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Myths about Hysterectomy
Hysterectomy, or the removal of the uterus, is a common gynaecological surgery. The primary reasons include uterine fibroids, adenomyosis, heavy menstrual bleeding, abnormal uterine bleeding, endometriosis, and uterine prolapse. Other reasons include gynaecological cancers such as endometrial cancer, ovarian cancer, and cervical cancer. Doctors will recommend a hysterectomy based on the medical condition and necessity.
Q2. What tissues are removed in a hysterectomy?
The procedure often involves a total hysterectomy. It means both the uterus and cervix are taken out. It is also recommended to remove both fallopian tubes since they are considered part of the same organ. After the uterus is removed, the fallopian tubes have no other function. Removing the fallopian tubes does not affect the function of the ovaries and can reduce the risk of developing ovarian cancer and the mortality rate from ovarian cancer in the future. If the fallopian tubes are retained, there may be a risk of hydrosalpinx, which can be easily confused with ovarian cysts and may require additional surgical intervention.
Q3. When removing the uterus, should the cervix be retained?
The cervix is the lower part of the uterus, which is cylindrical in shape and connects to the vagina. The cervix can be retained during a hysterectomy, and the surgery is generally simpler and quicker. However, this may lead to periodic light vaginal bleeding, similar to having a menstruation. It might also result in vaginal discharge, cervical stump prolapse and there could be an increased chance of urinary incontinence. Numerous studies have shown that keeping or removing the cervix has no impact on sexual, urinary, or bowel functions. If the cervix is retained during surgery, there is still a risk of cervical cancer and regular cervical cancer screening is needed. Therefore, removing the cervix in hysterectomy is the standard procedure, especially when there are concerns about cervical issues.
Q4. When removing the uterus, should the ovaries be removed as well?
For women who have not yet reached menopause, removing the ovaries will result in the loss of female hormone secretion, causing instant menopause. This may lead to hot flashes, sweating, palpitations, irritability, and other menopause-related symptoms. In the long term, it may increase the risk of osteoporosis, cardiovascular diseases, cognitive impairment, and an increase in all-cause mortality. Therefore, unless there are tumours in the ovaries or a concern about ovarian or breast cancer, doctors usually recommend keeping the ovaries. For postmenopausal women, since the ovaries are no longer producing hormones, it is usually recommended to remove the ovaries to reduce the future risk of ovarian cancer. For women who are nearing menopause, it is also recommended to consider removing the ovaries.
Q5. Does removing the uterus lead to earlier ageing? Can taking hormones help delay ageing?
The uterus itself does not have a hormone-secreting function. It is the ovaries that produce eggs, allowing for periodic ovulation and the secretion of female hormones. It causes the uterus to have periodic bleeding, which is known as menstruation. Removing the uterus simply results in no menstrual bleeding. If the ovaries are retained, hormone secretion will continue, and thus it does not result in menopause. If the patient is already menopausal, the presence or absence of the ovaries does not alter the body’s hormonal status. Therefore, removing the uterus does not accelerate ageing, and there is no need for hormone supplements.
Q6. Does removing the uterus affect sex life?
A hysterectomy generally does not affect a patient’s sex life. The surgery does not alter the length and width of the vagina, and the vagina and vestibular glands will still produce lubrication during intercourse. Therefore, there is no significant change in overall sexual function, and it does not affect the ability to achieve orgasm.
Q7. After removing the uterus, will there be an empty space in its place? Will other organs drop down?
A normal uterus is very small and occupies a very small space in the pelvic cavity. After removing the uterus, there will not be an empty space because the doctor will repair the top of the vagina during surgery. The intestines within the abdominal cavity will naturally fill the space where the uterus used to be, and they will not fall down.
Q8. Following a hysterectomy, will there be pelvic floor weakening or organ prolapse?
Each organ in the body is supported by ligaments and tissues to keep it in a specific position. The base of the uterus also has a pair of ligaments that maintain the uterus in its normal position in the pelvic cavity. The uterus itself does not support other organs, and removing the uterus does not necessarily involve cutting the main ligaments, especially if the surgery is performed laparoscopically. Even if the ligaments are severed, doctors will suture them when repairing the vaginal apex, preventing pelvic floor muscle relaxation and organ prolapse. In patients who have no prior history of vaginal delivery or pelvic organ prolapse, the risk of prolapse after a hysterectomy is very small.
Following a hysterectomy, will there be urinary leakage or incontinence?
A hysterectomy may affect the lower urinary tract system, increasing the risk of urinary incontinence, especially in women aged 60 or older. However, conclusive causal evidence is still lacking. The risk of urinary incontinence increases with age and menopause. A hysterectomy is not considered an independent risk factor for urinary incontinence. Instead, factors such as potential pelvic organ prolapse, previous childbirth, and vaginal delivery significantly contribute to urinary incontinence following a hysterectomy.
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