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What is Total Vaginal Hysterectomy (TVH) and how is it performed?
A vaginal hysterectomy is the least invasive technique for hysterectomy. It is performed entirely through the vagina with no abdominal incisions whatsoever. However, not every patient is a candidate for this surgical approach. Many factors go into this decision, and this can be discussed with your surgeon. In general, vaginal hysterectomies are most commonly performed in patients who have had at least one prior vaginal birth and who may have pelvic organ prolapse or pelvic floor laxity, which is further discussed below. While some patients with fibroids or enlarged uteri may be candidates for a vaginal approach, vaginal hysterectomies do have some size limitations. You and your surgeon can discuss whether the vaginal approach is safer for you.
Other procedures done with TVH for pelvic floor issues
Vaginal hysterectomy is one of many options available to women with pelvic floor disorders such as pelvic organ prolapse and incontinence. While hysterectomy is not necessary to correct these disorders, it is an option that can be discussed with your Female Pelvic Medicine and Reconstructive (FPMRS) surgeon.
Other vaginal surgeries that can be performed with or without a vaginal hysterectomy
- Natural tissue vaginal vault suspensions (repair of vaginal prolapse)
- Anterior vaginal repair/cystocele repair (repair of bladder prolapse)
- Posterior vaginal repair/rectocele repair (repair of rectal prolapse)
- Perineorrhaphy (repair of perineum)
- Urethral slings (supporting the bladder and its opening)
What is the typical recovery for vaginal surgery?
Recovery after vaginal surgery is often quick as there are no abdominal incisions. Many patients can go home either the same day or the morning after surgery depending upon the complexity of their case. While most patients begin feeling well after vaginal hysterectomy within a few days to 2 weeks, full recovery after vaginal hysterectomy is based on the expected time for the internal, vaginal incision to heal, which is about 6-8 weeks. Patients can walk, eat, do basic things around the house immediately after surgery. There may be pain or soreness in the lower pelvic area, however, most patients will require only small doses of narcotics, if any. There may be some light vaginal bleeding or spotting for a few weeks after surgery.