Remove the uterus completely to save it. Types of consequences after hysterectomy and how to deal with them? Intimate life and sex

Hysterectomy is a common operation that involves removing the uterus and is performed for certain indications. This is usually experienced by women after 45 years of age. Especially those who have lived with fibroids for many years.

Hysterectomy and panhysterectomy

Before the intervention, enteroscopy and hysteroscopy are performed, during which the uterine cavity is examined and then all manipulations are performed to eliminate it.

Hysterescomy is performed through laparoscopic openings and by open surgery. In the first case, the uterus is removed through the vagina with 1 cm long incisions, and a blind sac is formed. General anesthesia is given. The stitches are not removed, the woman is on sick leave for 14 days.

Extirpation of the uterus without appendages on the operating table (open surgery) extends sick leave to 1.5 months. Excision is carried out horizontally, in the future the scar is noticeable.

The second option involves removing the uterus through the abdominal wall (laparoscopy). General anesthesia is also given. The woman stays in the clinic for 2-3 days, with sick leave for a month. The stitches are removed after a certain time.

Pfannenstiel laparotomy is also considered a common way to approach the uterus. The laparotomy procedure is considered an open method, involving an incision in the peritoneum.

Panhysterectomy, what is it and how is it done, you can learn about it from your doctor. During the operation, not only the uterus is removed, but also the ovaries and appendages. Such radical manipulation changes a woman’s life.

Complete rehabilitation is 2 weeks. Extirpation of appendages can significantly change your lifestyle for the worse in sexual terms. During Wertheim's operation, the greater omentum, or part of it, is removed.

Supravaginal amputation of the uterus is also performed, which involves removing the organ while preserving the cervix. In the process, lymph is disrupted. The basic tactics of the procedure are no different from the above. According to Wertheim, they are excised in almost all open operations.

Often one ovary is amputated in the pelvic area without touching the fallopian tubes. This is due to the presence of such a growth as a borderline tumor. Removing one ovary does not lead to significant changes. Fertility is preserved; you can get pregnant both naturally and with the help of IVF. The main thing is to prevent polycystic disease. The reasons for such an operation are extensive. Among them are cysts and cancer. Every woman needs a correct diagnosis.

It is also noted that it is possible to remove the uterine cavity during menstruation, but taking into account the current condition of the woman and the general results of the tests. During a caesarean section, the uterine cavity can also be removed if during such a birth there is a partial rupture or ruptures on its own. The fetus is extracted using a vacuum.

If there are no emergency prohibitions on the procedure, then a subtotal hysterectomy will take place. Contraindications – inflammatory processes, acute respiratory infections, infections of the cervix and vagina.

Removal of the uterus for fibroids

The hysterectomy procedure for fibroids 100% prevents the development of relapse, but here the inability to give birth to a child is at stake. For this reason, surgery is prescribed for those women who have already reached menopause.

A medical procedure for extirpation is prescribed in such cases as:

• Large fibroids (comparable to a 3-month pregnancy).
• Pronounced tumor clinic.
• Myoma together with uterine prolapse.
• Sumbucous fibroid with bleeding.
• Presence of a tumor on the leg.
• Traces of degeneration of fibroids into cancer.
• Pressure from the growth on nearby organs.
• Development of fibroids on the cervix.

Such an operation, when the fibroid is removed along with the uterus, is the worst development of the disease. They resort to surgery if other treatments have not produced any results.

After the procedure, you need to adjust your diet, lifestyle, and review the amount of physical activity.

If hysterectomy does happen after 40 years, despair is the last thing. After the operation, it is necessary to change your lifestyle and be more attentive to your health, to prevent the development of a cyst. In old age, after fibroids are eliminated, granulation takes longer.

Consequences after hysterectomy

After a hysterectomy is performed, a woman forgets about bleeding, pain, “movements” of organs, and a serious condition before menstruation.

When the organ is removed, a uterine stump remains, which means that some endometrium is still present. In this case, there will be cleaning, after which the tissue will be sent for analysis (histology). This means that there will be discharge and this is the norm.

The histology result will show the presence of malignant cells.

If endometriosis occurs during the recovery period, recovery will be delayed. Ablation may be used due to a disease such as adenomyosis.

A woman does not always discuss issues concerning her life and health with a doctor. The fair sex cares about their appearance, sexual relationships and quality of life in general. Not surprisingly, menstruation occurs after surgery. This is due to incomplete removal of the organ. It’s all due to hormonal imbalance and cavity remnants.

The consequences of the operation are quite obvious - the woman will no longer be able to give birth.

In addition, the organs in the pelvis will move slightly. If the procedure is done in a timely manner, the woman quickly comes to her senses and lives a normal life. In any case, it is important to monitor your health and be attentive to every little detail.

If you experience painful spasms in the peritoneal area or bleeding, you should consult a doctor as an emergency. No matter how many months have passed since surgery, you need to understand that this is a big risk.

Symptoms that may occur after hysterectomy surgery include:

• Painful cramps (back, lower abdomen). This is due to slow scarring of the incision or the formation of adhesions. It hurts to go to the toilet, the lower abdomen hurts both constantly and in surges.
• Hematoma. May occur on the abdomen after an open removal procedure.
• Discharge. The ichor comes out. A sign that the ovaries continue to work, and the cervix is ​​under pressure from sex hormones. Developed thrush indicates an infection; a doctor’s help is needed.
• Breast. It may swell and ache. The mammary glands are also subject to diagnosis.
• Temperature. It may increase slightly. Usually on the first day. At this time you need to be under the supervision of doctors.
• Bleeding. In some cases it can last for several weeks. If blood loss is already significant, there is a reason to consult a specialist.
• Cystitis. A burning sensation in the perineum when urinating is not uncommon. This cannot be called a disease, since the condition passes quickly.

If a woman is diagnosed with cervical cancer (oncology), they resort to radiation therapy, after which hair falls out.

Radio irradiation cannot be the only treatment, so the course of medication must be completed. Having completed therapy, the woman needs peace and competent care. There are many contraindications, but there are also many advantages. Irradiation is one of the most unpleasant disadvantages of therapy; hair loss is often observed.

Nutrition for oncology should be selected by a doctor. If metastases are started, chemotherapy begins.

Total hysterectomy is rarely performed and requires serious reasons (cancer, large tumor).

Pericultitis may also occur, especially after 60 years of age, which can be successfully treated with Trichopolum and similar drugs. In any case, you need to consult a doctor and undergo tests.

Complications after removal

There are some complications, if they develop, you need to immediately go to the doctor or call an ambulance.

We are talking about conditions such as:

• Heavy bleeding.
• Festering stitches.
• Inflammation in the perineum (lymph nodes).
• Intense pain.
• Disturbed urination.
• Redness in the lower leg area (development of blood clots).

All complications after removal of the uterus are caused by physiological processes, since the functioning of the bladder and intestines is disrupted. Typically, the pelvic floor muscles become weak and cannot support the vagina as they once did. For this reason, Kegel strengthening exercises or vaginal tightening procedures are recommended after a hysterectomy procedure.

Resection of the uterus is a generally safe and fairly common operation, but after the procedure, urinary incontinence, vaginal prolapse and hemorrhoids, bladder prolapse, fistula formation, and regular pain may occur.

Late complications are cultitis and mastopathy. Usually appears 30 days after the procedure to remove the organ. Accompanied by pain (joints) and discharge.

Lymphocyst is a terrible complication. It is diagnosed at stage 3, so treatment is long, sometimes without results.

Only the attending physician can give a prognosis after examination and consultation.

Most patients are frightened by such a procedure, so they deliberately delay the removal process. It is important to understand that ignoring the problem will not solve the problem, but will only worsen the consequences after surgery.

Intimate life and sex

If the uterus was amputated without removing the ovaries, then the hormonal system does not fail. Consequently, libido remains as before, and sensations during sex are similar to previous ones. Intimate life will be normal.

When the uterus and ovaries are removed, the desire may fade a little or disappear. Everything will be restored later, when the course of drugs is completed.

Sexual life after removal of the uterus usually does not change, the only difference is the ability to feel arousal. With any gynecological pathology, the arousal function is impaired. As a rule, this is temporary.

An examination by a gynecologist should take place one month after extirpation. The doctor will evaluate the internal condition of the vagina and make recommendations.

It is possible that the first time you have sex will be uncomfortable. There is no need to be afraid of this, because over time it will return to normal.

The organ inside is removed, the clitoris remains. Therefore, a man should carefully and slowly relax his partner so that she does not feel pain.

Menopause after hysterectomy

Menopause in women that occurs after a hysterectomy is considered a long-term consequence. It must be remembered that if the uterus is removed without appendages, then menopause will occur as it should be genetically.

According to statistics, it turns out that menopause after surgery will occur 5 years earlier than expected.

There is no specific justification for this phenomenon, but it is believed that the blood supply to the ovaries after the removal of the organ begins to malfunction, and this affects the hormonal system.

To understand the problems of menopause, it is important to know the terms that doctors use.

• Natural menopause(cessation of menstrual cycles due to fading of the functioning of the gonads).
• Artificial menopause(cessation of menstruation due to removal of the uterus or suppression of ovarian function with the help of hormonal drugs Remens).
• Surgical menopause(Removal of ovaries and uterus).

The onset of surgical menopause is difficult to bear. This is caused by the inability of the ovaries to produce hormones. As a rule, the process of reducing hormones lasts several years.

When the uterus and appendages are removed, the body undergoes global changes. The consequences will be more serious if the woman could still give birth.

Symptoms of this menopause are noticeable a couple of weeks after surgery. First of all, hot flashes and sweating are of concern. They are followed by emotional lability and changes in appearance (withering skin, brittle nails). There is urinary incontinence and vaginal dryness. Bladder problems are a complaint of many.

If the uterus and ovaries are removed, then hormone therapy takes place. This is especially true for young women under 50 years of age. Estrogens (Divigel) and gestogens are usually prescribed.

It happens that the cavity is removed due to the development of large fibroids, then the woman must take not only pills, but suppositories with pills.

Hysterectomy with appendages performed against the background of endometriosis requires treatment with estrogen. As a rule, taking medications begins 30-60 days after the procedure. Hormone therapy reduces the risk of heart pathologies and osteoporosis.

But it is worth taking into account individual characteristics; such treatment is not prescribed for everyone. You should not start taking medications if you have:

• Breast cancer.
• Surgery (uterine or cervical cancer).
• Thrombophlebitis.
• Pathology of the kidneys and liver.
• Meningioma.

Treatment with HRT lasts for a long time - from two to five years. For example, with the drugs Femiton Feminorm, Femoston.

You should not expect rapid improvement during postmenopause and the disappearance of climatic manifestations.

Adhesions after surgery

Any operation on the abdominal cavity and within it is accompanied by the development of adhesions. Adhesions after surgery to remove the uterus are cords that connect the peritoneum and internal organs. They are also located between the organs inside.

After a hysterectomy, about 90% of the female population experiences a similar condition, the cause is unknown.

The process of development of adhesions after removal of the uterus depends on several factors:

• Duration of the procedure.
• Volume of operation.
• Loss of blood (leakage, bleeding).
• Development of infection after surgery.
• Genetics.
• Asthenic physique.

If after the operation you feel pain, aching in the lower back, difficulty urinating and constipation, then it is likely that this is a signal of adhesions.

To prevent their occurrence, antibiotics, anticoagulants, and physiotherapy are prescribed. Rehabilitation must be arranged competently; this is the only way to avoid unpleasant consequences.

Treatment after surgery

Antibacterial therapy is prescribed mainly for prevention, since the organs have had contact with air. This means that infectious agents could get inside. The course of treatment is a week.

Anticoagulants are allowed in the first days after surgery. They are able to thin the blood, protect against the formation of blood clots and the development of thrombophlebitis. Intravenous medication is given on the first day after surgery. This replenishes blood loss.

HRT with the uterus and ovaries removed is important for a woman. The drugs will help normalize imbalances and support the body. Hormone replacement therapy is important, otherwise the system will fail extensively, after which all body functions will fail.

If after removal of the uterus the condition does not worsen and no symptoms appear, then the postoperative period is considered easy. You can judge further consequences by the first week. Without an ovary in the first 3 days after the procedure it will be more difficult than with the removal of one uterus.

After amputation of the uterus, you need to take painkillers.

Recovery period

Postoperative replacement therapy is aimed at restoring water balance and preventing inflammation.

The support of the patient is important, so you need to pay attention to the psychological aspect. Any operation brings stress to the body, and intervention in gynecology is a serious shock.

A woman must adhere to a diet - do not eat foods that irritate the mucous membranes.

It is necessary to remove from the menu such drinks and food as:

• Chocolate.
• Cottage cheese.
• White bread.

To get your intestines back on track, you should eat often, but in small portions. Water consumption – up to 4 liters per day.

It is allowed and approved to eat porridge and drink meat broths. The main thing is to stick to the diet that the doctor prescribed for the first days after discharge.

During the rehabilitation period after surgery to remove the uterus and ovaries, you should not put stress on the body. You cannot lift more than 5 kg. Physical exercises and gymnastics are allowed to be performed only after the stitches have completely healed.

Most doctors advise after surgery (on the 3rd day) to get up and slowly walk if your legs don’t hurt. Such a load will speed up the blood, and recovery will go faster. In addition, 30 days after abdominal surgery it is allowed to pump up the press.

A hysterectomy often changes a woman's lifestyle.

For a quick and successful recovery, experts recommend:

1. If the course of the postoperative period is smooth, you need to continue to engage in prevention aimed at the occurrence of long-term consequences, then changes in the body will be minimal.
2. Bandage. Is a good help. Women whose abdominal muscles are weakened even without surgery should wear a bandage. There is more than one type of corsets of this type. You need to choose the one with less discomfort. The main thing is that the width of the “accessory” should be 1 cm above and below the scar.
   
3. Sex after hysterectomy. It is better to refrain from intimacy. Your doctor will tell you when you can have sex. Each woman is individual, and sexual life begins when the patient herself feels it. If you left the ovaries, then you don’t have to worry about libido. Sexual rest is necessary for a long time. When intimacy begins, you need to protect yourself so as not to introduce a new infection.
4. gravity. Until the seam is healed, you should not lift weights exceeding 5 kg. This is fraught with suture divergence and repeated visits to doctors. The doctor's testimony must be taken into account from beginning to end.
5. Discharge. After removal of the uterus, they will last 1-1.5 months. During this period, it is advisable not to lift anything heavier than a plate, otherwise there is a high risk of bleeding inside the peritoneum. Hygiene must be maintained.
6. Gymnastics and exercises. To strengthen the vaginal muscles, you should perform exercises using a special exercise machine (perineal gauge). It is this that provides the effect of intimate gymnastics. It is also recommended to perform Kegel movements, which are also aimed at strengthening the vaginal muscles.
7. Sport. This means yoga, Pilates, shaping, swimming, fitness. You can think about classes only after 90 days from surgery. And then provided that there were no complications. You can play sports, but only light physical activity. If you want to spin a hoop, you definitely need to talk to a doctor.
   
8. After a hysterectomy, for 60 days you cannot take baths, use tampons, douche, go to a sauna or bathhouse, or swim. If there is any discharge, you should use pads exclusively.
9. Nutrition. A proper diet is important after surgery. To prevent constipation and bloating, you need fluid and fiber. These are vegetables and fruits in any form. You cannot drink strong tea or coffee drinks. Alcohol is strictly prohibited; it also has the ability to provoke bleeding. A woman should receive the bulk of her calories before lunch. You should also remove fatty, smoked and fried foods from the menu. Vitamins and regimen are required.
10. Sick leave. The average period of incapacity for work is 40-45 days. This is relevant if not, and there were no complications. If they are available, the sick leave is extended. During this period, at least 2 ultrasounds should be done. Doctor's supervision is required.
11. A tan. You shouldn't hide from the sun, but it's not recommended to sunbathe on purpose. You can go to the sea, but you shouldn’t swim, it’s better to walk along the shore. A trip to a sanatorium, where the woman will be provided with a therapeutic massage, will be told what prevention against complications is, and, if necessary, will be given compression stockings, will not hurt.

Forecast

Many people do not know that a hysterectomy is a cause of disability. This depends on the extent of the procedure, the reason for removal and any complications encountered.

It happens that a disability group is assigned, but only for 1 year. If you want to extend it, most likely there will be a refusal. There are no options for lifelong disability for this operation.

In gynecology, in the treatment of uterine bleeding in recent years, various conservative methods of influencing the uterus have been used, for example, hysteroresectoscopic removal of the myomatous node and endometrial ablation, thermal ablation of the endometrium, hormonal suppression of bleeding. However, they often turn out to be ineffective. In this regard, surgery to remove the uterus (hysterectomy), performed both planned and emergency, remains one of the most common abdominal interventions and ranks second after appendectomy.

The frequency of this operation in the total number of gynecological surgical interventions in the abdominal cavity is 25-38%, with the average age of women operated on for gynecological diseases being 40.5 years and for obstetric complications - 35 years. Unfortunately, instead of trying conservative treatment, there is a tendency among many gynecologists to recommend that a woman with fibroids have her uterus removed after 40 years, citing the fact that her reproductive function has already been realized and the organ no longer performs any function.

Indications for hysterectomy

Indications for hysterectomy are:

• Multiple uterine fibroids or a single one more than 12 weeks in size with a tendency to rapid growth, accompanied by repeated, heavy, prolonged uterine bleeding.
• The presence of fibroids in women over 50 years of age. Although they are not prone to malignancy, cancer develops much more often against their background. Therefore, removal of the uterus after 50 years, according to many authors, is desirable in order to prevent the development of cancer. However, such an operation at approximately this age is almost always associated with subsequent severe psycho-emotional and vegetative-vascular disorders as a manifestation of post-hysterectomy syndrome.
• Necrosis of myomatous node.
• with a high risk of torsion on the stem.
• , growing into the myometrium.
• Widespread polyposis and constant heavy menstruation, complicated by anemia.
• and 3-4 degrees.
• , or ovaries and associated radiation therapy. Most often, the removal of the uterus and ovaries after 60 years is carried out specifically for cancer. During this age period, surgery contributes to a more pronounced development of osteoporosis and a more severe course of somatic pathology.
• Prolapse of the uterus of 3-4 degrees or its complete prolapse.
• Chronic pelvic pain that cannot be treated with other methods.
• Uterine rupture during pregnancy and childbirth, placenta accreta, development of consumption coagulopathy during childbirth, purulent.
• Uncompensated hypotension of the uterus during childbirth or in the immediate postpartum period, accompanied by heavy bleeding.
• Gender change.

Although the technical performance of hysterectomy has improved greatly, this method of treatment still remains technically challenging and is characterized by frequent complications during and after surgery. Complications include damage to the intestines, bladder, ureters, the formation of extensive hematomas in the parametrial area, bleeding, and others.

In addition, there are also frequent consequences of hysterectomy for the body, such as:

• long-term recovery of intestinal function after surgery;
• development (menopause after removal of the uterus) is the most common negative consequence;
• development or more severe course of endocrine and metabolic and immune disorders, coronary heart disease, hypertension, neuropsychiatric disorders, osteoporosis.

In this regard, an individual approach in choosing the volume and type of surgical intervention is of great importance.

Types and methods of hysterectomy

Depending on the volume of the operation, the following types are distinguished:

1. Subtotal, or amputation - removal of the uterus without or with appendages, but preserving the cervix.
2. Total, or hysterectomy - removal of the body and cervix with or without appendages.
3. Panhysterectomy - removal of the uterus and ovaries with fallopian tubes.
4. Radical - panhysterectomy in combination with resection of the upper 1/3 of the vagina, with removal of part of the omentum, as well as the surrounding pelvic tissue and regional lymph nodes.

Currently, abdominal surgery to remove the uterus is carried out, depending on the access option, in the following ways:

• abdominal, or laparotomy (a midline incision in the tissues of the anterior abdominal wall from the umbilical to the suprapubic region or a transverse incision above the pubis);
• vaginal (removal of the uterus through the vagina);
• laparoscopic (through punctures);
• combined.

Laparotomy (a) and laparoscopic (b) access options for hysterectomy surgery

Abdominal access method

It has been used most often and for a very long time. It is about 65% when performing operations of this type, in Sweden - 95%, in the USA - 70%, in the UK - 95%. The main advantage of the method is the possibility of performing surgical intervention under any conditions - both during planned and in case of emergency surgery, as well as in the presence of other (extragenital) pathology.

At the same time, the laparotomy method also has a large number of disadvantages. The main ones are the serious traumatic nature of the operation itself, a long hospital stay after the operation (up to 1–2 weeks), prolonged rehabilitation and unsatisfactory cosmetic consequences.

The postoperative period, both immediate and long-term, is also characterized by a high incidence of complications:

• long-term physical and psychological recovery after hysterectomy;
• adhesive disease develops more often;
• it takes a long time for intestinal function to be restored and the lower abdomen hurts;
• high, compared to other types of access, the likelihood of infection and increased temperature;

Mortality with laparotomy access per 10,000 operations averages 6.7-8.6 people.

Vaginal removal

It is another traditional access used for hysterectomy. It is carried out through a small radial dissection of the vaginal mucosa in its upper parts (at the level of the fornix) - posterior and possibly anterior colpotomy.

The undeniable advantages of this access are:

• significantly less trauma and the number of complications during surgery compared to the abdominal method;
• minimal blood loss;
• short duration of pain and better health after surgery;
• rapid activation of the woman and rapid restoration of intestinal function;
• short period of hospital stay (3-5 days);
• good cosmetic result, due to the absence of an incision in the skin of the anterior abdominal wall, which allows the woman to hide the very fact of surgical intervention from her partner.

The recovery period with the vaginal method is much shorter. In addition, the frequency of complications in the immediate postoperative period is low and there are no complications in the late postoperative period, and mortality is on average 3 times less than with abdominal access.

At the same time, vaginal hysterectomy also has a number of significant disadvantages:

• the lack of a sufficient area of ​​the surgical field for visual inspection of the abdominal cavity and manipulation, which significantly complicates the complete removal of the uterus for endometriosis and cancer, due to the technical difficulty of detecting endometriotic foci and tumor boundaries;
• high risk of intraoperative complications in terms of injury to blood vessels, bladder and rectum;
• difficulties in stopping bleeding;
• the presence of relative contraindications, which include, in addition to endometriosis and cancer, significant tumor sizes and previous operations on the abdominal organs, especially on the lower organs, which can lead to changes in the anatomical location of the pelvic organs;
• technical difficulties associated with uterine retraction in obesity, adhesions and in nulliparous women.

Due to such restrictions, in Russia vaginal access is used mainly for operations for prolapse or prolapse of an organ, as well as for gender reassignment.

Laparoscopic access

In recent years, it has become increasingly popular for any gynecological operations in the pelvis, including hysterectomy. Its benefits are largely identical to the vaginal approach. These include a low degree of trauma with a satisfactory cosmetic effect, the possibility of cutting adhesions under visual control, a short recovery period in the hospital (no more than 5 days), a low incidence of complications in the immediate and their absence in the long-term postoperative period.

However, there are still risks of such intraoperative complications as the possibility of damage to the ureters and bladder, blood vessels and large intestine. The disadvantage is also the limitations associated with the oncological process and the large size of the tumor formation, as well as with extragenital pathology in the form of even compensated cardiac and respiratory failure.

Combined method or assisted vaginal hysterectomy

It involves the simultaneous use of vaginal and laparoscopic approaches. The method allows you to eliminate the important disadvantages of each of these two methods and perform surgical intervention in women with the presence of:

• endometriosis;
• adhesions in the pelvis;
• pathological processes in the fallopian tubes and ovaries;
• myomatous nodes of significant size;
• history of surgical interventions on the abdominal organs, especially the pelvis;
• difficult uterine descent, including nulliparous women.

The main relative contraindications forcing preference for laparotomy access are:

1. Common foci of endometriosis, especially retrocervical with growth into the wall of the rectum.
2. Pronounced adhesive process, causing difficulty in cutting adhesions when using laparoscopic techniques.
3. Volumetric formations of the ovaries, the malignant nature of which cannot be reliably excluded.

Preparing for surgery

The preparatory period for planned surgical intervention consists of conducting possible examinations at the prehospital stage - clinical and biochemical blood tests, urine tests, coagulogram, determination of blood group and Rh factor, studies for the presence of antibodies to hepatitis viruses and sexually transmitted infectious agents, including including syphilis and HIV infection, ultrasound, chest fluorography and ECG, bacteriological and cytological examination of smears from the genital tract, extended colposcopy.

In the hospital, if necessary, additional, separate, repeated ultrasound, MRI, sigmoidoscopy and other studies are carried out.

1-2 weeks before surgery, if there is a risk of complications in the form of thrombosis and thromboebolism (varicose veins, pulmonary and cardiovascular diseases, excess body weight, etc.), a consultation with specialized specialists and the use of appropriate medications, as well as rheological agents and antiplatelet agents.

In addition, in order to prevent or reduce the severity of symptoms of post-hysterectomy syndrome, which develops after removal of the uterus in an average of 90% of women under 60 years of age (mostly) and has varying degrees of severity, surgical intervention is planned for the first phase of the menstrual cycle (if any) .

1-2 weeks before the removal of the uterus, psychotherapeutic procedures are carried out in the form of 5-6 conversations with a psychotherapist or psychologist, aimed at reducing the feeling of uncertainty, the unknown and fear of the operation and its consequences. Phytotherapeutic, homeopathic and other sedatives are prescribed, concomitant gynecological pathology is treated, and cessation of smoking and drinking alcoholic beverages is recommended.

These measures can significantly ease the course of the postoperative period and reduce the severity of psychosomatic and vegetative manifestations provoked by the operation.

In the hospital on the evening before the operation, food should be excluded, only liquids are allowed - loosely brewed tea and still water. In the evening, a laxative and a cleansing enema are prescribed, and a sedative is taken before bedtime. On the morning of the operation, the intake of any liquid is prohibited, the ingestion of any medications is discontinued, and the cleansing enema is repeated.

Before the operation, compression tights and stockings are put on, or the lower extremities are bandaged with elastic bandages, which remain until the woman is fully activated after the operation. This is necessary in order to improve the outflow of venous blood from the veins of the lower extremities and prevent thrombophlebitis and thromboembolism.

Providing adequate anesthesia during surgery is also important. The choice of the type of anesthesia is carried out by the anesthesiologist, depending on the expected volume of the operation, its duration, concomitant diseases, the possibility of bleeding, etc., as well as in agreement with the operating surgeon and taking into account the wishes of the patient.

Anesthesia for hysterectomy can be general endotracheal combined with the use of muscle relaxants, as well as its combination (at the discretion of the anesthesiologist) with epidural analgesia. In addition, it is possible to use epidural anesthesia (without general anesthesia) in combination with intravenous drug sedation. Installation of a catheter in the epidural space can be prolonged and used for postoperative pain relief and faster restoration of bowel function.

The principle of the operation technique

Preference is given to laparoscopic or assisted vaginal subtotal or total hysterectomy with preservation of the appendages on at least one side (if possible), which, among other advantages, helps reduce the severity of posthysterectomy syndrome.

How is the operation performed?

Surgical intervention with a combined approach consists of 3 stages - two laparoscopic and vaginal.

The first stage is:

• introduction into the abdominal cavity (after gas insufflation into it) through small incisions of manipulators and a laparoscope containing a lighting system and a video camera;
• performing laparoscopic diagnostics;
• separation of existing adhesions and isolation of the ureters, if necessary;
• application of ligatures and intersection of round uterine ligaments;
• mobilization (release) of the bladder;
• the imposition of ligatures and the intersection of the fallopian tubes and the uterine ligaments or the removal of the ovaries and fallopian tubes.

The second stage consists of:

• dissection of the anterior vaginal wall;
• intersection of the vesicouterine ligaments after displacement of the bladder;
• making an incision in the mucous membrane of the posterior vaginal wall and applying hemostatic sutures to it and to the peritoneum;
• applying ligatures to the uterosacral and cardinal ligaments, as well as to the vessels of the uterus, with subsequent intersection of these structures;
• bringing the uterus into the wound area and cutting it off or dividing it into fragments (if the volume is large) and removing them.
• suturing the stumps and the vaginal mucosa.

At the third stage, laparoscopic control is performed again, during which small bleeding vessels (if any) are ligated and the pelvic cavity is drained.

How long does a hysterectomy surgery take?

This depends on the method of access, the type of hysterectomy and the extent of surgery, the presence of adhesions, the size of the uterus and many other factors. But the average duration of the entire operation is usually 1-3 hours.

The main technical principles for removing the uterus using laparotomy and laparoscopic approaches are the same. The main difference is that in the first case, the uterus with or without appendages is removed through an incision in the abdominal wall, and in the second, the uterus is divided into fragments in the abdominal cavity using an electromechanical instrument (morcellator), which are then removed through a laparoscopic tube (tube ).

Rehabilitation period

Moderate and slight bleeding after removal of the uterus is possible for no more than 2 weeks. To prevent infectious complications, antibiotics are prescribed.

In the first days after surgery, bowel dysfunction almost always develops, mainly associated with pain and low physical activity. Therefore, the fight against pain, especially in the first day, is of great importance. For these purposes, injectable non-narcotic analgesic drugs are regularly administered. Prolonged epidural analgesia has a good analgesic effect and improves intestinal motility.

In the first 1-1.5 days, physiotherapeutic procedures, physical therapy and early activation of women are carried out - by the end of the first or at the beginning of the second day they are recommended to get out of bed and move around the department. 3-4 hours after the operation, in the absence of nausea and vomiting, it is allowed to drink still water and “weak” tea in small quantities, and from the second day - to eat food.

The diet should include easily digestible foods and dishes - soups with chopped vegetables and grated cereals, fermented milk products, boiled low-fat fish and meat. Foods and dishes rich in fiber, fatty fish and meats (pork, lamb), flour and confectionery products, including rye bread (wheat bread is allowed on the 3rd - 4th day in limited quantities), chocolate are excluded. From the 5th – 6th day the 15th (general) table is allowed.

One of the negative consequences of any abdominal surgery is the adhesive process. It most often occurs without any clinical manifestations, but can sometimes cause serious complications. The main pathological symptoms of adhesions after hysterectomy are chronic pelvic pain and, more seriously, adhesive disease.

The latter can occur in the form of chronic or acute adhesive intestinal obstruction due to disruption of the passage of feces through the large intestine. In the first case, it is manifested by periodic cramping pain, gas retention and frequent constipation, moderate bloating. This condition can be resolved with conservative methods, but often requires elective surgical treatment.

Acute intestinal obstruction is accompanied by cramping pain and bloating, lack of stool and flatus, nausea and repeated vomiting, dehydration, tachycardia and initially an increase and then a decrease in blood pressure, a decrease in the amount of urine, etc. In case of acute adhesive intestinal obstruction, emergency resolution is necessary through surgical treatment and intensive care. Surgical treatment consists of cutting adhesions and, often, intestinal resection.

Due to the weakening of the muscles of the anterior abdominal wall after any surgical intervention in the abdominal cavity, the use of a special gynecological bandage is recommended.

How long to wear the bandage after hysterectomy?

Wearing a bandage at a young age is necessary for 2 - 3 weeks, and after 45-50 years and with poorly developed abdominal muscles - up to 2 months.

It promotes faster healing of wounds, reduces pain, improves intestinal function, and reduces the likelihood of hernia formation. The bandage is used only during the daytime, and later - during long walking or moderate physical activity.

Since after the operation the anatomical location of the pelvic organs changes, and the tone and elasticity of the pelvic floor muscles are lost, consequences such as prolapse of the pelvic organs are possible. This leads to constant constipation, urinary incontinence, deterioration of sex life, vaginal prolapse and also to the development of adhesions.

In order to prevent these phenomena, it is recommended to strengthen and increase the tone of the muscles of the pelvic floor. They can be felt by stopping urination or defecation, or by trying to squeeze a finger inserted into the vagina with its walls. The exercises are based on a similar compression of the pelvic floor muscles for 5-30 seconds, followed by their relaxation for the same duration. Each exercise is repeated in 3 approaches, 10 times each.

A set of exercises is performed in different starting positions:

1. The legs are set shoulder-width apart, and the hands are on the buttocks, as if supporting the latter.
2. In a kneeling position, tilt your body towards the floor and rest your head on your arms bent at the elbows.
3. Lie on your stomach, put your head on your bent arms and bend one leg at the knee joint.
4. Lie on your back, bend your legs at the knee joints and spread your knees to the sides so that your heels rest on the floor. Place one hand under the buttock, the other on the lower abdomen. While squeezing the pelvic floor muscles, pull your arms up slightly.
5. Position - sitting on the floor with crossed legs.
6. Place your feet slightly wider than your shoulders and place your straightened arms on your knees. The back is straight.

In all starting positions, squeeze the pelvic floor muscles inward and upward, followed by relaxation.

Sexual life after hysterectomy

In the first two months, it is recommended to abstain from sexual intercourse to avoid infection and other postoperative complications. At the same time, regardless of them, removal of the uterus, especially during reproductive age, in itself very often becomes the cause of a significant decrease in the quality of life due to the development of hormonal, metabolic, psychoneurotic, autonomic and vascular disorders. They are interconnected, aggravate each other and are reflected directly on sexual life, which, in turn, increases the degree of their severity.

The frequency of these disorders especially depends on the volume of the operation performed and, last but not least, on the quality of the preparation for it, the management of the postoperative period and treatment in the longer term. Anxiety-depressive syndrome, which occurs in stages, is noted in every third woman who has undergone hysterectomy. The timing of its maximum manifestation is the early postoperative period, the next 3 months after it and 12 months after the operation.

Removal of the uterus, especially total with unilateral, and even more so with bilateral removal of the appendages, as well as carried out in the second phase of the menstrual cycle, leads to a significant and rapid decrease in the content of progesterone and estradiol in the blood in more than 65% of women. The most pronounced disorders of the synthesis and secretion of sex hormones are detected by the seventh day after surgery. The restoration of these disorders, if at least one ovary was preserved, is observed only after 3 or more months.

In addition, due to hormonal disorders, not only does libido decrease, but many women (every 4 to 6 women) develop atrophy processes in the vaginal mucosa, which leads to dryness and urogenital disorders. This also adversely affects sex life.

What medications should be taken to reduce the severity of negative consequences and improve the quality of life?

Considering the staged nature of the disorders, it is advisable to use sedatives, antipsychotic drugs, and antidepressants in the first six months. In the future, their use should be continued, but in intermittent courses.

For preventive purposes, they should be prescribed during the most likely periods of the year for exacerbations of the pathological process - in autumn and spring. In addition, in order to prevent the manifestations or reduce the severity of post-hysterectomy syndrome, in many cases, especially after ovarian hysterectomy, it is necessary to use hormone replacement therapy.

All drugs, their dosages and duration of treatment courses should be determined only by a doctor of the appropriate profile (gynecologist, psychotherapist, therapist) or together with other specialists.

The procedure for removing the uterus is quite common for women of different ages and the need for it does not depend on status, position in society and age.

Before deciding on such a procedure, it is necessary to undergo a series of examinations and consultation with an experienced specialist in the field of gynecology and obstetrics.

Removal of the uterus or hysterectomy

The scientific name for removing the uterus is hysterectomy., which is often carried out in connection with cancer, fibrosis, infection after childbirth, etc.

If doctors cannot stop the bleeding immediately after birth, emergency hysterectomy is prescribed to prevent various complications. Many diseases require alternative therapeutic treatment, but if the diagnosis is uterine cancer, only hysterectomy is possible.

Removal of the uterus while preserving the ovaries

The procedure has several main subtypes, depending on the severity and complexity of the surgical intervention.

Among the main types, the most gentle is subtotal hysterectomy, in which the uterus is removed, but the ovaries and cervix remain.

This removal of the uterus is prescribed when a diagnosis of uterine fibroids is made, for example. Then only the uterus is removed and conservative treatment therapy is prescribed.

But in this case, women need to be prepared to live with mild pain and inconvenience. The type of surgical intervention that will be chosen directly depends on the reasons for which the operation is prescribed.

Under what circumstances should the uterus be removed?

Among possible gynecological diseases, hysterectomy is prescribed in the case of:

If one of the diseases described above is suspected, the woman first undergoes many different examinations to confirm or refute the diagnosis.

Surgical methods

Which method of hysterectomy to choose depends on how serious the woman’s diagnosis is.

Depending on the severity of the surgical intervention and the volume of soft tissue removed during surgery, hysterectomy can be divided into 4 main types:

1. Radical involves removal of the uterus with appendages, cervix, lymph nodes, pelvic tissue and upper vaginal area.
2. Hysterosalpingo-oophorectomy– a procedure in which the uterus, tubes, ovaries and appendages are removed.
3. Total regulates the removal of the uterus and cervix.
4. Subtotal– surgery to remove the uterus, which preserves the ovaries and cervix.

The most commonly used procedure is total removal of the cervix, which is performed with a mandatory abdominal section of the abdominal cavity. After this, stitches and a sterile bandage are applied. All procedures are carried out using general anesthesia so that the patient remains unconscious the entire time.

The disadvantages of this type of hysterectomy include the long rehabilitation period and the traumatic nature of this method. To reduce damage after a hysterectomy, some types can be performed through the vaginal cavity. In this case, the cervix is ​​initially removed, and then the uterus itself.

This technique is only available to women who have already given birth to children, due to the fact that they have an enlarged vagina and wider access. Choosing this method of inserting the instrument allows you to get rid of scars after the procedure.

Today, minimally invasive laparoscopic methods of hysterectomy are gaining great popularity. These are methodologies that can significantly reduce the number of incisions and, accordingly, scars on the abdomen. Special laparoscopic equipment inserts tubes into the abdominal cavity, a video camera and additional instruments to carry out the procedure as quickly and painlessly as possible.

Postoperative period

The postoperative period after hysterectomy is divided into two main types:

But the first 1-2 days are especially difficult, when a hysterectomy has already been done. At this time, the woman experiences the following sensations:

Treatment after surgery

Treatment after hysterectomy consists of complex measures:

1. Infusion therapy, including drip intravenous infusions on the first day after hysterectomy. These measures allow you to restore the composition and volume of blood.
2. Use of antibiotics to prevent the development of infections, inflammation, and to relieve pain. The course of therapy lasts at least 7 days.
3. Use of anticoagulants for 3-4 days it makes it possible to thin the blood and prevent the formation of blood clots and thrombophlebitis.

Possible early complications after surgery

Among the most common complications of the early period:

If the nature of the discharge changes, for example, rot appears, you should immediately consult a doctor. This situation may cause the development of inflammation at the seams.

Infection of the suture, accompanied by high fever and a general deterioration in health, should also cause serious concern. In this case, the patient is prescribed a course of antibiotics and treatment of the sutures with Curiosin solution. This promotes better healing and tissue regeneration.

Removal of the uterus after 40-50 years

Removal of the uterus for women after 40-50 years of age can be prescribed for a variety of reasons:

It is worth knowing that after removal of the uterus in women over 40-50 years of age, the risk of developing vaginal prolapse increases significantly. This is a phenomenon in which the upper part of the vagina descends with a decrease in supporting functions. These are the reasons for a repeat surgical procedure.

Consequences after surgery

The consequences after an operation such as hysterectomy can be not only physical, but also emotional, and do not appear immediately, but after a while.

Emotional problems

Uterus is a symbol of femininity and all living things, the true feminine principle. And with its removal, the woman experiences not only physical pain, but also emotional changes, for example, stress, depression and much more:

Women who have the following psychological problems are most susceptible to mood decline:

• Painful symptoms do not go away.
• Serious complications arise.
• Repeated surgery is required.
• We did not understand all the risks before the procedure.

Inability to have children

Separate question– this is the inability to continue one’s family, to give birth to a child after removal of the uterus.

Some women attribute this to the positive characteristics of the procedure, but most people find it disgusting and cause severe, deep depression. This is especially a stress factor if the woman is still young or has not yet had children.

Due to the appearance of such factors after surgery, doctors carefully weigh the pros and cons before prescribing hysterectomy. Also, a woman should carefully study and evaluate all the risks and consequences of hysterectomy.

And if it is possible to preserve the reproductive organ, it is necessary to refuse hysterectomy. Even if the uterus was removed but the ovaries were left, a woman can still become a mother through artificial insemination or surrogacy.

You need to know that the procedure for removing the uterus is not the end of a normal sexual and intimate life. However, in the postoperative period for 2 months it is worth giving up intimacy and giving the body a rest. After this, the body’s tone will return to normal, and full sensitivity will return to normal.

After turning 40, many women and men experience some changes in their sexual desire and libido.

Many experience a significant decrease in activity, and many experience an increased sex drive after hysterectomy.

This difference in sensations is associated with the indications for surgery and compliance with the expected results.

If a woman gets rid of pain after the procedure and there is no longer a need to take care of an unwanted pregnancy, libido increases and the infusion becomes significantly higher.

In addition, the hysterectomy procedure has a beneficial effect on the libido of women during menopause.

But it is worth noting that after a surgical procedure to remove the ovaries, women may experience vaginal dryness and a lack of natural lubrication. This makes sexual intercourse much more difficult and requires the use of additional lubricant. In this situation, experts recommend using a synthetic water-based lubricant, a pessary, or an estrogen-based vaginal cream.

Adhesive process

In the process of suturing a peritoneal wound, it leads to disruption of the initially formed fibrous overlays. Due to this, increased adhesion formation occurs.

This post-operative event depends directly on several key characteristics:

Often, the risk of formation of adhesions after surgical removal of the uterus occurs due to the genetic predisposition of the patient.

This is due to the high level of production in the body of the genetically determined enzyme N-acetyltransferase. This element dissolves fibrin deposits and is responsible for the risk of formation of adhesions.

The first symptoms of adhesions after surgery can be determined by the following signs:

1. Systematic or sudden onset of painful symptoms in the lower abdomen;
2. Pain when urinating;
3. Inconvenience during bowel movements;
4. Diarrhea;
5. Dyspeptic symptoms.

The following medications are used as the main measures to prevent the appearance of adhesions:

• Anticoagulants which are involved in blood thinning and prevent adhesions;
• Antibiotics, preventing the development of infection in the peritoneal cavity.

In addition, to prevent adhesions, it is recommended to perform little physical activity on the first day, namely no more than turning from side to side.

After a few days, when the patient can already move normally, physiotherapeutic procedures are prescribed:

• Ultrasound;
• Electrophoresis with Lidase, Hyaluronidase.

Effectively carried out therapy in the postoperative period will prevent the formation of adhesions and other unpleasant consequences.

Other consequences

Few people know, but after such a complex operation on the female reproductive organs, such a syndrome appears as a symptom of surgical menopause. It manifests itself after 14-20 days and is practically no different in symptoms from natural menopause, only it can occur at any age.

When signs of menopause appear, the following symptoms are observed:

To reduce symptoms and adverse effects on the body after surgery, it is necessary to strictly follow the recommendations of the treating specialist.

Life after hysterectomy

Despite all the unfavorable symptoms after the procedure and the severity of the postoperative period, women, of course, are not given disability.

And every patient who has undergone this surgical intervention must learn to live a normal life after this.

But, sooner or later, complications in the late or early postoperative period may arise.

To do this, a set of procedures and measures is used, which include the use of hormones, homeopathic remedies that contain phytoestrogens.

Such measures help to effectively get rid of the symptoms of premature menopause or significantly alleviate its course.

To prevent the consequences of oophorectomy and hysterectomy, patients must strictly follow the doctor’s prescriptions and recommendations. And even when the symptoms of postoperative complications pass and life returns to normal, be examined by a doctor every 6 months.

Women need to clearly understand that removal of the uterus is not a death sentence, it does not mean that she has ceased to be a woman! In some specific situations, the diseases of the female reproductive organs are so great that such a procedure is the only solution that will provide healing and deliverance!

Moderate exercise and Kegel exercises

Numerous reviews confirm the high effectiveness of Kegel exercises. A full range of activities will not make it difficult for a woman; the activities can only be performed in any comfortable position.

But there are a number of indications that must be performed first:

The Kegel exercise is not difficult; to quickly restore function, it can be done at home and at work, and even on public transport. It is recommended to do at least 4-5 approaches during the day.

Hormone replacement therapy

2-3 days after the removal of the reproductive organ, the patient experiences significant changes in the body. This is an unfavorable situation for a woman, because this hormone plays a vital role - it regulates the normal level of muscle mass in the body.

It is the insufficient level of this hormone that causes a woman to gain significant weight after surgery. It is also worth clarifying that it is the hormone testosterone that is responsible for a woman’s libido level and sexual desire.

To normalize its level in the body in the postoperative period, doctors prescribe additional hormonal medications and specialized supplements, the basis of which is estradiol and testosterone:

1. Tablets "Estrimax", allowing to compensate for the lack of estradiol, which should naturally be produced by the ovaries.
2. Tablet form "Estrofem""Has a similar effect.
3. Medication "Feminal" is an effective drug that allows you to delay the early occurrence of menopause and improve the patient’s condition. This is the most preferred drug in the period after removal of the uterus, appendages and ovaries.
4. For external use, to eliminate unpleasant symptoms, use “Divigel”, a drug belonging to the group of progestin drugs for stimulating estrogen cell receptors. The drug is effectively used in the presence of osteoporosis or the risk of developing thrombophlebitis.

Divigel

Estrimaks

Estrofem

Hormone replacement therapy is most often prescribed for 5 years after surgery.

The operation is performed under anesthesia, which in turn leads to bloating and imbalance of the intestines. Also, this development of events may be affected by hormonal imbalance in the postoperative period.

To prevent a woman from gaining weight and normalize the functioning of the gastrointestinal tract, it is necessary to adhere to some rules for forming a diet.

So, it is necessary to minimize or completely exclude the following products from the menu:

• pickles, spices, seasonings;
• spicy and fatty foods;
• fresh baked goods;
• confectionery;
• smoked sausages, lard;
• fried food.

It is also worth limiting the consumption of fresh legumes; in no case should you eat grapes, radishes, fresh or processed cabbage.

This is due to the fact that this list of products stimulates increased flatulence, diarrhea and bloating. It is strictly forbidden to consume strong and low-alcohol drinks, strong coffee and black tea.

If you follow all the instructions of a nutritionist and are observed by a specialist, and correctly plan your daily diet, you can quickly restore the functions of the stomach and establish effective functioning.

To do this, you can include in your diet:

After surgery, dehydration should not be allowed, so women should drink plenty of fluids (green tea, fruit juice, compote, decoctions of medicinal plants). Coffee can be replaced with chicory.

You can eat small portions 6-7 times a day. To keep your weight the same, you can reduce the serving size. Your weight will remain normal if you follow a diet for 2 to 4 months after surgery.

The effect of hysterectomy on sex life

Despite popular belief, removal of the uterus and ovaries does not have a significant impact on sex life.

Women are very worried that they are losing their sexual attractiveness and may even become depressed.

Patients can fully expect to have a fulfilling sex life and enjoy sexual intercourse. This type of surgery does not change the ability to have orgasms.

Doctors recommend abstaining from sex for 7-8 weeks after surgery. After this time, sexual intercourse will no longer cause unpleasant and painful sensations. But at first it is better to use lubricant, since the operation leads to increased vaginal dryness.

During the operation, only the body of the uterus can be removed, while the cervix remains.

This operation is called supravaginal uterine amputation (USA). Removing the cervix along with the body is called hysterectomy.

Reasons for having a hysterectomy

Surgery to remove the uterus is performed in the following pathological conditions:

• cancer of the uterus or other organs involving the uterus in the tumor process;
• uterine fibroids of large size or with a pronounced clinical course;
• endometriosis of the uterus, accompanied by severe bleeding and the development of anemia;
• uterine prolapse;
• obstetric hemorrhage, when other measures to stop it are ineffective.

There are other indications for removal, but in each specific case, doctors take into account the patient’s age and desire to have children, and in non-life-threatening conditions they try to carry out organ-preserving intervention.

Do you want to know more about the treatment of gynecological diseases?

Our gynecologists have summarized the most important information.

Methods for removing the uterus

There are several methods of this intervention, which differ in access to the organ and the use of endoscopic equipment.

Laparotomy– an abdominal version of the operation to remove the uterus, which is used for large sizes of the uterus or if a tumor process is suspected, since the doctor has the opportunity to conduct an audit of all organs in the pelvis. The postoperative period after this type of operation is the most difficult and the rehabilitation is the longest. This happens because during the intervention the anterior abdominal wall is cut. The healing of muscle tissue is accompanied by long-term pain, which limits a woman’s mobility and can cause a number of complications.

Vaginal hysterectomy is an operation that is performed on a gynecological chair, and, as a rule, is used for various types of uterine and vaginal prolapse. In the postoperative period, in this case, the woman is prohibited from sitting for a long time to prevent complications in the postoperative sutures.

Laparoscopy– a low-traumatic operation to remove the uterus using special instruments through small incisions in the abdomen. This is the least traumatic operation, however, it is limited by the size of the uterus and the availability of special equipment. The advantage of this technique is rapid recovery after removal of the uterus and minimal consequences.

The choice of method depends on the pathology, the availability of the necessary equipment (laparoscope), and the qualifications of the doctor.

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Consequences of hysterectomy

Complications that may arise in the postoperative period include:

• postoperative bleeding;
• suppuration of the surgical wound;
• formation of adhesions in the abdominal cavity.

A special feature of this intervention is changes affecting the reproductive function of women. This could become a psychological trauma for her, but there is no point in worrying and worrying about this. You need to correctly assess the pros and cons of the operation.

So, after surgery to remove the uterus, the following consequences are possible:

• cessation of menstruation – surgical menopause or amenorrhea;
• absolute infertility - it is possible to obtain offspring only through IVF with a surrogacy program;
• reducing the risk of developing ovarian cancer;
• increased risk of pelvic organ prolapse.

The cessation of menstruation does not indicate a loss of femininity. It is important to understand that when the uterus is removed, the ovaries remain in place and continue to function as usual; only the visible sign of their work – menstruation – is absent. Therefore, removal of the uterus or removal of the fallopian tubes is not equivalent to the onset of menopause.

Menopause occurs in women with a removed uterus at the age at which it would have occurred if the uterus had not been removed.

The inability to give birth is a serious problem, especially for those who do not yet have children. But there is a surrogacy program in which your eggs can be used for fertilization. This will be genetically your child. As a last resort, you can adopt a baby; many children from the orphanage need affection and care.

There is, of course, a risk of pelvic organ prolapse, but there are a number of exercises to strengthen the pelvic floor. Additionally, exercising can also help. You need to monitor your weight, as obesity can be a provoking factor.

The big plus is that the unpleasant symptoms of the disease that bother you will disappear.

In addition, studies show that when the uterus is removed, the likelihood of developing ovarian cancer decreases.

After the rehabilitation period, the woman can lead a normal life and have sexual intercourse.

Sexual life after surgery

Sexual desire may be reduced by depression, which often occurs after such surgery.

A woman may consider herself inferior. This is the only obstacle to a normal sex life. From a physiological point of view, the absence of an organ does not affect sex in any way, because the level of hormones in the blood remains the same, and this does not affect the feelings of partners.

During supravaginal amputation, the cervix is ​​not removed, therefore, when interviewing the husbands of patients, they do not notice any changes in sensations. Moreover, sexual relationships may improve. Before surgery, the woman suffered from pain, bleeding or urinary incontinence.

Now these symptoms are gone. In addition, there is no need for contraception. Using the barrier method makes sex worse for both partners, but since the woman becomes infertile after surgery, condoms are no longer needed.

Possible obstacles to intimate relationships:

• period of physical rehabilitation after the intervention (usually no more than 2 months);
• decreased desire in a woman due to depression;
• decreased desire in the husband due to awareness of the fact that his wife lacks some genital organs;
• a woman’s fear that during sexual intercourse the sensations will be different;
• religious beliefs of one or both spouses that do not allow further sexual activity.

Problems in the intimate sphere, according to statistics, are not observed in approximately 75% of women. Their sex life remained the same or improved after surgery.

About 20% note a slight deterioration, which is associated more with a violation of the psycho-emotional status than with the state of physical health. Only 4-5% of women stop being sexually active after surgery altogether, or do so extremely rarely.

If it is difficult for you to understand your situation and continue to live in your usual rhythm, you can contact a psychologist. Psychotherapy sessions help to look at the situation correctly and overcome the complexes that have arisen.

Content

Removal of the uterus (hysterectomy) is one of the most commonly performed gynecological operations in women. After removal, the patient forever loses the opportunity to become a biological mother. Such an operation is performed only for serious indications and most often when there is no other option.

When is hysterectomy necessary?

Removal is sometimes the only possible way out of a situation when a woman’s health is in serious danger. In what cases do doctors remove the uterus and is it possible to do without it? Indications for removal of the uterus are the following situations.

1. Too many benign tumors. These include fibroids, in which the nodes grow and prevent neighboring organs from functioning normally. In addition, such formations cause heavy bleeding.
2. The presence of malignancy of malignant or benign tumors not only of the uterine body, but also of its cervix, as well as the fallopian tubes and ovaries.
3. Internal injuries that are serious, cannot be treated surgically, and pose a threat to the patient’s life.
4. Tears that appeared during the process of delivery (during natural childbirth or performed by cesarean section), breakthrough bleeding.
5. Infectious inflammations that cannot be removed with conservative treatment, as well as uterine prolapse.
6. The third or fourth degree of endometriosis, which affects neighboring organs.

In addition, complete removal can be carried out when there is no threat to the patient's life. Indications for complete removal of the uterine body here may be the following: severe pain in this organ, vaginal or uterine bleeding, which is repeated very often, as well as myomatous nodes.

In such situations specialists give the patient the right to choose whether to continue living with constant discomfort and pain or decide to have a hysterectomy. Sometimes, this operation can save a woman's life.

Preparation and performance of the operation

Removal of the uterine body is a very serious surgical procedure and is performed in a hospital setting. A woman must undergo a thorough examination before undergoing surgery. It includes radiography, ultrasound diagnostics and biopsy. If, after all, the patient is allowed to remove the uterus, and specialists have the necessary indications for surgery, surgical intervention can be performed.

A consultation with an anesthesiologist is mandatory, who will identify and prevent the occurrence of allergic reactions to the drugs used for amputation. Before the operation, exactly one day before, the patient needs to cleanse the intestines with an enema. In addition, the woman must follow a special diet for some time. In some clinics, before surgical procedures, the patient is given a special remedy that will help cope with the fear of surgery.

The method and extent of the operation depends on the reasons why the uterus needs to be removed. Depending on the degree of damage and what indications the patient has for complete removal of the uterus, the following types of hysterectomy are used.

1. Subtotal. Using this method, the uterine body is completely removed, but its appendages and cervix are left.
2. Total (extirpation). This method involves removing the organ and its neck. This operation is indicated when there are serious lesions or damage, as well as for cancer of the uterus.
3. Hysterosalpingo-oophorectomy. With this method, the organ along with its appendages is completely amputated. Indications for such an operation arise when the tubes, ovaries and the body of the uterus itself are simultaneously affected.
4. Radical hysterectomy. This method is indicated when the patient has metastases on the ovaries or cervix. In this surgical procedure, not only the uterus is removed, but also the appendages, as well as the upper part of the vagina, pelvic tissue and surrounding lymph nodes.

The method of removal is chosen by the doctor, in accordance with the type of uterine lesion.

For example, laparoscopic involves removal of the appendages (if necessary) and the body of the uterus itself.

The abdominal (laparotomy) method of surgical intervention, when a woman’s entire uterus is removed, allows us to find out in detail the condition of the woman’s organs.

If such indications exist, then not only the uterus itself is removed, but also the appendages, as well as the cervix. This method is most often used when a woman has profuse bleeding or cancer metastases and large tumors have been identified. This is why sometimes even young patients need to have their uterus removed.

How is the postoperative period going?

After removal, the woman must stay in a medical facility for at least 2 weeks. A week after the hysterectomy, the specialist removes the staples from the stitch. The speed with which postoperative wounds heal will depend on the individual characteristics of the woman’s body. If during hysterectomy all lymph nodes and ligaments were removed, then global changes may occur in the pelvis in such cases. They can delay the recovery process after removal of the uterine body.

Doctors in a medical institution restore the water and electrolyte balance in the patient’s body, and also take preventive measures to prevent inflammatory processes from occurring. In addition, special attention is paid to psychological aspects. The fact is that any surgical intervention is extremely stressful not only for a woman’s body, but also for her psyche. Especially if it's a deletion.

It is best if a psychologist talks to the patient after such surgical procedures. After a hysterectomy, a sick leave certificate is issued, which lasts up to 50 days (depending on the severity of the operation). But some women calmly tolerate such manipulations and return to work 21 days after the operation.

Special diet and exercise

After a woman has had her uterus removed, she must adhere to a special diet. The main recommendations on this matter are given by the doctor at the medical institution where the patient had her reproductive organ removed. The diet should be gentle. That is why you should not include in your diet foods that are irritating or aggressive to the mucous membranes. It is necessary to remove strong tea, coffee, any sweets (including honey), and bread made from wheat flour from the daily menu.

In order to “start” the intestines, you need to eat food not in very large portions, but as often as possible (up to 7 times a day). Excessive overeating is also not encouraged. As for drinking liquid, you need to drink at least 4 liters per day. Particular attention should be paid to water. It should be at least 70% in the patient’s diet.

It is very important to strictly adhere to all nutritional advice given by your healthcare provider. Compliance with them will help you go through the postoperative period without any complications.

Loads should be minimal. It is strictly contraindicated to lift more than 5 kg. Prohibitions are also imposed on physical exercise. You can do them only after all the incisions have completely healed. Why should this be done? The fact is that with sudden movements the seam may come apart. After this period, you can only engage in those gymnastic exercises that are recommended and authorized by a specialist in a medical institution.

After the patient is discharged home, she can walk at a leisurely pace for short distances. This type of physical activity will prevent blood from stagnating in the organs, which is why the recovery process will go much faster.

Complications that may occur

After a hysterectomy, you may experience severe pain. They appear due to bleeding or the formation of adhesions. In what cases can this happen? Most often, these symptoms occur during the first few days after removal. Among other things, they include impaired urination, the appearance of hematomas, and thrombosis of the veins in the legs. The stitches may fester.

Any of these complications affects the recovery process after hysterectomy. Very often, patients may experience signs of menopause.

Also, after removal, dryness sometimes appears inside the vagina, and the level of sexual desire for a partner decreases. But such phenomena were recorded in only 5% of the total number of all patients who underwent such an intervention. In addition, women after a hysterectomy become more susceptible to atherosclerosis and osteoporosis.

What should the discharge be like?

After the uterus is removed, the woman may experience bloody discharge. This is due to the fact that sex hormones do not affect the cervix of this organ due to the fact that the functions of the ovaries were not affected. It is very important to monitor the nature of such discharge. If they only get worse over time, you should consult a doctor. He will conduct the necessary examination and make the correct diagnosis.

What cases require mandatory contact with a medical institution? This:

• unpleasant odor that comes from the discharge;
• attacks of nausea;
• there are large clots in the discharge;
• frequent bright red blood discharge.

If the patient after discharge from the hospital, at least one of the above symptoms appears, this is a reason to immediately contact a medical facility.

The appearance of early menopause

If the appendages were preserved during a hysterectomy, then there will be no effect on hormonal metabolism. In this case, the ovaries continue to function normally. If the ovaries have been removed, the hormone estrogen ceases to be produced completely, which leads to large-scale and sudden hormonal disruption. That is why such a situation necessarily causes menopause.

This condition after surgery is tolerated by the woman in a fairly severe form. It is associated with a sharp change in hormonal levels. Menopause brings especially uncomfortable sensations to young women. Older patients tolerate it much easier. To ease the symptoms of menopause, hormone replacement therapy is prescribed immediately after a hysterectomy. It will gradually prepare the woman’s body for menopause.

In order to maintain normal health after the removal is carried out, it is necessary to unquestioningly follow all the doctor’s recommendations. This will help speed up the recovery process in a short time. The only thing that changes after such surgery is the complete disappearance of reproductive function. As for other aspects of health, they all remain at the same level. This is why the patient can live a full life after surgery.