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How Does a Hysterectomy Work?

March is Endometriosis Awareness Month. Endometriosis is a condition when the tissue lining the inside of the uterus that is usually shed during menstruation, grows outside of the uterus. Oftentimes endometriosis can be treated with hormonal birth control or surgery to remove excess uterine tissue. In some extreme cases, however, a hysterectomy is performed to treat severe symptoms of endometriosis.

What is a hysterectomy?

A hysterectomy is a surgical procedure where the uterus is removed. A hysterectomy can be done to treat uterine fibroids, a uterine prolapse where part of the uterus slides into the vagina, endometriosis as mentioned above, chronic pelvic pain, abnormal vaginal bleeding, adenomyosis (a thickening of the uterus), or uterine, ovarian or cervical cancer. 

What are the different types of hysterectomies?

Depending on the reason for the hysterectomy, different parts of the reproductive organs will be removed. In a supracervical hysterectomy, the upper part of the uterus is removed. A total hysterectomy removes the whole uterus and the cervix. A radical hysterectomy removes the entire uterus, the cervix, the surrounding tissue, and the top part of the vaginal canal. A radical hysterectomy is less common than the other types and is used only when cancer is being treated and removed.  

Either an open hysterectomy or a minimally invasive hysterectomy will be performed. The type of hysterectomy performed depends on the surgeon doing it, and also the reason for the surgery, as well as the patient’s overall health. There are differences in healing time, as well as how invasive the surgery is, so it is important that the type of surgery best serves the patient and their condition. An open or abdominal hysterectomy is most common and includes an incision being made across the patient’s belly. The uterus is removed through this five- to seven-inch incision. Because the patient has to be surgically cut open, they often spend a few days in the hospital afterward for recovery. There will also be a visible scar on the patient’s belly as they heal. 

What is a vaginal hysterectomy?

A minimally invasive hysterectomy has a few different approaches. One minimally invasive option is a vaginal hysterectomy. This consists of a surgeon making an incision in the vagina and removing the uterus this way. Since the incision would be inside the body, there is no visible scar left behind. A laparoscopic hysterectomy is done using a laparoscope to guide the surgeon as they perform the hysterectomy outside the body. The laparoscope has a camera on the end and is inserted into a small cut made in the belly or belly button. The surgeon is able to remove the uterus by viewing the inside of the body through this camera. Wild!

A laparoscopic-assisted vaginal hysterectomy combines the two options listed above, using the laparoscope to help remove the uterus through an incision in the vagina. Because this procedure is less invasive and doesn’t require as large of an incision, the recovery is a little less intense. A minimally invasive hysterectomy is only a good option depending on the person and severity of the condition, which is why an open hysterectomy is much more common. 

What can you expect from the recovery process?

The recovery process after a hysterectomy is similar to recovery after any major surgery. An open hysterectomy requires about four to six weeks of recovery time. The patient needs to rest, refrain from physical activity, and shouldn’t do any heavy lifting during this time. For a minimally invasive hysterectomy, recovery time is similar but lasts about three to four weeks instead. After the hysterectomy, the patient should feel relief from the symptoms associated with whatever condition prompted the surgery. 

If the ovaries are still in the body after the surgery, the patient shouldn’t experience any hormonal changes. If the ovaries are removed, however, and the patient has not experienced menopause yet, they are now in menopause. The ovaries contain the eggs that are released every month that causes menstruation, so if you no longer have ovaries, you can no longer menstruate, thus entering menopause. Because of this, the patient will likely experience symptoms associated with menopause such as mood swings, hot flashes, change in sex drive, and vaginal dryness. These symptoms can be treated with hormone replacement therapy. If the patient is under the typical age when menopause usually begins (between 45-55), their doctor will very likely have them use hormones so they are better able to navigate these changes. 

No matter the type of hysterectomy, it is recommended to wait to have sex for at least six weeks as the body heals. Some patients might notice their pelvic floor feels weaker after this surgery, which can cause less control over your bladder, as well as loss of sensation during sex. Pelvic floor exercises or even pelvic floor therapy can help with the healing process as well. Kegel exercises are a great option to strengthen the pelvic floor.

Who should consider having a hysterectomy?

A hysterectomy is not taken lightly and is performed to treat uterine fibroids, a uterine prolapse where part of the uterus slides into the vagina, endometriosis as mentioned above, chronic pelvic pain, abnormal vaginal bleeding, adenomyosis (a thickening of the uterus), or uterine, ovarian or cervical cancer. Because the uterus is removed, it is no longer possible to experience pregnancy. Despite that consideration, hysterectomies help treat a variety of serious conditions and can be life-changing in terms of pain relief and cancer removal for those experiencing any of the conditions mentioned above. 

It is important to stay on top of your reproductive health. Women and people with uteruses should visit their gynecologist on a yearly basis, receive scheduled Pap smears, as well as physical exams. If you’re experiencing any severe pain abdominal pain or abnormal bleeding, contact your doctor right away. You should not have to live in severe pain due to your reproductive organs, and this intense pain could be indicative of something much more serious. Because reproductive organs are tucked away inside of us, it is hard to know what is going on without consulting a professional. Looking after your reproductive health is just as important as maintaining your physical health overall. 

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Cervical Health and Prevention

January is cervical health awareness month. Hooray! Although it’s great to be aware, what even are we being aware of? What is a cervix and how can it be healthy? All good questions with answers!

What is the cervix?

The cervix is essentially a small area of your body that connects your vagina to your uterus. The cervix sits at the top of the vaginal canal and has very small openings on either end. The cervix is about 1 to 2 inches long, and the openings open and close just to let out discharge, menstrual blood, or to let sperm pass through. The cervix opens super-wide during childbirth, and acts as a barrier to keep bacteria out of the womb all the time, but especially during pregnancy. 

The cervix is super important for your reproductive health because it does so much to keep your vagina and uterus clean and healthy. Just like any other part of your body, the cervix can be unhealthy. The main concern with cervical health is cervical cancer. When someone with a cervix turns 21 or becomes sexually active, regardless of their age, they should start having regular Pap smears. 

What happens during a cervical Pap smear?

A Pap smear is a procedure done by your gynecologist in their office to test the cells of your cervix. Your doctor will take a small sample of cervical cells by using a little brush to gently scrape your cervix and collect the cells. You might be thinking, “Uhh how can a scrape be GENTLE?!” It is uncomfortable, but the actual test takes literal seconds. Your doctor will have you undress from the waist down, put your feet in some stirrups so your legs are spread easily, and takes a look. Your gynecologist will prop open your vagina using a speculum, which kind of looks like a long beak made out of metal or plastic. The speculum holds your vaginal walls open so your doctor can reach your cervix. They’ll reach in with their brush, scrape the cervix really quickly, then take the speculum out and you’re done. Some doctors will also use their fingers to reach inside and feel around your vagina and feel the cervix to make sure nothing feels off. The whole exam is uncomfortable, but it shouldn’t be painful. If you experience pain during any part of the exam, tell your doctor immediately! You might bleed a little bit after the exam. Mild bleeding is normal, but if you bleed excessively, call your doctor immediately.

How often should I have my Pap smear?

If you are 21-25ish and have never had an abnormal result from a smear, it’s recommended to get a Pap test done every three years. Women in their thirties through menopause should get one every three years along with an HPV test. Women over the age of 65 who have never had an abnormal result might be able to stop getting Pap smears done altogether. If you’ve had an abnormal result before, have a history of cervical cancer, or have any conditions that weaken your immune system, you should get one done every year, regardless of your age. Talk to your doctor and they’ll be able to tell you how often you should get a smear done to maximize your health. 

What are possible cervical health risks?

Unhealthy cervical cells are most commonly caused by HPV or human papillomavirus. HPV is the most common sexually transmitted disease. If you are sexually active, you will almost certainly have HPV at some point in your life. There are about 200 types of HPV, and most types are harmless, show no symptoms, and go away on their own. It’s possible you’ll never know you’ve had HPV. HPV is so common because its spread sexually, but also through skin-to-skin contact. If you do show symptoms, you will likely get warts, genital or otherwise. They can easily be treated. In most cases, HPV is harmless and will go away on its own before you ever have symptoms. Think of it kind of like the common cold. You can get a cold through contact with other people and their germs. Most of the time your cold will go away on its own, but in some cases, it can turn into something more serious. About 12 types of HPV can cause cancer, including types 16 and 18, which are the main culprits. 

There is no cure for HPV, which is why getting regular Pap smears done is so important so abnormal cervical cells can be detected and removed right away. You can also get an HPV vaccine, which is recommended for kids of all genders when they’re about 11 or 12. The HPV vaccine is given in three rounds and helps protect against most types of HPV that cause cancer. Just because you’ve had the vaccine, however, doesn’t mean you won’t have another type of HPV at some point–just hopefully not the cancer-causing kind. If you’re an adult and haven’t had the HPV vaccine, it’s never too late! The HPV vaccine used to only be given to girls in middle school, but since it first hit the scene research has been done that boys should also get the vaccine. Although boys and men don’t typically have cervixes, they can still carry and spread HPV, which could lead to cervical cancer in a partner with a cervix. Now people up to age 45 can get the vaccine if they didn’t get it as a kid. 

Your cervix is an easy part of your body to forget about because it’s tucked away inside of you, working away without much notice. Because you can’t see your cervix, it’s important to stay on top of your cervical health. Get regular Pap smears done once you become sexually active or once you turn 21. After your first smear, your doctor will tell you how often you should get your Pap smear done going forward. Check and see if you’ve had the HPV vaccine, and if you have kids, make sure they get the vaccine as well. You can also ask your doctor to do an HPV test to check your cervical health that way as well. Now go schedule your annual, or semi-annual Pap test!

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New Cervical Cancer Testing Guidelines

PAP smear tests are recommended every one to three years for people with uteruses ages 21 to 65. PAP smears help detect abnormal or unhealthy cells in one’s cervix, which could indicate cervical cancer. A recent update from the American Cancer Society is changing those requirements. On July 30 in the publication “CA: A Cancer Journal for Clinicians,” the American Cancer Society released updated requirements for cervical cancer screenings with new cervical cancer testing guidelines. Previously, people with cervixes would get a PAP smear every one to three years starting at age 21. An HPV test would be added as well once the patient is 30, and the PAP and HPV test would be done every one to three years until the patient is 65. The new recommendation is now phasing out PAP tests and simply testing for HPV every five years in patients ages 25-65.

Human papillomavirus is the most common sexually transmitted disease. Most people will have HPV at some point in their lifetime, and most cases of HPV are so mild that you won’t even know you’ve had it. Most cases also go away on their own. In some cases, however, HPV can develop into cervical cancer. These new recommendations suggest that testing specifically for HPV every five years will be a stronger way to detect cervical cancer than PAPs every three years. After a PAP test is done, if there are any abnormal cells in your cervix, an HPV test is ordered. These new recommendations would eliminate the PAP and just test for HPV right away.

The American Cancer Society says testing just for HPV every five years is a good idea due to the popularity of the HPV vaccine. Both boys and girls receive the vaccine now starting at age 11, greatly reducing the number of HPV cases. They also recommend starting HPV testing at age 25 because cervical cancer is incredibly rare in people under that age. The report said that the goal is to eventually phase out PAP smears altogether.

I’m not a doctor, but I do wonder if no longer having any PAP smears is a good idea. The PAP smear detects unhealthy cells in your cervix. Although HPV tests screen for cervical cancer, I wonder, what if you have unhealthy cells that aren’t due to HPV. How would that be detected then? Obviously this new requirement was done after much research and consideration, and like I said, I’m not a doctor, just curious.

I encourage you to ask your gynecologist about this new requirement in testing during your next visit. It’s important to be informed on your sexual health and know why procedures are changing and how that affects you. Regardless of the new requirements, it is important to start seeing your gynecologist for cervical health screenings regularly. The previous guidelines state starting at age 21 or once you become sexually active. Call your gynecologist and ask about the new HPV testing, or simply wait until your next scheduled appointment and chat about it then.

It’s incredibly important to stay on top of your sexual health and visit your gynecologist regularly. As I mentioned, HPV is very common and goes away in most cases, but just in case, it is super important to get tested regularly, whether that be according to the old guidelines or the new.

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