Surgeons at Western Baptist Hospital perform some 200 hysterectomies every year. This surgery can be performed through an abdominal incision or through a vaginal incision with or without laparoscopy.

About Hysterectomy

A hysterectomy is surgical removal of the uterus. More than half a million hysterectomies are performed in the United States every year, making it the second most frequently performed major surgery in America. In fact, experts estimate that over a third of all American women have had a hysterectomy by the time they are 60 years old.

There are many reasons why your doctor may prescribe a hysterectomy:

Pelvic Inflammatory Disease

Pelvic Inflammatory Disease or PID is a general term for an infection of the uterus, Fallopian tubes or ovaries. It is fairly common and can be very serious. PID is the leading cause of infertility. PID usually occurs in sexually active women. Many cases result from sexually transmitted diseases, such as gonorrhea or chlamydia. Use of an IUD (intrauterine device) also increases the risk of PID. The design of the IUD allows bacteria to travel from the cervix up through the uterus and into the tubes and ovaries. Treatment for PID generally includes antibiotics and bed rest. If not discovered early enough, abscesses may develop and immediate surgery may be needed.

Uterine Fibroids

Fibroids are tumors or lumps that grow out from the surface of the uterus into the pelvis, may be buried inside the wall of the uterus or may protrude into the uterus. The most common cause of hysterectomies, fibroids vary in size and do not always cause symptoms. Your doctor may find them during a routine pelvic exam. Or you may feel pain in the abdomen or experience painful intercourse. Nearly all fibroids are benign (non-cancerous).

Endometriosis

Sometimes, cells of the lining of the uterus or endometrium begin growing outside the uterus. These cells act just like the uterine lining -- they thicken and bleed each month according to your menstrual cycle. Eventually, scar tissue results and adhesions (bonds attaching one organ to another) develop. Symptoms can include premenstrual and menstrual pain; tenderness in the lower abdomen; sharp, stabbing pain during intercourse; and back pain.

Adenomyosis

Endometrial tissue may sometimes grow inside the uterine wall itself and cause heavy bleeding, abdominal pain and tenderness. While this usually occurs in women 40 to 50 years of age, it may occur earlier. It may also be called internal endometriosis.

Endometrial Hyperplasia

This change in the lining of the uterus occurs most often in women going through menopause. There is a thickening of the endometrial tissue. While usually benign, it can progress to a precancerous condition called adenomatous hyperplasia. Symptoms include heavy or irregular bleeding or prolonged menstrual periods.

Prolapsed Uterus

The dropping down or falling of an organ is called a prolapse. The ligaments and muscles hold the pelvic organs -- the bladder, uterus and rectum -- inside the pelvis as long as they are strong. Age, repeated childbirth or other pelvic trauma may weaken these muscles, causing the uterus, bladder or rectum to be displaced downward. Surgical correction or removal of the uterus may become necessary.

Cancer

Several different types of cancer or malignant tumors can require a hysterectomy:

Cervical Cancer is one of the most common cancers. Because cancer spreads or metastasizes, doctors want to find any cancer as early as possible. A Pap smear is a test used to detect cervical cancer. It should be done annually, starting at age 18 or earlier, if a woman is sexually active. Your doctor may adjust this schedule according to your risk or your family history.

Normal cervical cells can become abnormal or dysplastic. Although dysplasia is not cancer, it may later develop into cancer. Dysplasia is classified as mild, moderate or severe.

Cancer of the cervix which is diagnosed in the earliest stages is called carcinoma in situ and involves only the top layer of cervical cells. It develops most frequently in women ages 30 to 40, but can occur at any age. Invasive cervical cancer has spread deeper into the cervix and surrounding tissues. Most invasive cancer can be prevented by having regular Pap tests.

Results of the Pap test are usually given by class:

• Class 1: Completely normal.
• Class 2: Some cells abnormal. None suggest cancer. May be inflammation or infection. Repeat test in three to six months.
• Class 3: Dysplasia present. Follow up with another Pap test and possible biopsy.
• Class 4: Carcinoma in situ. Follow up with Pap and definitely biopsy.
• Class 5: Invasive cancer. Biopsy necessary.

Treatment of cervical cancer may involve cryosurgery, cauterization, conization, laser treatment or hysterectomy. Your doctor will discuss the best treatment for you.

Ovarian Cancer usually develops after menopause, but occurs occasionally in younger women. It is harder to diagnose than cervical cancer. Most ovarian cancer is discovered during a routine pelvic exam. Unfortunately, no specific test such as the Pap has been developed to detect ovarian cancer. However, your doctor may recommend an ultrasound exam to confirm the diagnosis.

Ovarian cancer is difficult to detect, because often there are no symptoms. When symptoms do occur, they may include an enlarged abdomen, abnormal vaginal bleeding or abdominal pain.

Treatment consists of removal of the affect ovary or ovaries. Following surgery, radiation or chemotherapy may also be given. Your doctor will discuss the best treatment for you.

Endometrial Cancer. The endometrium is the inner layer of the uterus. Cancer of the uterus is thus called endometrial cancer, because it develops in that layer. Abnormal bleeding after menopause it the most common symptom. Treatment may include hysterectomy, radiation therapy, hormone therapy or chemotherapy, according to the stage of the cancer at diagnosis. Your doctor will discuss the best treatment for you.

How Your Surgery Will Be Performed

Hysterectomies can be performed through either an abdominal incision or through the vagina. The type of operation used depends on the reason for the surgery and any scarring a woman may have from previous surgeries or infections. If your uterus is enlarged or if your tubes and ovaries need to be removed, you will usually have an abdominal hysterectomy. Your doctor will discuss the way the surgery will be performed.

Abdominal Hysterectomy

An abdominal hysterectomy is the removal of the uterus or womb through a 6" to 8" incision made in the abdomen. The incision may be made horizontally, just above the pubic area, or vertically, between the naval and the pubic area.

Vaginal Hysterectomy

A vaginal hysterectomy is removal of the uterus or womb through an incision made up inside the vagina or birth canal.

Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

LAVH is the removal of the uterus or womb through the vagina using laparoscopes. The laparoscope allows the surgeon better visualization so the uterus can be removed vaginally. There are usually two or three "band aid size" incisions about an inch in length. One will be located beneath the naval and one or two more in the lower abdomen.

Salpingo-Oophorectomy

A salpingo-oophorectomy is the surgical removal of the Fallopian tube(s) or ovary(ies).

Truths and Myths about Hysterectomy

Your surgery will:

• relieve pain and bleeding
• completely cure early cervical cancer and most endometrial cancer
• make your sex life more enjoyable if your condition makes intercourse painful for you
• make your more comfortable physically
• prevent pregnancy

Your surgery will not:

• make you gain weight
• cause depression
• ruin your sex life
• reduce your femininity
• cause you to grow facial hair

Possible complications which can occur with any abdominal surgery include:

• infection
• postoperative bleeding
• damage to the bladder, ureters or bowel
• adhesions (fibrous scar tissue within the body that joins normally unconnected parts)
• poorly functioning ovaries due to decreased circulation
• blood clots --- thrombophlebitis
• nausea and vomiting

After Your Surgery

Most women leave the hospital two to three days after surgery. Home instructions include:

• You will need to wear sanitary pads for several weeks after your surgery. Panty liners are usually sufficient. Do not douche or use tampons. Most women have a vaginal discharge for anywhere from two to six weeks after a hysterectomy.
• If your doctor has used removable stitches on the incision, you will need to visit the doctor's office seven to ten days after surgery to have them removed. Your doctor will instruct you.
• Gradually increase your activity level. You will tire more easily during the first few weeks. You will probably be able to resume normal activities within four to six weeks.
• Do not lift anything over ten pounds. Keep stairs to a minimum.
• You will probably be ready to drive after about two to four weeks.
• You may take a shower and wash your hair.
• If your ovaries have been removed, your doctor may prescribe hormone replacement therapy. This will prevent symptoms normally associated with menopause. Women who are unable to use hormone replacement therapy should talk to their doctors about other ways of handling menopause symptoms.
• If you have had bladder repair surgery, you may be instructed to perform intermittent self-catheterization at home. Intermittent self-catheterization keeps the bladder from becoming overfilled and losing its muscle tone. It also eliminates residual urine, which can lead to bladder infections and urinary leakage. Your doctor or nurse will teach you how to do self-catheterization before you leave the hospital.
• Your doctor will want to see you for a check up about four to six weeks after surgery.

Sexuality After Hysterectomy

You will probably be able to resume sexual intercourse after you have seen your doctor for your four to six week check up. You may find that a water-based lubricant such as Replens, Lubrin suppositories or Ortho Personal Product increases your comfort the first few times you have intercourse.

You should not feel any soreness or pain during intercourse. If you do notice any uncomfortable changes, discuss them with your doctor. Since a hysterectomy often removes a source of discomfort, many women find their sex lives more enjoyable after surgery. Other women feel less inhibited, since they no longer have to be concerned about becoming pregnant.

A hysterectomy does not change your attitude about sex, your desire for sexual activity or your ability to achieve orgasm. You and your partner will probably not notice any physical differences during intercourse.

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