Hysterectomy is the surgical removal of the uterus, or womb. Depending upon the type of procedure that is performed and the reason for the surgery, hysterectomy may also include removal of the adjacent Fallopian tubes and ovaries. Hysterectomy is the most common major surgical procedure (unrelated to pregnancy) performed on women. Approximately 300 out of every 100,000 women will undergo a hysterectomy. The most common reason hysterectomy is performed is for uterine fibroids. The other reasons include abnormal vaginal bleeding, endometriosis and uterine prolapse. The choice of types of surgical procedures depends upon the reason for the procedure and the underlying medical condition of the patient. A hysterectomy is a major decision that patient should take after careful consultation with doctor. Patient should understand the reason for the operation, the benefits and risks and the alternatives to a hysterectomy.
Prior to the decision of a hysterectomy, the pelvic examination and Pap smear tests are must. For pelvic pain laparoscopy procedures are commonly undertaken. Removal of uterus is major decision and extensive evaluations are necessary before finalising this procedure.
There are 4 different methods for removal of the uterus. These include:
1.Total abdominal hysterectomy
The doctor removes the uterus, including the cervix though incision from the abdomen. The scar may be horizontal or vertical, depending on the reason the procedure is performed, and the size of the area being treated.
The uterus is removed through the vagina. It is an appropriate hysterectomy procedure for uterine prolapse, endometrial hyperplasia, or cervical dysplasia.
3.Laparoscopy-assisted vaginal hysterectomy
Laparoscopy-assisted vaginal hysterectomy (LAVH) is similar to the vaginal hysterectomy procedure conducted with the use of a laparoscope. Supra-cervical hysterectomyA supra-cervical hysterectomy is used to remove the uterus; the cervix is maintained. It is a simpler procedure and requires less time to perform.
All these procedures are conducted under spinal or general anaesthesia and taken usually 2- 4 hours depending in the type of procedure, size of the uterus and other related issues.
Hysterectomy is a treatment option in the treatment of uterine cancer, cervical cancer as well as for some benign conditions such as fibroids and endometriosis which results in abnormal bleeding, pelvic pain and discomfort to the patient.
Like any surgery, patient must discuss all the health concerns with the doctor prior to the procedure. Young women must recognise that after hysterectomy, they can bear children and must evaluate all the pros and cons prior to the surgery. Patient’s diagnosis with uterine cancer needs follow up treatment for cancer. All the physiological parameters of the patient must be stable at the time of surgery. Post-surgery patient must take sufficient rest and should not lift heavy weights, join strenuous exercise programmes. Patient should join back normal activities only after the advice from clinician.
Will I lose all desire for sex?
Hysterectomy should not affect desire. The most common causes of decreased sexual desire are stress causing fatigue, anger at one's partner (conscious or unconscious), and fear of pain with relations. All of these components can change with hysterectomy and the time of recovery.
Are there any advantages to having a vaginal hysterectomy rather than an abdominal hysterectomy?
Yes, vaginal hysterectomy is beneficial than an abdominal hysterectomy. The main advantage is quick recovery. However, vaginal hysterectomy isn't appropriate for all conditions.
Will I still menstruate after I have a hysterectomy?
After a hysterectomy you will no longer menstruate or be able to conceive, but you will still be able to engage in sexual activities.
What different evaluations one must take before deciding for hysterectomy?
Abnormal uterine bleeding is the symptom that something is not right for the woman and all possibilities must be ruled out. These include evaluation for endometriosis thickening (inner lining of the uterus), presence of fibroids, uterine cancer or precancerous stage, cervical cancer and pelvic inflammatory diseases.
Is Laparoscopy-assisted vaginal hysterectomy a preferred surgical procedure?
NO; it is not. It takes longer time and recover period is longer than the abdominal and vaginal hysterectomy.
Myomectomy, sometimes also fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids.
Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix and the tissues of the vagina and vulva. Many premalignant lesions and malignant lesions in these areas have discernible characteristics which can be detected through the examination.
A Caesarean section is a surgical procedure in which one or more incisions are made through a mother's abdomen (laparotomy) and uterus (hysterectomy) to deliver one or more babies. A Caesarean section is often performed when a vaginal delivery would put the baby's or mother's life or health at risk.
Childbirth is an intense event with very strong emotions. The process of normal childbirth is categorized in three stages of labour: the shortening and dilation of the cervix, descent and birth of the infant, and the placenta being expelled. The most prominent sign of labour are the strong contractile waves that move the infant down the birth canal.
Menopause is the stage in a woman's life when menstruation stops and a woman can no longer bear children. This phase leads to gradual depletion in the production of female hormones estrogen and progesterone.
Infertility is the inability of a person to conceive children. Female infertility includes inability of the woman to conceive as well as inability to carry a pregnancy to full term until the child birth. About 40% of the issues involved with infertility are due to the man, another 40% due to the woman, and 20% result from complications with both partners.
Cervical cancer is a cancer arising from the cervix. It is the abnormal growth of cells that invade or spread to other parts of the body. Worldwide, cervical cancer is both the fourth most common cause of cancer and deaths from cancer in women.
Breast cancer is when cancer develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, fluid coming from the nipple, or a red scaly patch of skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.