A hysterectomy is a surgical procedure that involves the removal of the uterus, one of the major organs unique to the female body. When a woman decides to undergo this procedure, it can cause complex emotions, including feelings of emasculation and likely feeling robbed of her female sexual identity.
The decision to undergo a hysterectomy can be driven by various medical reasons. Not all hysterectomies are the same, and the procedure may or may not include the removal of one or both ovaries and the fallopian tubes. Understanding the potential side effects and taking proactive steps before the surgery, can contribute to a smoother recovery and embrace life.
WHY IS HYSTERECTOMY RECOMMENDED?
A hysterectomy is usually recommended when other surgical or pharmacological options may not be possible or have been proven ineffective for presented symptoms.
Numerous uterine conditions may call for a hysterectomy. Some are benign or non-cancerous, whilst others are malignant or cancerous.
Benign, or non-cancerous conditions, include:
- Fibroids
- Endometriosis (though research has shown this may not be the gold standard for this condition)
- Adenomyosis
- Uterine pelvic floor rehabilitation for Pelvic Organ Prolapse
- Heavy menstrual bleeding
THE THREE MAIN TYPES OF HYSTERECTOMIES:
- Total Laparoscopic Hysterectomy (TLH)
A laparoscope is inserted through multiple small incisions in the abdominal wall, allowing the surgeon to see into the abdomen. Since this approach is minimally invasive, recovery is generally faster compared to other methods.
- Abdominal Hysterectomy
This is when a lower abdominal incision is made, horizontal or vertical.
- Sub-total or partial hysterectomy: Removal of only the upper two-thirds of the uterus, this preserves the woman’s fallopian tubes, ovaries, and cervix.
- Total hysterectomy: Removal of the entire uterus and the cervix, this preserves the woman’s fallopian tubes and ovaries.
- Hysterectomy with salpingo-oophorectomy: Removal of the fallopian tubes, the whole uterus and cervix, together with one or both ovaries. This kind of procedure, where one or both the ovaries are removed results in more sexual dysfunction compared to a hysterectomy alone.
- Vaginal Hysterectomy
As the name suggests, this hysterectomy is performed through the vagina. There are no abdominal incisions.
WHAT ARE SOME SIDE EFFECTS OF A HYSTERECTOMY?
The side effects of the procedure depend on the surgeon’s approach. More general side effects include anaesthetic complications, wound infections, blood clots in the legs or lungs, and respiratory tract infections. These would be thoroughly discussed by the medical procedural team prior to the operation.
Speaking as a women’s health physiotherapist, I see the biggest side-effects involve changes to pelvic floor muscles and the vulvovaginal tissues. These structures, abundant in oestrogen receptors, thrive on oestrogen produced by the ovaries. The removal or suppression of ovaries, either surgically or pharmacologically, can have distressing impacts. Additionally, the removal of the uterus and other pelvic floor structures can lead to:
- Pelvic floor weakness
- Stress or urge urinary incontinence
- Changes in bowel habits
- Pelvic organ prolapse
- Changes in sexual desire, arousal, and orgasm
- Painful intercourse or dyspareunia
- Vaginal dryness
- Reduced lubrication
- Discomfort such as burning/stinging/rawness with penetration
- Discomfort accommodating the penis or dildo, inserting a tampon or undergoing a PAP smear
There is always good news!
Research backs that addressing pelvic health concerns in collaboration with a women’s health physiotherapist can often improve or eliminate pelvic floor symptoms. Additionally, we can better help you understand what to do before and after your procedure!
HOW CAN PHYSIOTHERAPY HELP ME RECOVER FROM A HYSTERECTOMY?
- Working alongside your physiotherapist can help identify the best course of treatment
- Making recommendations for appropriate vaginal moisturisers and lubrication
- Designing a personalised pelvic floor muscle program with appropriate stretches
- Introducing graded touch and tissue desensitisation techniques
- Recommending a dilator program using vaginal trainers
- Discussing approaches to a fulfilling intimate relationship
- Referring you to a sex counsellor or psychologist to address changes in your body image, sexuality, fear, anxiety, and coping
- Supporting your emotional and physical health
- Helping you embrace life
We help women recover from hysterectomy and other gynaecological surgeries through physiotherapy. If you have any questions about a hysterectomy, please call or WhatsApp us at 9780 7274, or get in touch by email at help@embracephysio.sg.
Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.
Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as personal medical advice.
References:
- https://www.embracephysio.sg/how-can-physiotherapy-help-my-endometriosis/
- https://www.embracephysio.sg/managing-pelvic-organ-prolapse-yes-you-can-feel-better/
- https://www.embracephysio.sg/what-is-urinary-incontinence/
- https://www.asahq.org/madeforthismoment/preparing-for-surgery/procedures/hysterectomy/
- https://www.embracephysio.sg/how-to-heal-pelvic-pain-and-dyspareunia-in-women/#content
