Hysterectomy is a surgery to remove the uterus (also known as the womb), which may also include removal of the ovaries, cervix and the fallopian tubes. Hysterectomy may be performed totally or partially by a gynecologist, where you will either remove only the uterus or remove the ovaries and fallopian tubes as well. After this surgery, you will no longer have menstruation, and you won’t be able to conceive.
Reasons for having hysterectomy for sex reassignment
Women, in general, have their uterus removed when they experience heavy or irregular periods, dysmenorrhoea (severe period pain), prolapse and fibroids. Besides this, trans-men go for hysterectomy for a similar reason when it comes to pelvic cancer and other FTM purposes.
- Failure to get pap tests when risk of cervical cancer is evident
- When history of pelvic cancer runs in the family
- To remove fibroid cysts and treat endometriosis
- Severe abdominal pain in trans-men is common as testosterone causes atrophy in the uterus. As this puts a strain on the enveloping ligaments, one can experience painful cramps, which is why hysterectomy is recommended.
- Practice of unsafe sex that increases risk of STDs and unwanted pregnancy.
- To eliminate estrogen hormones for testosterone to work.
Things to consider before a hysterectomy
A thorough discussion with your surgeon will be done in:
- Your medical history
- Pros and cons of laparoscopic surgery and vaginal surgery
- Your support options and feelings about changes after the surgery
- Several tests before hysterectomy
Types of hysterectomy
- Total hysterectomy: This involves the removal of the uterus and the cervix.
- Partial (subtotal) hysterectomy: The uterus is removed, but the cervix is left untouched. Surgeons recommend the removal of the cervix as well because it poses the risk of cervical cancer.
- Bi-lateral salpingo-oophorectomy: The uterus is removed along with the ovaries and fallopian tubes.
- Radical hysterectomy: This is the most extensive approach as it removes the uterus, ovaries, fallopian tubes, associated pelvic ligaments and upper part of the vagina.
The surgical procedure
Surgery on hysterectomy is performed by one large incision in the lower abdomen, three or four small incisions in your abdomen or vaginal surgery.
A horizontal incision will be made in the lower part of your abdomen, along your pubic area. In rare cases, vertical incisions are made, depending on how large the uterine fibroid is. This approach is recommended for patients with cancer or large fibroids.
A small incision is made below the navel to insert a laparoscope to see the pelvic system. This will follow small incisions in three or four places to use other surgical instruments. Your abdomen will be inflated with carbon dioxide for a clear view of your pelvic organs, after which a careful operation will remove your uterus and if necessary your ovaries and fallopian tubes.
Stitching made on the top of the vagina via keyhole incisions is called total laparoscopic hysterectomy.
In this approach, an incision is made on the top of the vagina. This is usually performed for uterine prolapsed where the uterus and the cervix protrude out of the vaginal lips.
Although hysterectomy is a standard procedure, the complications should not be underestimated. There are potential short term and long term risks involved in this surgery.
Short- term risks
- There will be adverse nausea and vomiting accompanied by breathing difficulty and certain heart anomalies due to anesthesia
- As your abdomen gets inflated with carbon dioxide for a clear view inside your pelvis, the CO2 may get trapped in your diaphragm which will cause pain in the diaphragm, shoulder and surrounding organs.
- Without antibiotic treatment, you may have an infection of the chest, abdomen, and bladder.
- UTI is a common risk along with infections in the kidney.
- During surgery, you will lose blood excessively which may cause hemorrhage.
- Accidental damage in the pelvic nerves may cause urinary frequency or incontinence.
- You will be going through menopausal symptoms like hot flashes, headaches, and insomnia.
- There is a possibility of reduced sexual sensation after hysterectomy.
- Internal scars can stay attached to the adjacent organs and cause pain in the long run.
- Abdominal hysterectomy has a higher risk of infection and pain than a vaginal hysterectomy
After the hysterectomy procedure
A day after the operation your surgeon will encourage you to take a brisk walk, as it will improve normal blood flow. This reduces the risk of blood clots in your legs.
Recovery time will depend on your age and health status. Generally, after a vaginal or laparoscopic hysterectomy, the patients are allowed to discharge in two to four days. Whereas, in the case of abdominal hysterectomy, you will have to stay in the hospital for about five days.
Full recovery is usually longer for abdominal hysterectomy as compared to laparoscopic or vaginal hysterectomy.
Frequently Asked Questions (FAQs)
Can a minor get hysterectomy?
A: Since the surgery involves major procedures, you will be required to be 21 years and above. Heavy bleeding and extreme pain can occur in a minor patient.
How long do I stay in the hospital after the surgery?
A: Depending on the type of surgical procedure, the number of days for you to stay after surgery will be determined likewise. Your stay will not last for more than five days.
What is the level of pain after surgery?
A: The level of pain will depend on what type of surgery you underwent and what organs you removed. If you have gone for laparoscopic or vaginal hysterectomy, you will experience moderate pain for about two to three weeks. As for abdominal hysterectomy, the pain will last for up to 5 weeks. Painkillers will be prescribed by your surgeon.
How will my scars look after a hysterectomy?
A: Depending on the type of surgery your scars will vary. There will be no visible scars for a vaginal hysterectomy since the incisions are made internally. As for the other approaches, an abdominal hysterectomy will leave a visible scar along your lower abdomen, and small incision scars in three to four places will occur in laparoscopic hysterectomy. Generally, the scars will fade to some extent but will not look flawless.