From Encyclopedia of Sex and Sexuality
The operation performed to remove a woman’s uterus (womb). The uterus contains two parts, the body (or corpus) and the cervix (or neck). A total hysterectomy involves removal of the entire uterus—the body and the cervix. A subtotal hysterectomy is an operation in which only the body of the uterus is removed but the cervix is left in place. Sometimes, at the time of a hysterectomy, the woman’s fallopian tubes and ovaries are also removed. If this is done, the procedure has the medical designation “hysterectomy with bilateral salpingo-oophorectomy,” meaning removal of the fallopian tubes and ovaries from both sides. Salpingo-oophorectomy (removal of tubes and ovaries) can be performed with either a total hysterectomy or a subtotal hysterectomy. In common parlance this nomenclature is confused so that the term total hysterectomy is erroneously used to mean a total hysterectomy and bilateral salpingo-oophorectomy, and partial hysterectomy is used to mean total hysterectomy without removal of the tubes and ovaries. This is an inaccurate and confusing usage of the terms.
A radical hysterectomy is the procedure performed for some types of uterine cancer. This operation involves not only a total hysterectomy, but removal of the ligaments and connective tissue surrounding the uterus as well as the lymph vessels that drain the uterus and the lymph nodes into which they drain. Usually both tubes and ovaries are also removed during a radical hysterectomy. The purpose of a radical hysterectomy is to treat cancer limited to the pelvis. When cancer cells spread from the cervix, they spread to adjacent tissues and, through lymphatic vessels, into the lymph nodes, the first line of the body’s defense. The theory of a radical hysterectomy is that it removes the cancer together with its primary area of spread so that all the cancer cells have been removed.
There are several methods of performing a hysterectomy. Vaginal hysterectomies can be performed with the assistance of a laparoscopic procedure to help remove tissues not readily accessible through the vagina. In addition, a subtotal hysterectomy can be performed through a laparoscopic procedure, without the need for a vaginal incision. An abdominal hysterectomy is performed through a surgical incision in the lower part of the belly. This incision can either be vertical (up and down) or transverse (side-to-side). There are many reasons for performing an abdominal hysterectomy, including the removal of large tumors and, if there is a possibility that cancer is present, the ability to evaluate and examine the entire abdomen for spread of the cancer. In patients whose conditions have been complicated by factors that resulted in the uterus being scarred or adherent to other structures in the abdomen, such as the colon or small intestines, the transabdominal approach is necessary to allow the physician to perform more delicate surgery. The major advantage to the abdominal approach is that it provides the surgeon with a larger field of view and better access to structures inside the abdomen. The obvious disadvantage is that it leaves a visible scar on the lower abdomen. The recovery period is slightly longer for abdominal than for vaginal surgery.
If the uterus is not adherent to other structures in the abdomen and it is not too large to safely remove through the vagina, a vaginal hysterectomy can be performed. In this operation a circular incision is made around the cervix, separating it from the vagina and adjacent tissues. The operation is then extended into the abdomen through the vagina, removing the uterus. The advantage of a vaginal hysterectomy is that there are generally fewer complications, no visible scars on the abdomen, and a shorter recovery period.
Hysterectomies are performed to save the woman’s life or to correct serious problems that interfere with the woman’s normal activities and thus improve her quality of life. One example of the life-saving potential of hysterectomy is in cases of severe uterine bleeding that cannot be stopped by medicines or more simple operative procedures; the bleeding will respond to hysterectomy. An example of the second reason is the relief of incapacitating pelvic pain that may be due to severe infections, symptomatic endometriosis, or fibroid-related pain. A woman’s quality of life may be measurably improved by a hysterectomy done to remove a prolapsed uterus that has lost its support within the abdomen and sags so that the cervix protrudes through the vagina.
Perhaps the most common reason for hysterectomy is in the treatment of uterine fibroids (myomas), benign (non-cancerous) tumors of the uterus. These fibroids may grow large enough to interfere with the function of other structures in the abdomen and produce discomfort or pressure on the bladder and/or rectum. Occasionally fibroids produce pain severe enough to require removal. Fibroids also are associated with prolonged and heavy bleeding, and this may also be an indication of the need for a hysterectomy.
Endometriosis is a non-cancerous condition in which the lining of the uterus develops in areas outside the cavity of the uterus. This can produce scarring and pain that may occasionally require a hysterectomy. Other causes of pelvic pain include chronic infections of the ovaries and fallopian tubes. These infections cause scars (adhesions) that hold together structures not normally connected. This can produce fairly severe discomfort and may require a hysterectomy as a definitive treatment.
If the woman has not yet gone through menopause and her ovaries are removed, this will result in a surgical menopause. This may produce unpleasant symptoms, such as hot flashes, sweats, fatigue, and vaginal dryness. Hormone replacement therapy may be necessary to reduce the risk of osteoporosis (thinning of the bones) and heart disease.
Major surgery is clearly a traumatic event; many patients experience an emotional depression several weeks after. A hysterectomy clearly indicates a final removal of all childbearing potential. Since to many women childbearing, possession of a uterus, and menstrual periods are indicative of normal female functions, the removal of a uterus may be associated with a sense of defeminization.
Hysterectomy may affect a woman’s enjoyment of sex, but if it removes a painful condition, it may also improve a woman’s sex life.