When Cancer Treatment Requires Removal of the Uterus and Cervix
A hysterectomy is the removal of the uterus and cervix. The cervix is the bottom portion of your uterus. The removal may be done through the vagina or through the abdomen. Which way depends on the diagnosis. It also depends on your risk factors. Often, it is done through an incision, or cut, made in the abdomen.
The cut can be vertical or transverse (horizontal). A transverse cut is made across the abdomen through the bikini line. A vertical cut allows better assessment. For these kinds of cancers, most surgeries are done with a vertical cut.
Hysterectomies may be done for reasons other than cancer. With cancer, the type of surgery is determined by several factors.
Total Abdominal Hysterectomy (TAH) — A TAH is usually done for cancer of the uterus or ovaries. It may also be done if there is a large amount of tumor that involves the surface of the uterus. It typically uses a vertical cut.
The cut runs from the bikini line up past the belly button. This large incision lets the surgeon look at and study all signs of disease. Surgical incisions and scars can affect how you feel about your body. They can make you uneasy in an intimate situation.
Vaginal Hysterectomy — A primary vaginal hysterectomy is not often done when a gynecologic cancer is found, however it may be a very good option for certain women with precancer of the cervix. The entire hysterectomy is done through the vagina so there are no visible scars on the belly or on the vulva. Ovaries and fallopian tubes can be removed this way – but may be more difficult to remove completely. The surgical incision is up on the top of the vagina and will need about 6-8 weeks of healing time before sexual activity can be resumed.
Laparoscopic Vaginal Assisted Hysterectomy of Total Laparoscopic Hysterectomy (LAVH or TLH) — This surgery removes the uterus with or without the fallopian tubes and ovaries. To do so, the surgeon uses a laparoscope. That’s a small instrument (a telescope with a camera) inserted through the belly button. Additional instruments are inserted on either side of the abdomen and often also at the bikini line. Most of the instruments are no bigger than your index finger or thumb. It allows the surgeon to see the pelvis and remove the uterus through the vagina. LAVH or TLH have less pain after surgery and requires less healing and recovery time. The scars are much smaller and often will be difficult to see after full healing.
Radical Hysterectomy — This surgery is often done for cancer of the cervix. The surgeon removes the uterus and cervix, the tissue around the cervix and the upper part of the vagina (usually about 1 inch). Other tissue inside the pelvis may be removed. If so, there may be temporary inflammation that makes it hard to empty your bladder. Some women need a urinary catheter for about a week. Some even go home with it until the inflammation heals.
Trachelectomy — This is a special type of surgery. It takes out only the cervix and leaves the uterus, fallopian tubes and ovaries in place. It may be used to treat early stage or noninvasive cancer of the cervix. Women after this procedure still ovulate normally and can get pregnant. Only certain women are candidates for this procedure.
Sexual Effects After Hysterectomy
After a hysterectomy, the vaginal canal may be shorter. This can cause discomfort with sexual intercourse. The vagina can stretch, though, during sex. Vaginal dilators can also help stretch the vagina in between sexual activity. So, sexual function and pleasure can be maintained. Since the uterus contracts during orgasm, some women say their orgasm is less intense after hysterectomy. Others, though, say there is no difference.
Some women also say that after the cervix is removed, there is less lubrication in the vagina. Again, others say they don’t notice a difference. Learning how your body responds after surgery will help you discover what is pleasurable. Some women fantasize or touch themselves to learn how their body responds.