Getting to understand hysterectomies before you go under the knife
Within the pelvic cavity, two ovaries connect via the fallopian tubes to the centrally positioned uterus, creating the female reproductive system. These organs produce female growth hormones, release ova (eggs), control the menstrual cycle, and oversee pregnancy, gestation, and the birth of a baby. Any damage or complication in any part of the reproductive system may call for the surgical pulling out of the uterus (hysterectomy) to avert any threat to overall health.
The decision to get a hysterectomy done is an important one, and should not be taken lightly. Deciding to have to have a Hysterectomy depends on the type of problems you are having and how bad they are. It also depends on whether you need major surgery to make your life better or, if you have a life threatening illness, to prolong your life. You need to discuss this with your surgeon.
The Prevalence of Hysterectomies as a Lifesaving Necessity
According to the Centers for Disease Control and Prevention (CDC), around 20 million American women have undergone a hysterectomy; making it the second most widely resorted to surgical practice after cesarean delivery.
Threats That Prompt the Surgical Removal of the Uterus
- Cancer: A hysterectomy becomes a preventive measure when cancer invades the ovaries, uterus, or cervix (the passage connecting the uterus and vagina).
- Endometriosis: The inner uterine wall called the endometrium lays the foundation for fetal growth. In some instances, the lining starts growing outwards into the pelvic cavity creating pain and causing female infertility.
- Uterine fibroids: These are abnormal but mostly non-cancerous growths of muscle and tissue within the uterine wall that trigger abnormal bleeding and painful menstruation.
- Uterine prolapse: In this condition, the supporting musculature and ligaments that keep the uterus in place begin to weaken, pushing the uterus into the vaginal passage, creating a lumpy unpleasant sensation.
- Menorrhagia: This is the abnormally heavy bleeding that accompanies menstruation, and is usually triggered by non-cancerous growths within the endometrial lining of the uterus or an uncontrollable infection.
Different types of Hysterectomies
- Total Hysterectomy- The body of the uterus and cervix is removed, but not the ovaries or fallopian tubes.
- Sub-total Hysterectomy –Removal of the body of the uterus but not the cervix.
- Total hysterectomy with bilateral salpingo-oophorectomy- The womb, cervix, fallopian tubes (salpingectomy) and the ovaries (oophorectomy) are removed.
- Radical Hysterectomy- Removal of the whole uterus, cervix, fallopian tubes and ovaries, lymph glands and fatty tissue.
Hysterectomies Are Carried Out in Three Different Ways
- The abdominal cut: The uterus is completely removed through an incision made in the lower navel, and both internal wounds and the incision are surgically sealed.
- The vaginal cut: The uterus is removed by cutting the upper reaches of the vaginal passage.
- Laparoscopic surgery: Also called keyhole surgery, the surgeon, guided by a camera and a specialized tool called the laparoscope, removes the uterus either partially or completely through small cuts in the abdomen.
Risks Involved in Conducting Hysterectomies
- The patient may develop sensitivity to anesthesia and follow-up medication.
- Adjoining organs and supportive structures may suffer damage, requiring further surgery.
- The risk of acquiring infections that need intensive treatment.
- Tiny blood clots may clog arterial vessels creating cerebral or cardiac embolisms.
- Difficulty in breathing.
- Uncontrolled bleeding.
Risks involved in not having a Hysterectomy
The risks involved in not having the procedure will depend on the reason for the surgery:
- If your problem is prolonged bleeding then you may develop anemia, which may need blood transfusions, and continued problems with heavy and irregular periods.
- If uterine prolapse is the reason for your surgery then not undergoing it can cause the uterus to drop down into the vagina and even outside the vagina where it can develop ulcers and cause considerable pain and discomfort.
- If you have a suspected tumor, then possible spread of cancer may result.
Recovering from a Hysterectomy
Post surgery, on recovering from the anesthetic you will be taken to your ward/room to recover until you are well enough to go home. You will need to visit the hospital again for follow up. Do expect to feel tired for sometime after surgery. You need to take things easy and gradually return to normal duties, as you feel able to.
Busting Common Misconceptions – A Hysterectomy Fact File
Does a Hysterectomy Lead to Menopause?
A hysterectomy is only concerned with the elimination of the uterus with or without the cervix, and the ovaries are left undisturbed. Since the ovaries, the primary source of the hormones estrogen and progesterone, remain intact, a hysterectomy does not trigger menopause.
Is Laparoscopic Hysterectomy Difficult?
The muscular nature and size of the uterus are not impediments to its laparoscopic removal as commonly believed. Using a morcellator, the surgeon slices and minces the uterine tissue into smaller components before removing the uterus through keyhole surgery.
Does It Take Forever to Recover and Resume Normal Activity, Post-Hysterectomy?
Laparoscopic surgery achieves the task (uterus removal) quickly through a keyhole-sized incision in the navel, and the patient does not require hospitalization beyond two days. The laparoscope gives the surgeon a commanding view of major blood vessels, nerves, and supporting structures, and lowers the risk of developing complications during surgery. Patients are encouraged to walk and continue normal activity soon after surgery.
Does a Hysterectomy Kill Our Libido?
A hysterectomy causes no changes in sexual ardor or activity. An orgasm is basically an event coordinated by the autonomous and central nervous systems through the skeletal muscles of the pelvis and diaphragm. The smooth cell walls of the vagina and possibly the anus also play a part in arousal. Loss of the uterus does not affect sexual energy and activity.
Does a Cesarean Section Rule out Laparoscopic Hysterectomy?
No, a cesarean operation does not get in the way of the procedure for removing the uterus. Sometimes, after the cesarean operation, adjoining organs such as the bladder and bowels may adhere to the uterus or cervix, changing the anatomy of the area. The laparoscope enables the surgeon to revisit the abdomen to remove anatomical abnormalities.