A hysterectomy is a surgical procedure to remove the uterus. The uterus is, in fact, one of the major organs of the body, unique to the female species. Therefore, it is not surprising that when a woman makes the tough decision to have it removed, it may result in feeling emasculated (why isn’t there a female version of this word?) and being robbed of her female sexual identity.
The indication to undergo one may vary. Not all hysterectomies are the same, and the procedure may or may not involve the removal of one or both ovaries and the fallopian tubes. In any case, understanding the potential side effects and what you can do preoperatively may help to enhance your 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 not helped your symptoms.
There are several uterine conditions that may call for a hysterectomy. Some are benign, whilst others are malignant or cancerous.
Benign, or non-cancerous conditions, include:
- Endometriosis (although, we now know from research this is not the gold standard for this condition)
- Uterine Pelvic floor rehabilitation for Pelvic Organ Prolapse
- Heavy menstrual bleeding
THERE ARE 3 MAIN TYPES OF HYSTERECTOMIES
1. Total Laparoscopic Hysterectomy (TLH)
A laparoscope is inserted through multiple small cuts in the abdominal wall to allow the surgeon to see into your abdomen. Since this approach is less invasive, recovery is generally faster.
2. Abdominal Hysterectomy
You will experience a lower abdominal incision which may be horizontal or vertical.
- A sub-total or partial hysterectomy will remove only the upper two-thirds of the uterus. The woman keeps her fallopian tubes, ovaries and cervix.
- A total hysterectomy involves the removal of the whole uterus and the cervix. The female keeps her fallopian tubes and ovaries.
- A hysterectomy with salpingo-oophorectomy involves the 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.
3. Vaginal Hysterectomy
As the name suggests, it is a hysterectomy performed via the vagina. There are no abdominal incisions.
WHAT ARE SOME SIDE EFFECTS OF A HYSTERECTOMY?
Depending on the surgeon’s approach, the side effects will differ. There are general complications such as problems with the anaesthetic, wound infections, blood clots in the legs or lungs and respiratory tract infections which the medical team treating you would have discussed with you prior to your operation.
However, in my view as a Women’s Health Physiotherapist, the biggest side-effects involve changes to your pelvic floor muscles and the vulvovaginal tissues. These structures are rich in estrogen receptors and love estrogen. The ovaries are responsible for the production of estrogen. If the ovaries are removed either surgically or suppressed pharmacologically, the impact can be quite distressing. The other consequence to consider with the removal of the uterus, and/or other pelvic floor structures, is a loss in the structural integrity of the pelvic floor. These changes can give rise 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
- Capacious feeling or the complete opposite – like the vagina cannot accommodate the penis or dildo or having difficulty with inserting a tampon or undergoing a PAP smear
The good news is, evidence suggests that in conjunction with your Women’s Health Physiotherapist, a program to address your pelvic health concerns can often improve, if not eliminate symptoms of the pelvic floor.
Also, find out what to do before and after a hysterectomy, from a Women’s Health Physio’s point of view.
HOW CAN PHYSIOTHERAPY HELP ME RECOVER FROM A HYSTERECTOMY?
- Working alongside your doctor to 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 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, do email us or call us at 9780 7274.
You can also visit our website to learn about other women’s conditions we treat through physiotherapy and how we can help you.