assisted vaginal hysterectomy is somewhat more
complex for the surgeon to perform though signif-
icantly faster recovery for the woman. It is an
appropriate option when hysterectomy is to treat
noncancerous conditions.
A laparoscopically assisted vaginal hysterec-
tomy generally requires no more than an
overnight stay in the hospital the night after the
surgery. A woman often can return to regular
activities in about six weeks with the laparoscopic
operation. The typical hospital stay for open hys-
terectomy is three to five days, with full recovery
and recuperation in about eight weeks.
Risks and Complications
The primary risks associated with hysterectomy
are possible excessive bleeding, BLOODclots, and
INFECTION. Complications may include damage to
the nerves that control the bowel or BLADDERthat
results inFECAL INCONTINENCEor URINARY INCONTI-
NENCEor damage to the structure of the bladder or
ureters (tubelike structures that drain URINEfrom
the KIDNEYS to the bladder). These complications
are uncommon though may have long-term con-
sequences. When the surgeon leaves the FALLOPIAN
TUBESand ovaries intact, these structures some-
times atrophy (shrink). Women who have total
hysterectomies with removal of the cervix some-
times experience PAINduring SEXUAL INTERCOURSE
for the first few months after surgery. Women
who have hysterectomies tend to enter
menopause somewhat earlier even when they
retain their ovaries.
Outlook and Lifestyle Modifications
Most women return to full, regular activities
within two months of surgery (and many sooner).
Hysterectomy means the end of MENSTRUATION
(though not necessarily the start of menopause),
which is sometimes an emotional adjustment. The
relief of symptoms related to the condition that
necessitated the hysterectomy is sometimes pro-
found, allowing the woman to return to a lifestyle
and activities that she had long enjoyed but had
stopped participating in because of the symptoms.
In circumstances other than cancer, it is important
for a woman to understand the nonsurgical
options that are available to treat her condition so
she can make a fully informed decision.
See also CANCER TREATMENT OPTIONS AND DECI-
SIONS; OOPHORECTOMY; SEXUAL HEALTH; SURGERY BENE-
FIT AND RISK ASSESSMENT.hysteroscopy A diagnostic or therapeutic proce-
dure to examine the interior of the UTERUSusing a
lighted magnifying endoscope. Hysteroscopy is an
outpatient surgical procedure that requires
regional or general ANESTHESIA. After the adminis-
tration of anesthesia the gynecologist dilates the
CERVIXand inserts the lighted, flexible tube of the
hysteroscope into the uterus and fills the uterus
with carbon dioxide gas or sometimes liquid saline
solution to push the uterine walls apart.
The hysteroscope allows the gynecologist to
closely examine the entire endometrium (lining of
the uterus) and the entries to the FALLOPIAN TUBES.
The gynecologist may use the hysteroscope to
obtain tissue samples for biopsy, remove UTERINE
FIBROIDSor polyps, and repair minor injuries to the
wall of the uterus and certain congenital malfor-
mations such as uterine septum.
The risks of hysteroscope include those of anes-
thesia as well as INFECTION, excessive bleeding, and
uterine perforation (puncture of the uterine wall).
These risks are uncommon though may require
further treatment. Infection requires treatment
with ANTIBIOTIC MEDICATIONS. Uterine perforation
usually heals on its own. Excessive bleeding may
require medications or follow-up surgery to con-
trol. Minor bleeding and discomfort (cramping)
are normal after hysteroscopy and may continue
for a few days.
See also COLPOSCOPY; ENDOSCOPY; SURGERY BENEFIT
AND RISK ASSESSMENT.292 The Reproductive System