.  You can drive and shower the next day.  Most of the time taking a bath will not be recommended until four to six weeks later.

You will also be able to move around comfortably within no time and also enjoy a normal diet. It is advisable that you don’t engage in heavy lifting that exceeds 20 pounds within the first four weeks. Ideally, full recovery takes 3-6 weeks, allowing you to resume normal activities, but sexual intercourse will be ok after 5-6 weeks due to the stitches at the top of the vagina..

What Complications Should You Expect after Vaginal Hysterectomy?

Although vaginal hysterectomy is relatively less risky as compared to abdominal hysterectomy, some complications could arise just like from any other surgery. Such include infection, blood clots, allergic reaction to anesthesia, bleeding, bowel obstruction, and damage to your urinary tract or bladder.

If you experience nausea, vomiting, chest pain, excessive fever or difficulty in breathing, consider alerting your doctor.

What Life Changes Should You Expect after Hysterectomy?

Depending on your life circumstances and reasons for surgery, you should expect some life changes and significant improvements in how you feel. For instance, you will no longer have monthly periods, any vaginal bleeding, or cramps. However, your sexual functionality will return to normal after fully recovering from this procedure.  Most women notice an improvement in sex because they no longer have any cramps or bleeding from a uterus.

If you did not have your ovaries removed, you should not have any lasting hormonal changes.  Sometimes in the first several weeks while healing you might notice some temporary and mild hormonal fluctations.  But, if you had your ovaries removed, you should also expect some hormonal changes.  Such symptoms include vaginal dryness, hot flashes, mood changes, night sweats, and decreased libido. If the symptoms become too severe, discuss with your doctor about possible remedies. You may also need to increase your vitamin D and calcium intake.

Summing Up

It is clear that vaginal hysterectomy involves spending less time in the hospital, and there is a lower complication rate compared to an open abdominal hysterectomy.  Although most women feel very good in 1-2 weeks, fatigue can be a factor while you are healing.   You will be able to achieve full recovery within 5 to 6 weeks; you should however maintain your post-surgery follow up appointments. Also, be sure to eat a healthy, balanced diet while drinking plenty of fluids.  Most importantly, you will want to report any unexpected symptoms to your doctor.

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