Hysterectomy: some definitions

by Ellen T Johnson

A few years ago, a friend told me she was at the end of her rope with endometriosis pain and had decided to have a “complete hysterectomy.” She hoped the surgery would alleviate her endometriosis pain. When I asked what she meant by “complete hysterectomy,” she replied, “I don’t know; I just told the doctor to take everything!”

Before any woman makes “the hysterectomy decision,” one of the many things she should know is exactly what the surgery involves. Listed here are a few definitions that may be helpful if you ever find yourself contemplating hysterectomy. Remember, however, that hysterectomy does not guarantee a relief from symptoms or from endometriosis. While hysterectomy may be warranted in certain situations, there may be other, less radical alternatives for women with endometriosis to consider (see: treatments for endometriosis).

1. Total (or complete) hysterectomy
   The entire uterus is removed, including the fundus (body of the uterus) and the cervix.
2. Sub-total hysterectomy
   The uterus is removed but the cervix is left intact.

Hysterectomies are performed three different ways in various combinations: abdominally, vaginally, and laparoscopically. If you are considering hysterectomy, discuss the best approach with your physician. As is true with any type of surgery, make sure the doctor you choose has considerable experience performing whatever method you choose.

TAH - total abdominal hysterectomy
A vertical or horisontal incision is made in the lower pelvis, and the organs are removed through the incision. Recovery time is usually longer than with the other methods.

TVH - total vaginal hysterectomy
The vagina is opened up and the uterus and cervix are removed through the opening. There are no incisions; therefore there is generally a shorter recovery time.

LAVH - laparoscopically-assisted vaginal hysterectomy
This is a total hysterectomy that combines surgery through the vagina with laparoscopy. Through the laparoscope, the surgeon may treat endometriosis at the same time. Although it takes longer to perform, there is generally a shorter hospital stay and shorter recovery time.

LSH - laparoscopic supracervical hysterectomy
This is a sub-total hysterectomy (cervix is retained) done completely through the laparoscope. Some advantages include shorter hospital stays, shorter recovery times, the pelvic support structures are retained, and there is no incision at the end of the vagina (which may cause pain during intercourse). A woman who undergoes a LSH must continue to get annual pap smears.

Supravaginal hysterectomy
Subtotal hysterectomy done completely through the vagina.

Deciding whether to have a hysterectomy is a very weighty, and personal decision. If you’ve been advised by your doctor to have a hysterectomy, a second opinion is always in order. Read books, articles, and personal stories about hysterectomy – especially articles written by women with endometriosis. It’s also important to understand that some women experience a recurrence of endometriosis and/or its symptoms after hysterectomy.

Discuss all the risks and possible side effects with your doctor and with women who’ve undergone hysterectomy. You may want to talk with women in your endometriosis support group about their experiences with hysterectomy. And finally, consider your decision very carefully because “the hysterectomy decision” is not reversible.

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