Vaginal hysterectomy is an operation to remove the uterus (womb) and cervix. The operation is carried out through the vagina; no cut is made on the abdomen. Commonly the operation is performed for prolapse of the uterus. However, the operation may also be undertaken for menstrual problems.
With vaginal hysterectomy, the womb and cervix are removed through an incision around the cervix at the top of the vagina. The womb is detached from the ligaments that hold it in place. These ligaments are used for supporting the top of the vagina (Vaginal vault). The blood vessels of the uterus and the tissue around it are clamped, cut and tied up. The hole made at the top of the vagina is closed up with stitches. The operation normally takes around one hour to complete. If vaginal repair is also needed, a longer surgical time may be required.
Sometimes during the operation additional stitches are required to offer support to the vaginal vault. These are attached to the ligaments on the side of the pelvis such as the sacrospinous ligament. If removal of the ovaries is required then the operation will need to be done with a laparoscopic assistant.
Vaginal hysterectomy is normally performed under a general anaesthetic. However, if you prefer it can also be done under local anaesthetic (where you are numb from the waist down).
The following complications can occur:
Urinary retention/voiding difficulty: This is the inability to pass urine. If this occurs, the urine can be drained using a catheter until you are able to pass urine independently, usually within 24 to 48 hours. If the problem persists, you will be taught Intermittent Self Catherisation (ISC). This is a procedure where you need to empty your bladder using a small tube or catheter.
Painful intercourse: Some women have problems with sex after any vaginal surgery because the vagina becomes very tight. While every effort is made to prevent this happening, it is sometimes unavoidable.
Damage to surrounding organs: This can include bowel or blood vessels. This is rare but requires repair and this can result in delay in recovery. Risk of damage to the bladder or ureters is low (2 in 1000 cases). Sometimes injury is not detected at the time of surgery and therefore requires a return to the operating theatre. If the rectum is damaged a temporary colostomy may be required but this is very rare.
Urinary incontinence: Unfortunately a small percentage of women develop stress incontinence after this operation even when it is not expected. You may find that you need further physiotherapy treatment or even surgery at a later date.
Recurrence of prolapse: If you have had one prolapse, there is a risk of having another prolapse sometime in your life. This is due to a weakness in the vaginal tissue and means that the repair could fail or may not work.
Pelvic pain: This can be related to adhesions around the pelvis.
Laparotomy: After your surgery has begun, your surgeon very occasionally finds conditions, such as extensive scar tissue, that make abdominal hysterectomy the better choice. Sometimes these conditions are not apparent before surgery. When this happens, the surgeon stops the vaginal procedure and changes to an abdominal approach.
Most women stay in hospital for two nights following a vaginal hysterectomy. Occasionally a longer stay may be required.
Although vaginal surgery does not produce a visible scar, the healing process still requires time. A creamy, brownish discharge, which is sometimes bloody too, is common for up to six weeks, and will gradually disappear as the stitches begin to be absorbed.
There is a risk of constipation for several weeks after surgery, and we can prescribe laxatives. No stitches will be damaged when the bowels do open, which will usually happen about two to three days after surgery.
You should be able to be fit enough for light activities within a month of surgery. However, we recommend that you avoid very heavy lifting, heavy household chores, driving and sport for at least six to eight weeks to allow the wounds to heal. Most people need about six to eight weeks off work.
For many women, sex after the operation is improved because there is no longer any discomfort due to prolapse. However, this may be different. We advise you to avoid penetrative intercourse for about six weeks or until after your check-up with your doctor. You are advised to use a vaginal lubricant (such as K-Y jelly) or vaginal moisturiser (such as Sylk or Replens). These are available to buy over the counter at your chemist. Some women may also benefit from vaginal oestrogen therapy.
The success rates for vaginal hysterectomy are mainly positive, with most women noticing a significant improvement in their symptoms. There is a risk of recurrence of the prolapse in 20–30 % of women. The prolapse can reoccur at the top of the vagina (vaginal vault prolapse) or in another area such as the front or the back of the vagina. Factors that increase the chance of recurrence are related to increased pressure on the pelvic floor such as through straining, lifting heavy objects or a high BMI.