A full hysterectomy, also called a radical hysterectomy, is a surgical procedure where the uterus (including the cervix), the fallopian tubes and both ovaries are removed. The surrounding lymph nodes may also be removed. A surgeon extracts the reproductive organs through the vaginal opening (radical vaginal hysterectomy) or through an incision made in the abdomen (radical abdominal hysterectomy). The most common reason for a radical hysterectomy is when cervical, ovarian or uterine cancer is present. The average healing time after a full hysterectomy is six weeks. After the six-week post-surgery recovery period, most women are fully able to return to their normal activities. Women experience some lifelong changes due to the hysterectomy, but they usually find the changes manageable.
The removal of the uterus and both ovaries during a full hysterectomy causes instant menopause. Surgical menopause is the term used to describe menopause caused by a full hysterectomy. After surgical menopause, a woman will no longer menstruate and becomes infertile, meaning she can no longer become pregnant or bear children.
A woman normally enters into menopause gradually as the ovaries produce less and less estrogen. With surgical menopause, ovarian estrogen production ceases instantly, which can make menopausal symptoms more severe at first. Symptoms such as vaginal dryness, hot flashes and depression are common. Hormone replacement therapy can significantly reduce or resolve menopause symptoms.
Many women who experienced pre-hysterectomy pain during sex, due to tumors or a uterine prolapse, discover that they have an improved sex life after a full hysterectomy because the pain caused by the tumor or prolapse is no longer present. However, a full hysterectomy can cause sexual problems in itself. Decreased estrogen levels can cause a thinning of the vaginal skin and vaginal dryness, which can make sex painful. But hormone replacement therapy can treat both vaginal dryness and vaginal thinning. A small percentage of women experience post hysterectomy pain due to vaginal scar tissue, which may require surgical treatment to be relieved. Shortening of the vaginal canal caused by removal of the cervix can cause difficulty during sexual penetration for some women. Hormone replacement therapy keeps the vaginal skin pliable so that it can stretch to allow for comfortable sexual penetration.
A study published in the British Medical Journal found that 100 percent of the 413 post hysterectomy women questioned on the quality of their sex lives, reported that their "sexual pleasure significantly improved" after their hysterectomies.
On rare instances, bladder damage occurs during a hysterectomy procedure. Damage results during surgery due to a nick from a surgical tool or by damage to the nerves that affect blood flow to the bladder. Bladder damage can cause difficult urination or incontinence, both of which are usually repaired during a second surgical procedure. According to the British Journal of Urology, "damage [to the bladder] during the course of a hysterectomy is unlikely unless the procedure is unusually radical."
Some women experience psychological effects after a hysterectomy. They may feel that they are no longer a whole or real woman because of the removal of their female organs. A woman also may become depressed because she can no longer bear children, or she may think that menopause equates to being old. It is normal to feel some degree of uncertainty after a medical procedure and during hormonal changes. When feelings of depression or uncertainty interfere with normal daily function and relationships, a woman should seek counseling.
- British Medical Journal v.327(7418); Hysterectomy and Sexual Wellbeing: Prospective Observational Study of Vaginal Hysterectomy, Subtotal Abdominal Hysterectomy, and Total Abdominal Hysterectomy; Jan-Paul W R Roovers, registrar, Johanna G van der Bom, assistant professor of epidemiology, C Huub van der Vaart, consultant, A Peter M Heintz, professor of gynaecology; Oct. 4, 2003
- British Journal of Urology Volume 54 Issue 5, Pages 501 - 504; An Anatomical Explanation for Bladder Dysfunction Following Rectal and Uterine Surgery; A. R. Mundy, FRCS, MRCP, Senior Lecturer in Urology, Guy's Hospital, St Thomas Street, London SE1 9RT; Nov. 26, 2008
- University of Wisconsin Health Services - Hysterectomy