What is Transvaginal Hysterectomy?

A Transvaginal Hysterectomy is a surgical procedure to remove the uterus through a small incision made in the vagina. Unlike an abdominal hysterectomy, which requires an external incision on the abdomen, this technique leaves no visible scars. Depending on the patient’s specific medical needs, the surgeon may also remove the cervix (total hysterectomy), and in some cases, the fallopian tubes (salpingectomy) and ovaries (oophorectomy).

During the procedure, the surgeon accesses the uterus through an incision made inside the vagina. Specialized instruments are then used to carefully detach the uterus from its surrounding ligaments and blood vessels. Once detached, the uterus is removed through the vaginal opening. In some cases, the fallopian tubes and ovaries may also be removed via the same vaginal incision if clinically indicated.

The innovation of the NOTES Technique?

The Natural Orifice Transluminal Endoscopic Surgery (NOTES) technique elevates the standard transvaginal hysterectomy to a more advanced level. In a NOTES procedure, a specialized endoscopic camera and instruments are passed through the vagina. This allows the surgeon to have a high-definition view of the pelvic organs. The uterus is carefully detached and removed through the vagina, leaving no visible scars on the abdomen. This “scarless” approach is a significant, minimally invasive gynecological surgery.

Who May Need a Transvaginal Hysterectomy (NOTES Technique)?

• Uterine Fibroids: Benign tumors that cause heavy menstrual bleeding, pelvic pain, and pressure.
• Endometriosis: A condition where the tissue that normally lines the uterus grows outside of it, causing significant pain.
• Adenomyosis: A condition where the uterine lining grows into the muscular wall of the uterus.
• Uterine Prolapse: When the uterus descends into the vaginal canal due to weakened pelvic floor muscles.
• Abnormal Uterine Bleeding: Persistent, heavy, or irregular bleeding that does not respond to other treatments.
• Chronic Pelvic Pain: When the source of the pain is determined to be the uterus.
• Gynecologic Cancer: Cancer of the uterus, cervix, or ovaries.
• Gender Affirmation: For female-to-male (FTM) individuals, a hysterectomy is a key component of the gender-affirming journey.

The Importance of Transvaginal Hysterectomy (NOTES) in FTM Gender-Affirming Care

For many transgender men (FTM) and gender non-conforming individuals, a hysterectomy is a crucial and affirming step in their transition. At WIH Hospital, we provide a safe, respectful, gender affirming environment and also minimally invasive Transvaginal Hysterectomy (NOTES technique) with the added advantage of no abdominal scarring, which can be particularly important for body image and a positive transitional experience.

Why is this procedure so important?

Alleviation of Gender Dysphoria: The presence of a uterus and the experience of menstruation can be significant sources of emotional distress and gender dysphoria. Removing the uterus can align one’s body with their gender identity.

Cessation of Menstruation: For individuals on testosterone therapy, breakthrough bleeding can still occur. A hysterectomy provides a definitive end to menstruation.

Preparation for Further Gender-Affirming Surgeries: A hysterectomy is often a precondition for genital reconstruction surgeries such as metoidioplasty or phalloplasty.

Eliminating the Risk of Uterine and Cervical Cancers: For individuals undergoing long-term testosterone therapy, a hysterectomy removes the risk of developing cancers in these organs.

Pre-operative and post-operative Care

Pre-operative Care

• Our team will provide instructions on which medications to stop or continue.
• Follow all fasting instructions.
• Stop smoking 1-2 weeks before the surgery.

Post-operative Care

• Our experienced nurses will monitor the patient in the recovery room.
• The surgeon will prescribe medication for pain and discomfort.
• Attend all follow-ups at the WIH hospital with the surgeon.

The Role of Ultrasound Detection After Transvaginal Hysterectomy

• Evaluate the Ovaries: If the ovaries were not removed, an ultrasound can be used to monitor them for any abnormalities.
• Assess the Vaginal Cuff: This is the area at the top of the vagina where the cervix was removed. An ultrasound can help to ensure it is healing properly.
• Investigate Any Post-Operative Symptoms: If the patient experiences any unusual pelvic pain or other symptoms, an ultrasound can be a useful diagnostic tool.

Recovery Timeline

• Week 1: The initial focus is on rest, and patients will be encouraged to take short walks.
• Weeks 2-3: The patient can move more comfortably and engage in light activities. Avoid heavy lifting and strenuous exercise. Some vaginal discharge or spotting is normal during this time.
• Weeks 4-6: The patient can return to work, depending on the nature of the job, and can increase the activity levels.
• After 6 Weeks: Most patients can resume all normal activities, including sexual intercourse. The internal tissues will continue to heal for several more months.

Limitations of Transvaginal Hysterectomy

• A very large uterus: It may be difficult to remove a significantly enlarged uterus through the vagina.
• Previous abdominal surgeries: Extensive scar tissue from earlier operations can complicate the procedure.
• Suspected or Confirmed Gynecological Cancer: In certain cases, an abdominal approach may be necessary for a better assessment of the disease’s extent.