Total / Partial Hysterectomy: Recovery & Life After a Hysterectomy

What does life look like for a woman after a hysterectomy? If you're facing this operation or have already had it: what will your life be like from now on? Read this article – we'd like to help you find some answers.

Did you know that your sex life can actually improve after a hysterectomy in certain circumstances? That said, there are indeed cases where side effects occur. Naturally, this depends above all on the reason the procedure was carried out. That's why this article tells you everything about the healing process and life after a hysterectomy.

What is a hysterectomy

A hysterectomy is the surgical procedure to remove the womb (it's often also referred to as removal of the uterus or extirpation). After the caesarean section, it is the second most common operation performed on women. 

A hysterectomy treats serious conditions, which is why your doctor may recommend this operation as a last resort to relieve certain symptoms or even save your life – for example if:

• you suffer from abnormal or very heavy vaginal bleeding and no other treatment is working
• you have endometriosis or adenomyosis, or very severe period pain that cannot be relieved by any other therapy
• you have endometrial hyperplasia
• you have severe pelvic pain linked to the womb that cannot be relieved by other treatments
• you have fibroids or recurring polyps in the womb
• you have a prolapsed womb (uterine prolapse) – when the ligaments and muscle fibres weaken so much that the womb drops towards the vagina or into the vagina
• you have uterine or cervical cancer, or are at high risk of developing it.

Depending on the reason for the procedure, different types of hysterectomy may be performed: sometimes only the upper part of the womb is removed, while in other cases the fallopian tubes, cervix and ovaries are taken out as well.

Since the baby develops in the womb, two immediate consequences are the cessation of periods and the inability to become pregnant in the future.

Types of hysterectomy

Depending on the severity of the condition, there are various types of hysterectomy. Your doctor will first make sure they only recommend this procedure if it is 100% necessary for your life and your reproductive needs.

Once that's established, you'll discuss which type of hysterectomy is recommended in your case – that is, whether the fallopian tubes and ovaries need to be removed as well:

• Partial hysterectomy
• Total hysterectomy
• Radical hysterectomy

Partial (supracervical) hysterectomy 

In a partial or subtotal hysterectomy, the doctor removes only the upper part of the womb (hence the term supracervical). The cervix is left in place.

A partial hysterectomy can be performed vaginally, abdominally or laparoscopically, and is recommended for treating abnormal bleeding, pelvic pain, endometriosis, fibroids, uterine prolapse or certain cancers (ovarian, cervical or uterine cancer).

Total hysterectomy 

The procedure in which the womb is removed in its entirety – including the lower part and the cervix – is called a total hysterectomy. The ovaries are not removed in this case.

Complete removal is usually recommended when there is a high risk of cancer or other gynaecological conditions – in this case the total hysterectomy is performed as a preventive measure.

Radical hysterectomy

In a radical hysterectomy, the surgeon removes the womb, the cervix, the tissue on either side of the cervix and the upper part of the vagina. This type of procedure is usually recommended for treating cervical or uterine cancer.

Total hysterectomy with bilateral salpingo-oophorectomy

In 50% of cases, the hysterectomy also includes an oophorectomy (removal of one ovary) or a bilateral oophorectomy (removal of both ovaries). The aim of an oophorectomy is to reduce or prevent the risk of ovarian disease and cancer.

A total hysterectomy with salpingo-oophorectomy therefore means the removal of the womb, the cervix, the fallopian tubes (salpingectomy) and the ovaries (oophorectomy).

How a hysterectomy is performed 

A hysterectomy is usually carried out under general anaesthetic and takes between 1 and 3 hours. This means you'll be unconscious during the procedure and connected to equipment monitoring your heart activity.

Alternatively, a regional anaesthetic (epidural) may be chosen, so that you remain awake but feel no pain during the operation.

There are various approaches to removing the womb and, depending on the case, the surrounding organs:

Vaginal hysterectomy 

With a vaginal hysterectomy there is no external incision. The doctor removes the womb through an incision in the vagina, which is then closed with dissolvable stitches.

This is the procedure with the quickest recovery (up to 4 weeks) and the fewest complications – you can usually go home the same day. As a rule, a vaginal hysterectomy is recommended when there is no cancer present (for example, in cases of uterine prolapse).

Abdominal hysterectomy 

In an abdominal hysterectomy, an external incision of 15 to 20 cm is made in the abdominal wall. The incision may be vertical (from the navel area down to the pubic bone) or horizontal, above the pelvis.

Recovery after an abdominal hysterectomy takes longer, and you'll need a longer hospital stay (2–3 days). The abdominal procedure is recommended when the womb is enlarged or when you have cancer or conditions that have spread to other organs in the pelvic area.

Laparoscopically assisted hysterectomy 

For a laparoscopic hysterectomy, the doctor makes a small incision near the navel, through which a tube with a camera at the tip (laparoscope) is inserted into the abdominal cavity. Additional surgical instruments are introduced through further small incisions, allowing the womb to be removed in sections via the vagina or through the same abdominal incisions.

Recovery is shorter than with an abdominal hysterectomy and less painful. Depending on the case, you may be able to go home the same day or may need to stay in hospital overnight.

Recovery after a hysterectomy 

Recovery time after a hysterectomy depends on the type of procedure and on the patient, and takes 4 to 6 weeks. Sometimes you can leave hospital the same day (after a vaginal hysterectomy) or after 2–3 days (following an abdominal hysterectomy).

After the operation, the medical team will monitor your condition and make sure there's no risk of complications (such as bleeding or blood clots) before you're allowed home. Your doctor will also explain the restrictions and recommendations for the recovery period – these include avoiding physical exertion and not inserting anything into the vagina. If you have questions about what you can and can't do, now is the right moment to raise them with the medical staff.

Your sex life after a hysterectomy 

In principle, you can resume your sex life 6 weeks after a hysterectomy, provided there are no complications or particular restrictions from your doctor.

If the condition treated by removing your womb previously affected your sex life (through pain or discomfort, for instance), the procedure often leads to an improvement in intimacy.

On the other hand, there are situations in which side effects can affect the quality of your sex life:

• Reduced sexual desire: the ovaries produce oestrogen and testosterone; removing them can lower hormone levels and therefore automatically reduce libido. This affects around 20% of women.
• Less intense orgasms: the womb and cervix contain nerves that are stimulated during sex and contribute to orgasm. When the womb and cervix are removed, these nerves are severed. This is rare – most women continue to experience orgasms after a hysterectomy.
• Pain during sex: removal of the ovaries and the cessation of periods can cause symptoms similar to the menopause (such as hot flushes, night sweats and so on). One of these symptoms can be dryness of the vaginal tissue, which can make sex painful.

Tips for women after a hysterectomy 

We'd always recommend following the advice of the doctor who performed your hysterectomy. They know your medical history and state of health best and can give you the most appropriate guidance.

If you've had this kind of operation, here are a few general tips:

Light bleeding in the first 1–6 weeks is normal. Don't use tampons. Instead, choose 100% organic pads or panty liners that contain no harmful substances which could increase the risk of infection.

Avoid lifting heavy objects for the first 4–6 weeks.

Don't insert anything into the vagina and avoid penetrative sex for 6 weeks – or as advised by your doctor.

Always attend your follow-up appointments as instructed by your doctor. This allows them to monitor your healing and see whether any additional measures are needed.

It's also really important to be patient with yourself. Listen to your body and resume your sex life gradually, at your own pace. Abstaining from sex for 6 weeks is simply the minimum recommendation. It shouldn't put you under pressure if you don't feel ready at the end of that time.

Many women associate the absence of the womb or the female reproductive organs with the loss of their femininity. Emotionally this can weigh on you and even reduce your interest in sex. If this sounds like you, speaking to a psychologist can help.

Remember: periods, cycles and pregnancy are part of femininity, but they do NOT define it. Breasts, womb, ovaries and the rest of the reproductive organs are part of your journey, but they don't make up your identity. You are no less a woman after a hysterectomy, because your femininity lies in many other things: in the courage to reinvent yourself, in the strength to overcome obstacles, and in your ability to define yourself.

Frequently asked questions about hysterectomy 

If you have further questions about recovery and life after a hysterectomy, do read this section too. Here are some common questions from women who have had this procedure:

What can I expect in the first few weeks after a total hysterectomy? 

Recovery after a hysterectomy usually takes 4 to 6 weeks. In the first few weeks, then, it's normal to notice the following:

• Vaginal discharge: pink or brownish discharge in small amounts and over short periods is normal. If the discharge persists, however, you should see your gynaecologist. There can be several causes for this, which we've covered in full HERE.
• Vaginal bleeding: it's normal to lose small amounts of blood in the first few weeks after a hysterectomy. Don't use tampons; opt instead for natural intimate care products, such as pads made from 100% organic cotton (they protect your intimate flora and contain no toxic ingredients that cause irritation and itching) and an intimate wash made from natural ingredients for gentle cleansing – free from fragrances and other irritants. If you're still bleeding after 4 weeks, or the bleeding is heavy, speak to your doctor.
• Itching, burning or pain: these sensations around the scar are normal until the wound has healed. Your doctor can prescribe painkillers or other medication to ease them.

When, or how soon, can I have sex after a total abdominal hysterectomy?

The general recommendation is to avoid sex for the first 6 weeks after a hysterectomy. The waiting time varies from woman to woman, however – depending on factors such as general health, complications and individual healing.

Follow your doctor's instructions on resuming your sex life. They may also carry out an ultrasound scan to confirm whether it's safe for you to be sexually active again.

What complications can occur with a hysterectomy? 

As with any other surgical procedure, certain complications can occur after a hysterectomy. These include symptoms similar to the menopause (such as vaginal dryness, hot flushes and so on), as well as reduced sexual desire.

Other complications can include various infections, weakening of the pelvic floor muscles, pain during sex or reduced sensation of pleasure, heavy bleeding, blood clots, urinary incontinence or constipation.

Will sex be painful after the operation? 

If you observe the waiting period recommended by your doctor, you shouldn't normally feel pain during sex. However, if complications arise or you suffer from vaginal dryness, sex can be painful. It's advisable to try different positions and use a lubricant – and to speak to your doctor if the pain persists.

Can I still have an orgasm after a total hysterectomy? 

For most women, a hysterectomy doesn't affect the ability to feel pleasure or to reach orgasm.

There are, however, cases in which women report that their orgasms are no longer intense, or that they can no longer reach orgasm at all. This is rare and is explained by the fact that removing the womb and cervix severs certain nerves that are stimulated during sex.

What are the risks of a hysterectomy?

Excessive bleeding and vaginal prolapse are among the most common risks of a hysterectomy. There is also a risk of post-operative infection and of injury to organs in the pelvic area (such as blood vessels, the bowel, the urethra or the bladder).

The anaesthetic used during a hysterectomy also carries certain risks. Some patients have an allergic reaction to particular anaesthetic agents, or have cardiovascular or respiratory problems. All of this should be mentioned to your doctor beforehand.