A hysterectomy is the surgical removal of the uterus, but may also include the fallopian tubes, ovaries and/or the cervix. It is sometimes recommended for women who have uterine fibroids, uterine prolapse, endometriosis, abnormal vaginal bleeding, chronic pelvic pain, adenomyosis (a thickening of the uterus), or cancer of the uterus, cervix, or ovaries. Hysterectomies are performed using one of the following techniques:
Abdominal or Open Hysterectomy requires a 4- to 8-inch horizontal incision below the belly button. The most invasive kind of hysterectomy, this type is performed under general anesthesia, with a typical hospital stay of 3-6 days and up to six weeks of recovery time.
Vaginal Hysterectomy uses a smaller incision inside the vagina, not visible externally, to remove the uterus and other organs. Vaginal hysterectomies usually require a 1-3 day hospital stay and up to four weeks of recovery time.
In Laparoscopic Hysterectomy, a thin, telescope-like instrument, called a laparoscope, and small surgical instruments are inserted through a few tiny incisions in the navel and abdomen to detach and remove the uterus. The laparoscope acts like a video camera, guiding the surgeon as he or she carefully removes the uterus (womb) through one of the openings. Laparoscopic hysterectomy usually requires only one day or less in the hospital and only six days of recovery time. Patients also experience less scarring and pain compared to other hysterectomy methods.
Benefits of Keeping Your Cervix
Many gynecologists feel that leaving the cervix in place is important to maintain good pelvic floor support. One of the most common pelvic floor support conditions is pelvic organ prolapse, in which organs in the pelvic region drop out of their normal position (prolapse). Prolapse can be uncomfortable both physically and emotionally, causing women to limit their movements because of pain, urinate more frequently and avoid sex. In addition, some research suggests the cervix may play a role in sexual arousal and the ability to achieve orgasm in some women.
Although most women are candidates for laparoscopic hysterectomy in which the cervix is retained, those with malignancy, or a history of cervical dysplasia or endometriosis near the cervix are not considered optimal candidates. Additionally, if the uterus is very large due to fibroids, laparoscopic hysterectomy may not be possible.
Like women who have not had a hysterectomy, those who have retained their cervix following hysterectomy should continue to have an annual Pap smear to screen for cervical cancer.