I’m Having a Hysterectomy: Myths and Truths

Melissa Bennett-Heinz
LICSW, LCSW, Gestalt Psychotherapist

Women's Issues

Working in my private practice as a psychotherapist who specializes in treating adult women, in particular women in perimenopause and menopause, as well as someone who had to have a total hysterectomy, I know something about the truths and misconceptions of hysterectomies.  As with all medical procedures where there will be some type of cut, there is pain involved. There have been major advancements in both reducing infections that begins at home before you even have surgery to improved pain management that begins while you are being prepared for surgery. Your doctor will most likely want to effectively work with you to manage pain after surgery, as you need to be able to move and walk in order to promote blood flow and healing, reduce infections, and blood clots from forming.  Remember your doctor is there to support you and discuss your needs so it is important you relay any concerns and ask all the questions you need to in order to be informed and prepared.

Now, it’s important to begin by first distinguishing the various types of hysterectomies. The first is a total and complete hysterectomy which involves removing the cervix and the uterus. The second, called a partial or subtotal hysterectomy, involves removing the upper two-thirds of the uterus, leaving the lower portion of the uterus, or cervix, intact. The third type, a radical hysterectomy, involves removing the uterus, the cervix, and the upper portion of the vagina. It is also important to understand there are several types of surgical procedures performed when a hysterectomy is needed:

1) Abdominal Hysterectomy: this type is done by making an incision in the abdomen that can be vertical or horizontal (approximately 3-4 inches long) often along the bikini line, which will leave a scar that will fade with time. This type of surgery allows the surgeon to have the best view of what is going on in your pelvic area. The drawbacks to this type of procedure are a greater risk of complications compared with other, less-invasive procedures. These risks can include infection, excessive bleeding, blood clots, and tissue or nerve damage. You will also likely need to be admitted to the hospital for at least one night.

2)  Laparoscopic Hysterectomy is a minimally-invasive procedure that uses surgical instruments inserted through several small incisions in the abdomen. The uterus is able to be removed in small sections, either through the incisions or the vagina. The advantages to a laparoscopic procedure, as opposed to an abdominal hysterectomy, are that there is likely to be less pain, decreased risk of infection and nerve or tissue damage, and is done as an ambulatory procedure – meaning you arrive and leave on the same day with no overnight stay. As with any procedure, there is still risk involved.

3) Vaginal Hysterectomy is performed entirely by going through the vaginal opening, without making any abdominal incisions at all. This type of procedure is often the preferred choice when having a hysterectomy unless there are reasons for using the more invasive procedures, such as growths like tumors, fibroids, or an enlarged uterus. You can likely expect healing more quickly and return to your usual activities sooner with a vaginal hysterectomy than with the other types of hysterectomies. 

If you have a hysterectomy, does that mean you are in menopause? Not entirely.  If you have a partial hysterectomy in which the cervix remains intact and you still have ovaries, you will still menstruate; however, this does not mean you will be able to get pregnant.

Now, as for “menopause,” none of these procedures remove the ovaries which are where your hormones are produced so you will not experience the common menopause symptoms that affect many women that include hot flashes, night sweats, mood swings, dry vagina, bone loss, or lowered libido.  You will not immediately be in full-blown menopause with any type of hysterectomy, and you may or may not have a monthly period. 

One myth that I often hear from women is, “I will no longer want to be sexually active and I will lose my sex drive.” If your ovaries are intact, you will not experience a decrease in libido simply due to a hysterectomy. In fact, many women have reported feeling liberated and their libido increasing. This is often due to the fact that they are no longer concerned with an unwanted pregnancy, are able to be more spontaneous when they engage in sexual activities, and no longer have to be concerned with birth control. As a result, the relationship with their partner deepens, and feels more connected.

I have heard the majority of women in my practice report they are grateful they had a hysterectomy and have never looked back as they no longer experience the monthly cycle of bloating, weight gain, increased cravings or appetite changes, insomnia, menstrual cramps, or have anemia which resolved without blood loss each month. Additionally, when anemia is no longer present and iron levels are restored to normal, they have a renewed energy they didn’t even know was gone until it returns. Many women are able to shift their mindset about “menopause” and experience a have freedom like never before. 

A hysterectomy doesn’t mean the end of your sex life or that you aren’t beautiful and feminine any longer, or all washed up.  It can be a liberation and owning an energy and lifeforce you didn’t know was lying within you.  It can be a new stage of empowerment, freedom, and a discovery of parts now available to you that you didn’t even know were there.