Life without a uterus

Hysterectomy is the surgical removal of the uterus for medical reasons. Most women fear the repercussions, like the effect on their libido. DR BRIGID MONDA has comforting answers

Hysterectomy is one of the most common surgeries for women, second only to the Caesarian section. It’s the surgical removal of a woman’s uterus.

Hysterectomy is a name derived for the word ‘hysteria’ because it was once thought that the womb was the seat of hysteria. Women being emotional sometimes during their periods cemented this notion. It can be performed through the abdomen (abdominal hysterectomy) or the vagina (vaginal hysterectomy). There are many different medical reasons why doctors do it.

Heavy bleeding is one of them. The uterus does two things: it bleeds and it carries babies. When baby carrying is over, it still bleeds.

When bleeding becomes heavy or prolonged due to fibroids causing life-threatening anaemia, a hysterectomy is needed. Fibroids are the most common sympom that warrant a hysterectomy.

Weakening of the supporting ligaments and of the pelvic floor muscles that hold in the uterus in place allow it to prolapse or ‘fall’. A ‘fallen’ uterus will cause back and thigh pain and urinary incontinence. In this case a hysterectomy would be crucial.

A hysterectomy is life-saving if you have cancer of the cervix or uterus. It may also be done for severe infections that are unresponsive to treatment and chronic pelvic pain.

A hysterectomy is only done when a woman does not want any more babies because a hysterectomy burns that last bridge of fertility.

Like anything in medicine, when it works well, it works great but when it doesn’t, things can go badly wrong. But serious complications from hysterectomy done by skilled hands are uncommon.

Laparoscopically Assisted Vaginal Hysterectomy

This is one of the newest techniques of performing a hysterectomy. It is done through the vagina with the aid of a laparoscopy — an instrument with a thin, long, rigid tube in which light travels along glass fibres to light up internal organs.

An attachment allows the surgeon to see into the abdomen and pelvis and view internal organs on a television monitor mounted in the operating room. The doctor is able to take photographs, operate, obtain biopsies of tissue and to remove organs like the uterus.

The surgeon uses a specialised instrument to release the uterus and then removes it through the vagina but it can only be done when the uterus is not too large.

Its many benefits include quicker recovery time from surgery and a shorter hospital stay. A patient often leaves hospital after only 24 hours to recover in the comfort of their own home.

This is certainly a change from the ‘old days’, where women lay in a hospital bed for seven days or longer before going home.

The small incisions are less painful and there are fewer wound infections. The cosmetic results are also good as the scar is limited to three or four small skin incisions.

Sex after a hysterectomy

During intercourse, the uterus undergoes vascular changes and there are rapid small contractions of the uterine muscle during orgasm. Obviously, you will not have these after a hysterectomy, though intercourse is not less enjoyable. You will have no cervix, which may cause a change in the way that penetration is experienced but vaginal contractions during orgasm will be the same.

During sex, almost all lubrication comes from vaginal walls so most women don’t report any change in lubrication after hysterectomy.

Ideally, a hysterectomy should not affect libido. If your sex life was good before a hysterectomy, it should continue to be so. Many women find their sex lives improved due to relief from the uterine problem the hysterectomy rectified.

Every woman will have a different reaction to her hysterectomy.

One woman may view it as necessary, not much different from having a tooth removed. But for a woman whose sexual self-image is tied to having a uterus, even if she is past her childbearing years, a hysterectomy may be a problem.

For this reason, women who are electing to have a hysterectomy have to make the decision carefully before the operation.

Pap smear after a hysterectomy

A woman does not have to continue having routine Pap Smear screening after they have had a hysterectomy for a non-cancerous condition like fibroids. A woman whose hysterectomy was for either cervical cancer or cervical dysplasia should continue to have regular, yearly Pap Smears, called a vault smear, even after hysterectomy.