What are the effects of total hysterectomy?

Total hysterectomy may have effects on the endocrine, urinary system, sexual life and psychology. Specific manifestations include fluctuations in ovarian function, increased risk of urinary incontinence, vaginal shortening, and anxiety and depression.

After total hysterectomy, the blood supply to the ovaries may be temporarily reduced, causing hormone levels to fluctuate. Some patients will experience hot flashes, night sweats and other menopausal-like symptoms, which usually recover gradually in 3-6 months. Since the loss of the uterus may change the pelvic anatomy and weaken the support of the bladder and urethra, about 20%-30% of patients will develop stress urinary incontinence after surgery, which is characterized by leakage of urine when coughing or jumping. The scar formed by the healing of the top of the vagina may shorten the vaginal length by 1-2 cm, and initial sexual life may be accompanied by discomfort. Most patients can adapt to this through lubricants and position adjustments. Changes in estrogen levels after surgery may reduce the elasticity of the vaginal mucosa and increase dryness. It is recommended to use topical estrogen ointment to improve it. About 15% of patients will experience persistent psychological adjustment disorders, manifested as confusion about female identity or anxiety about couple relationships, and require professional psychological counseling intervention.

A small number of patients may develop premature ovarian failure and persistent amenorrhea within 1 year after surgery, requiring long-term hormone replacement therapy. The incidence of pelvic organ prolapse is about 5%-8%, which manifests as vaginal wall bulging or rectal pressure. Severe cases require secondary surgical repair. A very few patients have hydronephrosis due to intraoperative ureteral injury, which needs to be solved by ureteral stent placement. The probability of postoperative deep vein thrombosis is 1.5-2 times higher than that of other gynecological surgeries, which is related to changes in pelvic venous return. Patients with scar constitution may develop granulation tissue hyperplasia in the vaginal stump, causing contact bleeding or abnormal secretions.

After surgery, it is recommended to wear medical elastic stockings for 3 months to prevent venous thrombosis, perform Kegel exercises daily to enhance pelvic floor muscle strength, and use vaginal dilators 2-3 times a week to prevent contracture. The diet should increase the intake of soy products and deep-sea fish to supplement phytoestrogens and omega-3 fatty acids, and avoid lifting heavy objects exceeding 5 kilograms. Pelvic ultrasound should be reviewed 6 weeks after surgery to evaluate ovarian blood flow. Swimming and bathing should be avoided within 3 months. Low-impact exercises such as yoga or swimming can be chosen. The spouse should participate in the postoperative recovery process and help with psychological adjustment through emotional support and moderate close contact. If persistent fever or severe abdominal pain occurs, seek medical attention immediately.