Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina. When the uterus is removed by making an incision over the abdomen, the surgical procedure is called an abdominal hysterectomy. The choice of surgery depends on the size and shape of the uterus and the indication for surgery, which is up to the surgeon. Following hysterectomy, a woman would no longer be able to get pregnant and their periods would stop as well. Hence, if a woman is planning to retain her fertility, it is advised to inform the doctor, so they would be able to suggest other treatment options. Hysterectomy is usually indicated to treat various gynecological conditions affecting the reproductive organs when other treatment modalities are ineffective. The female reproductive organs include the vagina, cervix, uterus, fallopian tubes, ovaries, other accessory glands, and external genitals.
Vaginal hysterectomy usually takes around 2 hours. It may take longer or shorter depending on the extent of disease in the reproductive organs for which hysterectomy is being performed. Vaginal hysterectomy involves detaching the uterus from the upper portion of the vagina, fallopian tubes, ovaries, the surrounding blood vessels, and connective tissues that support it and then removing the uterus. The cervix (mouth of the uterus) may be removed as well. If either one or both the ovaries and fallopian tubes are also removed along with the uterus, the procedure is called total hysterectomy with salpingo-oophorectomy. The hospital stays and the postoperative recovery period following vaginal hysterectomy are shorter compared to abdominal hysterectomy.
When is vaginal hysterectomy done?
Vaginal hysterectomy is indicated when other treatment modalities are ineffective and if the condition can’t be managed conservatively or by other less invasive procedures. Vaginal hysterectomy may be performed in the following conditions:
- Cancer of the reproductive organs: Hysterectomy is the choice of treatment when there is a cancer of any of the reproductive organs. Most other gynecological conditions may be treated by other less invasive treatment modalities. The choice between vaginal or abdominal hysterectomy for cancer depends on the extent of cancer and the parts of the reproductive system involved.
- Uterine prolapse: The muscles and ligaments of the pelvis weaken causing the uterus to prolapse into the vagina. Hysterectomy is the choice of surgery for uterine prolapse. It may be combined with pelvic floor repair to repair the weakened tissues of the pelvis.
- Endometriosis: The inner lining of the uterus (endometrium) grows outside the uterus, involving the ovaries, fallopian tubes, and other organs in the pelvis. Endometriosis can cause adhesions as well. Vaginal hysterectomy is done when less invasive procedures like laparoscopic or robotic techniques are not possible.
- Fibroids: Fibroids are benign tumors arising in the uterus. Hysterectomy is a permanent solution to treat fibroids, especially if they are large or multiple in number and the signs and symptoms associated with fibroids. Large fibroids may require an abdominal hysterectomy.
- Adenomyosis: In this condition, the inner tissue lining of the uterus grows into the uterine wall leading to an enlarged uterus with heavy and painful periods.
- Abnormal uterine bleeding: Very heavy, painful, irregular periods when medication and/or other less invasive procedures don’t help.
How is a vaginal hysterectomy performed?
The surgery is usually performed under general anesthesia or spinal anesthesia (the lower half of the body is numbed). The surgeon makes an incision inside the vagina to reach the uterus. The uterus is detached from the upper portion of the vagina, fallopian tubes, ovaries, the surrounding blood vessels, and bands that support it and then removed through the vaginal opening. The cervix may be removed as well. The ovaries and fallopian tubes may also be removed along with the uterus if indicated. All the sutures (stitches) used are usually absorbable. There are no external or visible incisions.
Patients are usually discharged 24 to 48 hours after surgery. Painkillers and antibiotics would be prescribed. Patients experience bloody vaginal discharge for a few days to weeks after surgery, so the patient would need to wear sanitary pads. The postoperative recovery period after vaginal hysterectomy is usually shorter and less painful compared to abdominal hysterectomy. Patients are advised to avoid lifting heavy objects, vaginal intercourse, or vigorous exercise for up to 6 weeks. Complete recovery may take 6-8 weeks. After a hysterectomy, the patient would no longer be able to get pregnant and their periods would stop as well.
What are the complications of vaginal hysterectomy?
Vaginal hysterectomy is relatively safe. However, like any surgery, there is a risk of complications. They include:
- Blood clots in the blood vessels
- Damage to surrounding organs, muscles, and other tissues
- Reaction to anesthesia
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