A hysterectomy is a surgery to remove a
woman’s uterus. If you've been
advised that you need a hysterectomy, the following discussion will help
you to be aware of the different issues
that may arise before and after the operation.
What
are the different types of hysterectomies?
There are two main types of hysterectomies
- a complete or total hysterectomy and a partial
hysterectomy. A complete hysterectomy is one in which the uterus as well as the cervix and ovaries are removed. In a partial hysterectomy, also
called subtotal or supracervical hysterectomy, only the uterus is removed, the cervix and the ovaries are left intact. The ovaries and the surrounding lymph nodes may or may not be removed, depending on the reason for the hysterectomy.
Are
the ovaries always removed if they are healthy ?
In young women below the age of 45 years,
healthy ovaries are not removed since they continue to secrete hormones like
estrogen and progesterone for at least another 10 years. In older women, the
ovaries are usually removed.
Whether the ovaries are removed will also depend on the reason
for the hysterectomy. The commonest reason is endometrial hyperplasia
(thickening of the uterine lining) and a
partial hysterectomy is adequate in this case. But in conditions like
endometriosis, a complete hysterectomy with removal of the ovaries will be necessary.
When
will I be able to join work again?
Most people are able to
return to work and
their normal routines after about
4-6 weeks. Till then, you can take light exercises like walking. But you will still need to take plenty of rest
and avoid lifting heavy weights during this time.
When
can I have sex again? Will it be painful the first time? Will I bleed? Will I
be able to orgasm?
If you have had a partial hysterectomy and
the cervix is intact, then you can have
vaginal intercourse after 4 weeks. But in case of a complete
hysterectomy, it will be better to wait
for 6 weeks since it takes that long for the incision in the upper vagina to
heal. Oral sex is possible earlier,
after the vaginal discharge stops.
There should be no pain the first time you
have sex after hysterectomy. Nevertheless, it will be better to try only gentle
and partial penetration. If the ovaries
are removed, there may be some amount of vaginal dryness and you may need to
use a lubricant during sex. And no, bleeding will not occur.
There is a misconception that removal of
the cervix causes difficulty in orgasm. But since orgasm is not dependent on
the presence of the uterus or cervix, it is not affected in any way.
Will
I get menopausal symptoms immediately after the surgery?
The periods will stop with the removal of
the uterus. In premenopausal women, removal of the ovaries will cause surgical
menopause. In this case, you may get menopausal symptoms like hot flashes and night sweats immediately after the surgery. But
if surgery is limited to just the uterus, then the level of estrogen in the
body will continue to be normal and you will not have any menopausal symptoms.
If
cervix is not removed, will I have periods?
If the cervix is not removed, you may get
an occasional spotting or mild bleeding at the time of the menstrual periods. But this
does not occur in all women and many women stop getting their periods even when the cervix is present.
Will
I need to get pap smears again?
Since the pap smear tests for cervical
changes (dysplasia), you will need to
continue to get pap smears after a
partial hysterectomy.
Pap smears are not necessary after a
complete hysterectomy, unless it was done for a cervical cancer or a precancerous
lesion.
Will
I need hormone replacement therapy (HRT)?
If you are below the age of 50 years and
the ovaries are removed, then yes, it will be better to start HRT immediately
after the hysterectomy. But if you had already attained menopause before the
hysterectomy, or if you are over the age of 50 years, then you may not need
HRT.
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