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Hysterectomy - Indepth

What is a hysterectomy?

A hysterectomy refers to an operation where a woman's uterus is surgically removed. This procedure spells the end of a woman's ability to become a mother. This may seem a rather drastic step to take, especially for women who want to have children. However, a hysterectomy becomes essential under certain circumstances. For instance, cancer of the uterus, ovary or cervix, prolapsed or 'dropped' uterus, severe pelvic infections, endometriosis or uncontrollable bleeding. In some cases, it also becomes necessary to remove the ovaries if they are diseased. If the ovaries of a premenopausal woman are removed, she goes into menopause and will need to take Hormone Replacement Therapy (HRT).

The procedure

There are basically two ways to perform a hysterectomy:

  • Total abdominal hysterectomy refers to a procedure involving the removal of the uterus and cervix through an abdominal incision. This method gives the surgeon better visibility of the pelvic organs and more space to maneuver. Doctors opt for this method if you have a large pelvic tumour or a suspected malignancy. The disadvantage of this method is that it means a longer hospital stay, greater postoperative discomfort and a visible scar. The surgeon can make a bikini incision, i.e. a horizontal incision just across the top of the pubic hairline. This scar will not be as noticeable.
  • In a vaginal hysterectomy, the uterus and cervix are removed through a small incision in the vagina. While this is a technically more difficult procedure because of the limited space the surgeon has in which to operate, it is ideal for cases where the uterus is not enlarged or has dropped as a result of the weakening of the surrounding muscles.

Explore other alternatives

Pelvic pain and vaginal bleeding are the symptoms most likely to lead to the performing of a hysterectomy. However, they do not always indicate that there is a problem with the uterus requiring a hysterectomy to be performed. Pelvic pain can be linked to conditions in the urinary tract, skeletal system or digestive system. It is essential that you perform all the diagnostic tests before you decide to have a hysterectomy. You must consult your doctor about alternative remedies.

When should a hysterectomy be avoided

Hysterectomy should not be performed in a postmenopausal woman who has vaginal bleeding until a D&C has been done. Women who are obese, diabetic, or have high blood pressure should only have a hysterectomy done if it is absolutely necessary. Conditions such as these increase the risks of major surgery. A hysterectomy should not be considered for the sole purpose of sterilization. Sterilization does not warrant such a major surgery.

The procedure is irreversible

The decision to have a hysterectomy is not an easy one, especially since it affects a woman's reproductive organs. The removal of a woman's womb is not a reversible procedure. The uterus seems to be a symbol of fertility and womanhood. This belief is irrational because the uterus merely serves as a temporary home for the growing foetus. A hysterectomy is particularly painful for young women who are yet to have children. 

The after-effects of a hysterectomy

On the up side, a hysterectomy spells freedom from heavy periods and from the fear of cervical and uterine cancer. However, some women have reported a decrease in their libido, less intense orgasms and slower arousal. The lack of uterine contractions may reduce the pleasure of orgasm for some women. On the other hand, relief that they do not have to worry about getting pregnant any more enhances sexual pleasure for others.

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