This 3-part series dissects all aspects of a hysterectomy, inclusively covering the needs and questions of transpeople of all identities who are interested in this procedure.
Brief Un-Medical Summary
Since I don’t undertake anything without substantial research beforehand, I learned a lot about the “female” reproductive system and its removal thereof in the weeks preceding my own hysterectomy. Moreover, I had no clue what the surgery itself entailed, as well as what pre-op and post-op experiences were like.
If you’re equally confounded, or just curious about a hysterectomy, follow along in this 3-part series specifically aimed at transguys, men, genderqueer, non-binary, and otherwise trans people.
Here’s a condensed version of my learnings as a non-medical non-professional. Most of this points to other (infinitely more useful and detailed) articles which you should check out.
Types of Hysterectomies
Though typically thought of or referred to as removal of the uterus, a hysterectomy can be removal of any combination of parts of the “female” reproductive system. These parts include uterus, cervix, vagina, fallopian tubes, and ovaries.
The type indicates which parts are kept and/or removed.
- Radical: uterus, cervix, and ovaries removed
- Total: uterus and cervix removed
- Subtotal or Partial: uterus, or portion of
Frankly I found this terminology confusing and sometimes conflicting, so I stuck with expressly stating which parts I was keeping and/or removing each time I referred to my surgery.
Removal of the cervix is recommended in most cases. If you don’t remove it, you will need pap smears and are at risk for cervical cancer, and there is a slight chance for continued menstruation (if you are not on T). The possibility of pelvic prolapse is unclear, but my research indicates it is unlikely in most cases. (Read this article for more info.)
Furthermore, a salpingectomy refers to removal of the fallopian tubes, while an oophorectomy refers to removal of the ovaries. While commonly performed together, it’s not a necessity – that is, you can get your tubes removed and leave in the ovaries. (More on this in the next article.)
Techniques for Hysterectomies
The way this surgery is performed is varied, and primarily affects your recovery as well as visible scars.
- Abdominal: an incision in the lower abdomen along the “bikini line” (wherever that is). This is an invasive surgery, as the incision cuts through skin and abdominal muscles.
- Vaginal: everything is done through down there.
- Laparascopic (robotic and non-robotic): Three or four tiny (5mm) incisions are made in your belly button and lower abdomen, through which a camera and surgical instruments are inserted, and everything is performed via fancy machines. This technique is perhaps the most common for voluntary hysterectomies and is definitely the best option, since it’s the least invasive, leaves minimal scarring, and has a significantly faster recovery time.
To be a candidate for a vaginal or laparoscopic hysterectomy there are a few factors involved, such as not having an enlarged uterus due to childbirth or fibroids, or not having too much abdominal scar tissue due to previous operations.
A hysterectomy is an outpatient procedure, with the patient going home typically the same day or the day after. It lasts about 3 hours, and the biggest risks for complication is nicking the bladder or other internal organs, as well as the usual ones associated with major surgery and anesthesia.
The day before surgery you undergo a very special “bowel prep” diet, which came as an unpleasant surprise for me. It involves ingesting only clear liquids and potentially laxatives for 24 hours, which empties your bowels and intestines in order to make room for the surgeon to see and to avoid accidentally cutting into them. It is not the funnest thing in the world, so you just have to suck it up.
Full recovery is 4-12 weeks, but this varies greatly depending on the the type of surgery.
Abdominal hystos need more time to heal. It takes a while to rebuild abdominal muscles, and some people can have a hard time getting up and moving around for a few days or weeks. Usually an overnight stay may be advised, and of course there is a visible scar left.
With laparoscopy you can be up and about in a few days or so. The main complaint during recovery, other than cramps, is gas build up, since CO2 is pumped into the belly, which enables the surgeon to see all your organs. This lasts only a few days.
I was back to “normal” in just under a week, meaning I was able to resume all my daily activities excluding exercise in just under 7 days.
So why 4-12 weeks recovery time for a laparoscopy if you’re back on your feet in a few days? Because there are stitched up incisions on the inside of your organs, so you have to limit yourself to “couch potato activity levels” (my surgeon’s term) to avoid rupturing them. Especially advised is no penetrative sex and no heavy lifting for the entire recovery period. So, just prepare to have your workout (and possibly bedroom) routine interrupted for a few weeks.
In the next two articles I’ll discuss pro’s and con’s of a hysterectomy particular to trans people, as well as the specific steps for making it happen.
- Dr. Kate O’Hanlan, a gynecologist in the San Francisco Bay Area, has published several resources specifically for Transguys getting hystos. Download her Instruction Sheet to get a good idea of everything that is involved.
- Hudson’s FTM Guide
- VCH Transhealth Brochure (pdf)
- About.com: Hysterectomy Summary (not trans-specific)
- Wikipedia: Hysterectomy
I’m not a medical professional and I possess no formal medical knowledge. This summary is a layperson’s understanding of personal research. It may or may not be accurate.