Reproductive surgeries are
surgical procedures which remove internal female
reproductive organs.
The female reproductive system is made
up of a number of organs.
- uterus
- usually two ovaries
- usually two fallopian tubes —
one tube from each ovary back to the
uterus
Hysterectomy is usually carried out under a
general anaesthetic and takes between one and
two hours.
There are a number of different surgical
procedures which relate to these organs.
- Hysterectomy — the removal of
the uterus, fallopian tubes and cervix, but
not the ovaries. (Sometimes called a a 'total
hysterectomy' or 'complete
hysterectomy').
- Partial hysterectomy — the
removal of the uterus and fallopian tubes,
but not the cervix and overies. (Sometimes
called a 'supracervical' or 'sub-total
hysterectomy').This procedure is not commonly
performed in Australia.
- Bilateral Salpingo-oophorectomy
(BSO) — the removal of both
fallopian tubes and both ovaries.
- Hysterectomy/BSO — the
removal of the uterus, cervix, both ovaries
and fallopian tubes.
The operation can be performed in several
different ways:
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Abdominal
hysterectomy — the
uterus is removed through a
horizontal incision (about
15cm long) along the pubic
hairline or as a vertical
incision from the navel to the
pubic hairline. Either of
these offer the surgeon the
best access to the pelvic
organs. The vertical incision
leaves a less obvious scar and
results in a shorter recovery
time.
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Advantages
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Disadvantages
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- A lower incidence of
damage to the urinary tract
and blood vessels than
other procedures.
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- More pain than other
procedures;
- Visible scar on the
abdomen;
- Costs are greater than
other procedures;
- Surgery usually takes
longer with a longer time
under anesthesia;
- Hospital stay and
recovery time are
longer.
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Vaginal hysterectomy
— a surgical incision is
made in the upper portion of
the vagina and the uterus is
removed through the
vagina.
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Advantages
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Disadvantages
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- Absence of a visible
scar;
- Less pain than other
procedures;
- Lower costs than other
procedures;
- A shorter hospital stay
and recovery timethan other
procedures.
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- Risk of injury to the
urinary tract, bladder or
bowel.
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Laparoscopically
assisted vaginal hysterectomy
(LAVH) or Laparoscopic
supracervical hysterectomy
(LSH) — a surgical
incision is made in the lower
abdominal wall so a small tube
with a camera attached to it
(a laparoscope) can enter the
pelvis. The laparoscope
enables the surgeon to perform
the procedure more easily.
In the LAVH procedure, the
uterus is freed from tissue
around it and removed through
the vagina.
In the LSH procedure, the
uterus is removed in small
pieces through the
incisions.
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Advantages of
laparoscopic
procedures
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Disadvantages of
laparoscopic
procedures
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- Less pain than other
procedures;
- Less cost than other
procedures;
- Short abdomen
scars;
- Shorter hospitalisation
and recovery time than
other procedures;
- Reduces the likelihood
of complications associated
with abdominal
hysterectomy.
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- Possible longer
operating time (depends on
how much of the operation
is performed
laparoscopically);
- Can sometimes be higher
costs than other
procedures;
- Risk of injury to the
urinary tract, bladder or
bowel. Surgeon's training
and skill in this
procedure, the laparoscope
and instruments is a
crucial issue in this
procedure.
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Comparison of Hysterectomy Procedures
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Abdominal Hysterectomy
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Vaginal Hysterectomy
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Laparoscopically-Assisted Vaginal
Hysterectomy (LAVH)
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Laparoscopic Supracervical
Hysterectomy (LSH)
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Incision Site
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Abdomen
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Inner Vagina
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Belly button/vagina
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Abdomen (4 small incisions)
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Hospital Stay
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5-6 days
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1-3 days
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1-3 days
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Outpatient to 1 day
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Recovery Time
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6 weeks
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4-6 weeks
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4-6 weeks
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2-3 weeks
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Retention of Cervix
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Upon request
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No
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No
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Yes
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Some reasons men undergo removal of
reproductive organs include:
- discomfort with having internal female
reproductive organs;
- discomfort with ongoing gynecological
care (eg., pap smears);
- to decrease the risk of developing
cervical, endometrial, and ovarian
cancer;
- to meet legal requirements in correction
of their birth certificate.
To keep or remove the cervix?
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leave the cervix
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remove the cervix
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The cervix is a normal organ, with
pelvic support functions, and should be
retained unless diseased.
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The risk to men taking testosterone
of cervical cancer is unknown and will
probably remain unknown.
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Men taking testosterone may have an
increased risk of cervical cancer.
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Removal of the cervix may interfere
with the nerve supply to the bladder
and bowel, and this may cause problems
with bladder and bowel function.
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The cervix is the cornerstone of the
pelvic support structures, and removal
can lead to weakening and atrophy of
the pelvic ligaments, which leads to an
increased risk of prolapse.
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The individual should continue
regular pap smear tests in case of
cervical cancer.
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Pap smears are no longer required -
although this depends on individual
gynaecological advice.
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There is some evidence that removal
of the cervix may interfere with sexual
response.
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It has not been proven that removal
of the cervix interferes with sexual
response.
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Conclusion
Men who have not had their cervix
completely removed still need to have regular
Pap smears after hysterectomy. It is recommended
that these men consult with a gynaecologist
about the need and frequency of further Pap
smears after hysterectomy.
Men who have had their cervix
completely removed report no reduction of
sexual response after removal of the cervix.
This network has received a number of reports
from members over the years (who have been
treated with testosterone for four years or
more), of pain on orgasm similar to muscular
ache. This experience has not been studied
anecdotally or medically at this time. Men
report, after removal of the reproductive
organs, pain on orgasm no longer occurs.
There is some debate, retaining the ovaries
(oestrogen) may protect from osteoporosis. Two
studies (Turner et al., 2004; and van Kesteren
et al, 1998) provide evidence that testosterone
provides protection from osteoporosis as well as
evidence of the broader male population.
As said elsewhere, this short section on this
type of surgery must not be your only research.
You can find further information on the internet
and you are advised to contact other men in a
similar situation for their personal
experiences. Contact gynaecological surgeons for
their advice and further information.
positives
- In Australia, legal requirements are
satisfied to correct the birth
certificate;
- reduces risk of gynaecological
cancers;
- natural fertility is permanently removed
(a positive for some men);
- can reduce the need for ongoing
gynecological care (eg., pap smears);
- offers comfort to some men to remove
internal female reproductive organs.
negatives
- natural fertility is permanently removed
(a negative for some men).
Further reading about reproductive
surgeries
Reproductive Surgeries
