A vaginal hysterectomy is a procedure that surgeons perform through the vagina to remove the uterus. A woman can often go home the same day or within 24 hours of the surgery. She can also return to normal activity after 6 weeks, though a hysterectomy has lifelong effects.
A hysterectomy through the vagina is minimally invasive, so recovery is normally shorter and easier than other types, such as abdominal hysterectomy. It also leaves no visible scar.
In this article, we look at what to expect after a vaginal hysterectomy, including timescales for returning to work, exercising, and driving. We also discuss recovery tips, long-term effects, and possible complications.
Surgeons can perform several types of hysterectomy, with each option dependent on a person's specific condition. The options are:
- Vaginal hysterectomy: An incision is made inside the vagina, and the uterus is removed through this incision.
- Laparoscopic hysterectomy: A thin, lighted tube and a small camera are inserted into very small cuts in the abdomen. The uterus is removed through the cuts.
- Abdominal hysterectomy: A larger incision is made in the abdomen to remove the uterus.
The American College of Obstetricians and Gynecologists (ACOG) recommend a vaginal hysterectomy for benign disorders where possible. Surgeons may use this method for the following conditions:
- small uterine fibroids or benign growth in the uterus wall
- heavy or irregular menstrual bleeding that does not respond to other treatments
- uterine prolapse when the uterus has slipped out of place
- adenomyosis or the uterus lining growing into the uterine wall, causing pain and heavy bleeding
Each woman's recovery after a vaginal hysterectomy is different. The following timescales are a guide to what a person may expect after this surgery.
Immediately after surgery
It is normal to feel drowsy and tired for several hours after surgery while the effects of anesthesia wear off. Nurses and other medical staff may be monitoring blood pressure, pain, and how the body is recovering, plus other factors.
Some women will be discharged from the hospital on the same day as their surgery, while others may need to stay for a day or longer. This depends on the success of their surgery and if any complications occur.
Right after the procedure, a woman may have:
- Stitches inside the vagina that dissolve on their own and do not need to be removed.
- Gauze, similar to a tampon, placed inside the vagina to help reduce bleeding from the surgery. This should be removed before going home.
- A small tube that is sometimes inserted into the vagina to help drain blood and fluid. This is also removed by a nurse before the individual is discharged.
- A urinary catheter inserted until she can walk around and has the feeling back to urinate. The catheter will be removed, and the doctor or nurse will make sure the woman can empty her bladder before she is discharged.
In the first few weeks
In the first few weeks after a vaginal hysterectomy, it is normal to have:
- bleeding similar to a light period that comes and goes but decreases over time
- some mild pain and discomfort in the lower belly
- bloating or constipation because the bowel has temporarily slowed down
Some women can go home on the day of their surgery or within 24 hours. Others may be in the hospital a day or two longer, depending on any complications or medical concerns that may arise.
Although a vaginal hysterectomy is less invasive than other kinds, it still takes some time to recover from and get back to normal activities. After a person leaves the hospital, it is essential that they limit activities for a few weeks and follow the surgeon's home care instructions.
Returning to work
Some women can go back to work after 2 to 3 weeks with their doctor's permission. Others may have to wait up to 6 weeks, depending on their job and how quickly they are recovering.
A woman may be able to drive after 2 to 3 weeks, or once they are:
- not taking any painkillers or other medication that can cause sleepiness
- able to comfortably sit in the car, wear a seatbelt, and use the controls without pain
- able to suddenly stop if needed by quickly moving their foot onto the brake pedal
- able to turn and twist their body to see in all directions
If a woman is getting some exercise each day, she may be able to get back to her workout routine after 4 to 6 weeks. She should talk with a doctor before resuming strenuous exercise, including HIIT (high-intensity interval training), weight-lifting or contact sports.
Most surgeons advise women to get plenty of rest during the first few weeks after a hysterectomy, though it is important to get up and move around too.
Light exercise, such as walking, helps get the bowels moving and may help reduce the risk of a blood clot. Starting with a short walk and making it longer each day helps build up endurance safely and can help increase energy levels.
Things to avoid
There are several things to avoid for a smooth recovery:
- Avoid putting anything in the vagina for at least 4 to 6 weeks. This means no tampons, douching, or sexual intercourse during this time.
- Heavy lifting should be restricted during the first 6 weeks. Avoid picking up children or moving furniture.
- Avoid doing strenuous tasks, for example, mowing the lawn, for the first 6 weeks.
- Avoid swimming until a doctor has confirmed that the vaginal stitches have healed completely.
Tips for a healthy recovery
If a womn follows the recommendations below, her body will heal quickly and successfully after a vaginal hysterectomy:
- Get lots of rest. Aim for at least 8 hours sleep a night and more if fatigue is an issue.
- Keep up with a nutritious diet. Eat plenty of fruits, vegetables, whole grains, and lean protein. Healthful foods contain nutrients that help the body heal and increase energy levels.
- Eat high-fiber foods. Constipation is common after surgery and can be made worse by certain pain medicines. If bowel movements are painful or difficult, even with a high-fiber diet, consider a stool softener or gentle laxative, and increase water intake.
- Avoid smoking. Smoking harms the body's healing processes and makes it more difficult to recover from surgery. Stopping smoking before the surgery reduces the risk of lung problems from anesthesia. Ask a doctor about smoking cessation plans or nicotine replacements before surgery if needed.
- Attend follow-up appointments. The doctor will recommend regular follow-up visits, which give a person the opportunity to discuss the healing process and ask any questions.
The ACOG reports that a hysterectomy is safe and has a low risk of complications when performed by a qualified surgeon. Though uncommon, complications include:
- heavy bleeding
- damage to nearby organs, including bladder or bowel
- blood clots in the leg
- anesthesia problems, affecting breathing or the heart, although these are rare
An individual can expect certain long-term effects after her uterus has been removed. These include:
- Menstrual periods that stop completely. This can be beneficial to women with irregular or heavy bleeding, endometriosis, or other issues related to their periods.
- A woman will no longer be able to get pregnant, but protection from sexually transmitted infections (STIs) is still necessary.
- If the ovaries are removed (oophorectomy), a woman will start going through menopause soon after the surgery. Symptoms may be more extreme than in women who have not had their ovaries surgically removed. If menopausal symptoms are interfering with life, a gynecologist can help with options for relief.
- If the ovaries are not removed, a woman will not experience menopause right away.
Depending on the route of a hysterectomy, a woman will still need regular Pap tests if the cervix was not removed. Other screenings also may be needed if cancer or precancerous cells are found.
Some women experience depression, emotional changes, or a sense of loss after a hysterectomy. They may also find that their interest in sex changes, especially if the ovaries were removed.
If a woman Is struggling with any of these issues, they can talk with a doctor who can offer advise on support, therapy, or medications that may be helpful.
The American College of Obstetricians and Gynecologists (ACOG) recommend vaginal hysterectomy as the first choice for benign conditions. It is less invasive than other types of hysterectomy, recovery is usually faster and easier, and there is no visible scar.
In some cases, a vaginal hysterectomy is not appropriate, and other kinds of hysterectomy are recommended instead. This is a decision that should be made jointly with a woman and her gynecologist.
Vaginal hysterectomy is usually avoided if a woman has:
- cancer or suspected cancer in a reproductive organ
- large uterine fibroids
- an enlarged uterus
- scarring or adhesions from prior surgeries
A hysterectomy may involve more than the removal of just the uterus. The variations in this surgery include:
- Total hysterectomy. The entire uterus and cervix are removed. The cervix is the lower end of the uterus; it is a narrow passage that connects to the vagina.
- Radical hysterectomy. This is a total hysterectomy that also includes ligaments attached to the uterus and the upper portion of the vagina. It sometimes includes lymph nodes close by, as well.
- Partial hysterectomy. Only the upper part of the uterus is removed. The cervix is left in place. This is also called a subtotal or supracervical hysterectomy. This type of hysterectomy cannot be performed by the vaginal method. It requires an abdominal incision.
It is important to know that the term 'hysterectomy' refers to removal of the uterus. When the fallopian tubes are removed it is called a salpingectomy, and when the ovaries are removed it is called oophorectomy.
When talking with a doctor about surgery, a person should make sure they ask if these procedures are planned in addition to the hysterectomy.
Most women recover quickly from a vaginal hysterectomy and can get back to healthy, active lives.
Making an informed decision about a vaginal hysterectomy will require a conversation with a gynecologist and surgeon to determine whether this surgery is the best option.