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Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina. Vaginal hysterectomy involves a shorter time in the hospital, lower cost and faster recovery than does the most common alternative, abdominal hysterectomy. However, if your uterus is enlarged, vaginal hysterectomy may not be possible.
Vaginal hysterectomy was shown to be superior to Laparoscospically Assisted Vaginal Hysterectomy (LAVH) and some types of laparoscopic surgery (sufficient data was not available for all types of laparoscopic surgery), causing fewer short- and long-term complications, more favorable effect on sexual experience with shorter recovery times and fewer costs. It is however not possible or very difficult to perform some more complicated surgeries using this technique.
A recent review recommends vaginal hysterectomy over other variants where possible. Laparoscopic surgery offers certain advantages when vaginal surgery is not possible but has also the disadvantage of significantly longer time required for the surgery.
Vaginal hysterectomy is the only available option that is feasible without total anaesthesia or in outpatient settings (although so far recommended only in exceptional cases).
Vaginal hysterectomy treats many different gynecologic problems, including:
Fibroids. Many hysterectomies are done to permanently treat fibroids — benign tumors in your uterus that can cause persistent bleeding, anemia, pelvic pain, pain during intercourse and bladder pressure. If you have large fibroids, you may need an abdominal hysterectomy.
Endometriosis. Endometriosis occurs when the tissue lining your uterus (endometrium) grows outside of the uterus, involving the ovaries, fallopian tubes or other organs. Most women with endometriosis have an abdominal hysterectomy, but sometimes a vaginal hysterectomy is possible.
Gynecologic cancer. If you have cancer of the uterus, cervix, endometrium or ovaries, your doctor may recommend a hysterectomy to treat it. Most of the time, an abdominal hysterectomy is done during treatment for ovarian cancer, but sometimes vaginal hysterectomy may be appropriate for women with cervical cancer or endometrial cancer.
Uterine prolapse. When pelvic supporting tissues and ligaments get stretched out or weak, the uterus can descend or sag into the vagina, causing urinary incontinence, pelvic pressure or difficulty with bowel movements. Removing the uterus with hysterectomy and repairing pelvic relaxation may relieve those symptoms.
Abnormal vaginal bleeding. When medication or a less invasive surgical procedure doesn’t control irregular, heavy or very long periods, hysterectomy can solve the problem.
Chronic pelvic pain. If you have chronic pelvic pain clearly caused by a uterine condition, hysterectomy may help, but only as a last resort. Chronic pelvic pain can have several causes, so an accurate diagnosis of the cause is critical before having a hysterectomy for pelvic pain.
For most of these conditions — with the possible exception of cancer — hysterectomy is just one of several treatment options. You may not even need to consider hysterectomy unless medications and less invasive gynecologic procedures have failed.
You cannot get pregnant after you’ve had a hysterectomy. If you’re less than completely sure you’re ready to give up your fertility, explore other treatments.