Trans Summer School: Hysterectomy

If you’ve got a uterus and you don’t want one, you’ll be spending some personal time with a gynecological surgeon. While this is obvious, it bears mentioning up front: If you have a hysterectomy, you will not be able to get pregnant — and this is an irreversible surgical procedure, so if you change your mind about getting pregnant and carrying a pregnancy to term in the future, you’re going to be out of luck. (Until uterus transplants are widely available, anyway.)

Depending on your circumstances and the surgeon’s approach, you may get a supracervical hysterectomy (your cervix remains in place) or a total hysterectomy (your uterus and cervix are removed). It may be possible to perform your surgery laparoscopically through small incisions in your abdomen and the miracles of science, or transvaginally, which is exactly what it sounds like, but you may be looking at an abdominal surgery — this isn’t just an issue because of the nifty scar, but because of the longer recovery time, since your surgeon will cut through the muscles in your abdominal wall. (Ouch!)

Sometimes your surgeon won’t be able to tell which approach is best until you’re already under anesthesia, so it’s possible you’ll go to sleep expecting a laparoscopic procedure and wake up with a nifty abdominal incision. The vaginal approach has the shortest recovery time, though, and it tends to be the procedure of choice, according to our friends at the American College of Obstetricians and Gynecologists.

When your uterus is removed, you may request the removal of your fallopian tubes and/or your ovaries, since you don’t need them anymore — and if you have concerns about ovarian cancer, you might as well take those little punks out. If both are being removed, you’ll be getting a salpingo-oophorectomy — if it’s just your tubes that are taking a long walk off a short pier, it’s called a salpingectomy, and if just your ovaries are heading out the door, it’s an oophorectomy.

Once you lose your ovaries, your body won’t be able to produce very much estrogen on its own, and would go into menopause without hormone replacement therapy. If you’re already on testosterone therapy, you’ll need to continue for life unless you want menopause symptoms (you don’t). If you aren’t on testosterone, you may consider starting after surgery. You can also discuss estrogen replacement therapy if that's of interest.

After your procedure, your uterus will get its revenge one last time: You’ll experience some bleeding for a couple of weeks, and you’ll need to wear pads for a little while. (Tampons and other insertables are a no-go during surgical recovery.) If you had a transvaginal or laparoscopic hysterectomy, you’ll probably stay in the hospital overnight, so queue up your favorite podcasts. If you have an abdominal incision, you’ll likely be looking at another day in the hospital.

Once you get sprung from the hoosegow, your doctor will have specific aftercare directions, but they typically include no sex for about a month (and specifically, no inserting anything into your vagina, whether solo, partnered, or otherwise), restrictions on how much you can lift, and a recommendation to get active and stay that way.

If you know you’re planning to get a phalloplasty, you might want to hold off on that hysterectomy. Getting the two procedures done at the same time can save money and recovery time. If you’re not sure, or if you want to get them done separately, surgeons who perform phalloplasties recommend a transvaginal approach to the hysterectomy so that you won’t have any scarring that might interfere with their work. Since different surgeons have different needs, you may want to identify the surgeon you want to perform your phalloplasty first, and discuss the best surgical approach.

This section is part of a larger piece, Trans Summer School: The Wide World of Surgical Transition. To read the whole piece or another section, click here!