Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina.
During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it, before removing the uterus.
Vaginal hysterectomy involves a shorter time in the hospital, lower cost and faster recovery than an abdominal hysterectomy, which requires an incision in your lower abdomen. However, depending on the size and shape of your uterus or the reason for the surgery, vaginal hysterectomy might not be possible. Your doctor will talk to you about other surgical options, such as an abdominal hysterectomy.
Hysterectomy often includes removal of the cervix as well as the uterus. When the surgeon also removes one or both ovaries and fallopian tubes, it's called a total hysterectomy with salpingo-oophorectomy (sal-ping-go-o-of-uh-REK-tuh-me). All of these organs are part of your reproductive system and are situated in your pelvis.
The ovaries, fallopian tubes, uterus, cervix and vagina (vaginal canal) make up the female reproductive system.
Vaginal hysterectomy treats various gynecological problems, including:
For most of these conditions — with the possible exception of cancer — hysterectomy is just one of several treatment options. You might not need to consider hysterectomy if medications or less invasive gynecological procedures manage your symptoms.
You cannot become pregnant after a hysterectomy. If you're not sure that you're ready to give up your fertility, explore other treatments.
Although vaginal hysterectomy is generally safe, any surgery has risks. Risks of vaginal hysterectomy include:
Severe endometriosis or scar tissue (pelvic adhesions) might force your surgeon to switch from vaginal hysterectomy to laparoscopic or abdominal hysterectomy during the surgery.
As with any surgery, it's normal to feel nervous about having a hysterectomy. Here's what you can do to prepare:
Talk with your doctor about what to expect during and after a vaginal hysterectomy, including physical and emotional effects.
You'll lie on your back, in a position similar to the one you're in for a Pap test. You might have a urinary catheter inserted to empty your bladder. A member of your surgical team will clean the surgical area with a sterile solution before surgery.
To perform the hysterectomy:
Except in cases of suspected uterine cancer, the surgeon might cut an enlarged uterus into smaller pieces and remove it in sections (morcellation).
You might be a candidate for a laparoscopically assisted vaginal hysterectomy (LAVH) or robotic hysterectomy. Both procedures allow your surgeon to remove the uterus vaginally while being able to see your pelvic organs through a slender viewing instrument called a laparoscope.
Your surgeon performs most of the procedure through small abdominal incisions aided by long, thin surgical instruments inserted through the incisions. Your surgeon then removes the uterus through an incision made in your vagina.
Your surgeon might recommend LAVH or robotic hysterectomy if you have scar tissue on your pelvic organs from prior surgeries or from endometriosis.
After surgery, you'll be in a recovery room for one to two hours and in the hospital overnight. Some women are able to go home the day of the surgery.
You'll take medication for pain. Your health care team will encourage you to get up and move as soon as you're able.
It's normal to have bloody vaginal discharge for several days to weeks after a hysterectomy, so you'll need to wear sanitary pads.
Recovery after vaginal hysterectomy is shorter and less painful than it is after an abdominal hysterectomy. A full recovery might take three to four weeks.
Even if you feel recovered, don't lift anything heavy — more than 20 pounds (9.1 kilograms) — or have vaginal intercourse until six weeks after surgery.
Contact your doctor if pain worsens or if you develop nausea, vomiting or bleeding that's heavier than a menstrual period.
After a hysterectomy, you might feel relief because you no longer have heavy bleeding or pelvic pain.
For most women, there's no change in sexual function after hysterectomy. But for some women, heightened sexual satisfaction occurs after hysterectomy — perhaps because they no longer have pain during intercourse.
You might feel a sense of loss and grief after hysterectomy, which is normal. Or you might have depression related to the loss of your fertility, especially if you're young and hoped for a future pregnancy. If sadness or negative feelings interfere with your enjoyment of everyday life, talk to your doctor.
After a hysterectomy, you'll no longer have periods or be able to get pregnant.
If you had your ovaries removed but hadn't reached menopause, you'll begin menopause immediately after surgery. You might have symptoms such as vaginal dryness, hot flashes and night sweats. Your doctor can recommend medications for these symptoms. He or she might recommend hormone replacement even if you don't have symptoms.
If your ovaries weren't removed during surgery — and you still had periods before your surgery — your ovaries continue producing hormones and eggs until you reach natural menopause.