What is a vaginal cuff and what are the risks?
Doctors recommend hysterectomies for women who would benefit from the surgical removal of the uterus. The cervix is the lowest part of the uterus where it meets the vagina.
During a total or radical hysterectomy, a surgeon removes the woman's whole uterus, including her cervix. The surgeon will then create a vaginal cuff in the place of the cervix.
Sometimes, a vaginal cuff procedure will be done separately from a hysterectomy if this area needs to be repaired due to tearing or improper healing.
A surgeon will create a vaginal cuff during a total or radical hysterectomy.
It is essential to speak to a doctor about the recovery process, as every woman is different and may benefit from an individualized recovery plan.
Usually, a doctor will give the following instructions to a woman who has just undergone a total hysterectomy:
- Get plenty of bed rest for the first few weeks.
- Avoid strenuous activities.
- Do not lift more than 10 pounds.
- Stay away from any activity that puts pressure on the pelvic area.
- Control chronic coughs.
- Avoid straining during bowel movements.
- Abstain from sexual activity.
- Do not use tampons.
- Do not insert anything other than prescribed medication into the vagina.
A doctor will also prescribe medications to prevent infections and reduce pain. A doctor may also recommend an estrogen cream that can be applied to the vaginal cuff to help it heal.
Recovering from a hysterectomy with a vaginal cuff takes a minimum of 6–8 weeks, but may take longer depending on a person's overall health.
While recovering from a hysterectomy with a vaginal cuff, a woman may be asked to see a doctor for a checkup.The doctor will make sure the vaginal cuff is healing properly and that there are no signs of infection.
If scar tissue is forming on the vaginal cuff site, the doctor may apply a small amount of silver nitrate to burn off the scar tissue and aid healing.
Removing the scar tissue may be uncomfortable but should not be painful. It can usually be done in the doctor's office without any need for a separate appointment.
Obesity increases the risk of experiencing a vaginal tear following a hysterectomy.
While vaginal cuffs are generally safe, there is a small risk of the cuff tearing. A vaginal cuff tear occurs when the edges of the wound split or rip.
A vaginal cuff tear, also known as vaginal cuff dehiscence, is rare. Due to the suturing or cutting technique, women are more at risk for this complication if they have undergone a laparoscopic or robotic hysterectomy instead of an abdominal or vaginal hysterectomy.
If the vaginal cuff tear is very large, additional complications may occur, including a bowel evisceration. This happens when the bowels push through the torn vaginal cuff.
Factors that increase the risk of a vaginal tear after a hysterectomy include:
- weakened pelvic floor muscles
- engaging in sexual activity before the vaginal cuff has healed
- smoking cigarettes
- uncontrolled diabetes
- chronic constipation
- any condition that causes chronic or severe coughing
- vaginal infections
- vaginal atrophy
- weakened immune system
- history of radiation in the pelvic region
Vaginal cuff tear symptoms
While vaginal cuff tears are rare, they can be a life-threatening medical emergency.
Women who are having a vaginal cuff as part of a hysterectomy should seek immediate medical attention if they develop any of the following symptoms:
- sudden or severe abdominal or pelvic pain
- vaginal discharge or bleeding
- pressure in the vagina or lower pelvic region
- fluid rushing into the vagina
- foul smell coming from the vagina
While vaginal cuff tears are most likely to occur within a few days of the hysterectomy, they can occur at any time following the procedure.
Most of the time, tears occur spontaneously, but they can also be triggered by sexual activity or a bowel movement.
Vaginal cuff repair
A doctor will recommend plenty of rest and avoiding any strenuous activity.
A person will need surgery to repair the vaginal cuff if they experience a vaginal cuff tear. Other complications that require vaginal cuff repair include:
- an abscess
- peritonitis, which is inflammation of the lining of the abdomen and its organs
- hematoma, which is a buildup of blood outside of the blood vessels
- bowel evisceration
In some cases of a partial vaginal cuff tear, a surgeon can repair the cuff through the vagina instead of making an external incision.
A person will be given intravenous fluids and antibiotics before and after surgery. The length of the surgical procedure may vary based what caused the tear or other complication.
After surgery, the person will be taken to a recovery room and monitored while the anesthesia wears off. They may have to stay overnight in the hospital, particularly if bowel function was affected.
After a vaginal cuff repair, people need to allow 8 to 12 weeks of recovery time. During this time, a doctor will recommend avoiding any activity that strains the new incision, including heavy lifting and sex. Many doctors will also suggest getting lots of rest and limiting strenuous exercise.
The best way for a woman to manage a vaginal cuff is to follow all of her doctor's instructions following a hysterectomy.
Some women may feel better in just a few weeks after surgery. They may push themselves too hard physically or have sex before the vaginal cuff has healed, accidentally causing an injury or tear.
A woman healing from a hysterectomy and a vaginal cuff procedure should be gentle on their body and avoid physical and sexual activity until the cuff has fully healed.
Vaginal cuff tears and complications are rare, but it is important to take precautions. Women can reduce their risk of experiencing these complications by following an individualized recovery plan after surgery and giving their body plenty of time to heal.
If a woman needs a vaginal cuff repair, she will likely need to spend up to 12 weeks recovering before a doctor clears her to resume normal activities, including exercise and sexual activity.