A hysterectomy is the surgical removal of the uterus (womb). Many women need their womb removed for medical reasons and this entry explains the possible reasons, the types of operation and how it can affect the woman, her partner and her family.

Reasons

• Cancer - Some people have a genetic tendency towards cancer.

• Fibroids - A benign tumour which usually develops on the wall of the womb.

• Molar pregnancy - If the chemotherapy is unsuccessful.

• Prolapse - A slipping down/forward of the wall of the womb.

• Endometriosis - A condition where the membrane lining of the womb appears outside of the womb with resultant pain.

• Heavy menstrual bleeding - Or heavy bleeding in between periods¹.

  The bleeding is a sod. You can't go out. You can't sit down. You can't drive more than ten minutes. You can't even walk up the stairs. It's thick and dark. It comes in lumps the size of half a pound of liver. I had to chuck out a whole bed in the end it was so disgusting.

The Process

Before the Operation

A bilateral oophorectomy (removal of the ovaries) is a big step and the patient needs to discuss with the surgeon whether or not the ovaries should be removed. A consent form will be supplied and must be read through and signed by the patient.

The Operation

Removal of the uterus may be performed in two ways:

• Suction - The full title is 'Laparoscopically assisted vaginal hysterectomy' (LAVH). The majority of the operation is done using laparascopic techniques (utilizing fibre optic instruments), and the uterus is then removed via the vagina. LAVH is much less traumatic than the traditional route.

• Abdominal incision - This is where the womb is removed through a cut in the abdomen.

After the Operation

The patient will have internal stitches (sutures) and the abdominal wound will have been closed with metal staples. Through the wound will be a drain, held in place by a stitch or two which collects the blood inside. The drain is removed a few days later. Before the patient is allowed home to recuperate, the staples must be removed by a nurse.

Aftercare

On no account should the patient attempt any housework, lifting, pulling, driving, etc for at least six weeks. This is the length of time it takes to heal internally. Sexual activity should be delayed until the woman feels comfortable resuming this. Her husband/partner needs to display the utmost patience here. It can take months for the woman to regain her sexual desires.

• Don't do any housework for six weeks after the operation. This is very important, otherwise you'll have to go back in. Externally you will repair a lot quicker than internally.

• Do go for your six-week post-op check-up.

• Do accept all offers of help.

• Do prepare yourself mentally, and you won't look back.

Hormone Replacement Therapy

Hormone replacement therapy (HRT) is offered to the patient immediately if she has had her ovaries removed as well as her womb (and she is under the age of 50 years). HRT can be taken orally as a low-dose birth control pill (eg, Climaval). Also via implants where a small amount of HRT is inserted under the skin, which is then absorbed slowly by the body. Alternatively, she may prefer to wear hormone patches. HRT is required until the woman is 50 years old, the age normally associated with the menopause. This is more commonly known as the 'change of life'; when her womb would have ceased to function naturally, as her ovaries shut down and stop producing oestrogen.

After-effects

• Scar - The deep red incision on the woman's bikini line does fade in time, and becomes barely noticeable. Although, as with all surgical scars, a lack of sensation around the area is normal. Sometimes it is necessary for the operation to be carried out through a vertical incision, leaving a more noticeable scar.

• Depression - It can be devastating for a woman to lose her reproductive organs. Even if her family was complete, her sense of purpose may be lost. Depression is relative to the sufferer. An understanding partner/friend/family can make all the difference. The woman should be made to feel worthwhile without her womb.

• New Lease of Life - For a woman who has suffered from excessive blood loss for months, maybe even years, the operation can effectively start a new life for her.

It was like being let out of prison. To never have to worry again about leakage; running out of sanitary towels; the embarrassment of having to ask for the largest, most absorbent pads in the chemists; to even go out wearing no underwear at all; it's a total new life for me.

Sex Life

Once the patient has attended her post-operative check-up at six weeks, and has been given the all-clear by her doctor, there is no reason why her sex life should not be resumed. With the removal of her uterus, an unplanned pregnancy is no longer a threat, therefore the woman should be more relaxed at the thought of recreational sex with no repercussions.

The HRT gave me hormones I'd not had as a teenager. From the uncomfortable hot flushes I'd been suffering from 'the change' I suddenly developed a 'teenage flush' and my sex-drive increased. My husband couldn't believe his luck.

A Poem by a Cancer Patient

Cursed

No one can give me back that which I have lost.
People tell me I am lucky, but at what cost?
They took away the very heart of me,
Stole something very precious so I will never be.

I have tried not to think of how much worse
It would be for me, if they had not removed the curse.
Of how no future was in sight,
For the curse would grow and I would lose the fight.

But somehow that does not seem so bad,
When I think of all that I could of had.
Maybe it is selfish, I want a little one of my own,
Someone to love, who came forth from the seed that I sown.

Now this miracle of life can never be,
This female right was taken away from me.
I did nothing wrong, but life was not kind,
A new meaning to life I have to find.

One day maybe I will look back,
And not mourn over what I lack.
But until that yearned for day arrives,
I will envy others, their new born lives.

A Personal Experience

My reproductive organs worked fine until I had a bladder-repair operation. After I had recovered from that (which was horrendous enough) to find myself having problems with my womb, including frequency and amount of blood loss, as well as pain, was quite a blow. When it got to the stage where I could not leave my home without being padded up with maternity sanitary towels and taking several changes of underwear out with me, I gave in and went back to my GP.

Luckily I live in England, so no medical bills, just a waiting-list. From my condition, my GP classed me as an emergency case and within a month I'd seen the surgeon for my first appointment. I had been given extremely strong pain-killers by my GP, but they made me dopey, so I was trying to do without them. The gynaecologist was very pleasant and understanding; at least I didn't feel like crossing my legs when talking to him. I went on the waiting list then had to sort out a foster family for my son (again), for my recuperation period (usually six weeks to three months). While I was on the waiting list (ten months) I read up what I could about what was going to happen to me. I came to the conclusion that, like childbirth, no two operations are the same, if anything, it would be similar to the one I had just had the year before. I prepared myself mentally for losing my reproductive organs. Luckily, compared to some women, I had finished my family. Mental preparation is vital to the recovery period, I am convinced of that.

The Operation

I was admitted the day before, and my nurse described me as 'calm'. On the morning of the operation, I had to sign a consent form. I was taken through it, everything being explained to me. I gave consent for 'anything untoward' being found, being removed. (Well who wants to be roused, mid-operation, and asked 'Do you mind...?') The pre-op injection was wonderful, instant euphoria. I remember being wheeled to the operating theatre, then feeling the cold numbness creeping up my arm as they injected me with the anaesthetic, then nothing until I awoke in after-care. Having already had a major operation the year before, I was well prepared for the after effects - nothing new there - except I wasn't hooked up to a catheter! Only a glucose drip and a drain (on my wound) to contend with... Luckily, I have always been alright with anaesthetic; most people get sick immediately after they come round - I never have. I was able to drink water immediately upon my return to the ward, so my drip was removed. This was a bonus compared to the bladder-repair operation, when I'd had to lug a catheter around for a week... Absolutely the worst part, for me anyway, was when the poor nurse came to remove the drain... first the removal of the stitches, then all they can do is tug... ooh, (wince, wince). If you do meditation, now is a good time. Compared to that, the removal of the staples is a doddle. A pair of tweezers, a fast, skilled nurse, you lie there and stare at the ceiling, I felt nothing and hugged my lovely nurse afterwards. What a star!

For what we ladies have to put up with, I am glad to say I never lost my sense of humour. I wish I could apologise to the ladies I shared my ward with, for how I made them laugh, and how uncomfortable it must have made them when they had to hang onto their staples for dear life... My surgeon came to see me the day after my op. He pulled the curtains round, which is no sound barrier, and you can guarantee silence befalls the rest of the ward, as the other patients hang on to every word! After he told me that he had not only removed my womb but also my Fallopian tubes and my ovaries, because he'd found a cyst on one, and my cervix (just to be on the safe side, his words), he asked me if I had any questions. I replied, yes, then 'Can I still have sex?' (sound of giggling from outside the curtains). The poor man rustled his papers then he looked at me and said: 'I have left you your vagina', (sound of muffled laughter from outside the curtains) to which I replied (well I was on a roll) 'I wasn't thinking about right now, doctor, but definitely later'. At which the doctor smiled, and he said he wished all his patients were as cheerful as me! After I was discharged, a week after my op, I was rushed back in with laboured breathing, I had all the symptoms of a blood clot, and it turned out to be a frozen shoulder. The steroid injection I had to have was extremely painful. I haven't got a clue how some people inject themselves for fun...

New Lease of Life

Two years on, I am having a new lease of life. No blood loss, no pain. I am on HRT, because I'd had my ovaries removed, not all hysterectomy patients do. This has given me the hormones of a teenager, without the acne!