From now until sometime in Spring 2023, we’ll be writing about gender affirming procedures. We’re starting with bottom surgeries and will end with office visit procedures such as fillers and botox. This week, we’re discussing hysterectomy. It is sometimes shortened to “hysto.”
Content advisory: we will be using anatomical terms and discussing surgical procedures in this article and this series. External sites that we link to may contain graphic images.
What is a Hysterectomy?
A hysterectomy is the removal of the uterus. A hysterectomy may be “partial” or “total.” A partial hysterectomy leaves the cervix intact. A total hysterectomy removes the cervix and then sews closed the top of the vagina.
During a hysterectomy, oophorectomy and salpingotomy may also be done.
Oophorectomy is the removal of one or both ovaries.
Salpingotomy is removal of the fallopian tubes which connect the uterus to the ovaries.
Hysterectomies may be done for gender affirmation, for fibroids, endometriosis, other issues with the lining of the uterus, heavy bleeding, pelvic inflammatory disease, cancer, and other pain or disease conditions.
When: Expected Prep and Recovery for Hysterectomy
Little prep is needed for a hysterectomy. Risks for complications are lower if your health is optimized prior to surgery. Most hysterectomies are now done laparoscopically–via a few small incisions in the abdomen and with slim tools and a camera that are inserted via the small incisions–rather than via a large incision in the abdomen. In a laparoscopic hysterectomy, the abdominal cavity is filled with gas during surgery. This gives the surgeon room to see and move around. Having just a few small incisions makes recovery a lot easier and shorter, but you’ll be bloated after surgery, and it may take some time for all of the gas to get out. You’ll probably spend one night in the hospital.
You could have a vaginal or abdominal hysterectomy, however. Incisions for a vaginal hysterectomy are done at the top of the vagina: no visible scars! A vaginal hysterectomy may also be done in combination with laparoscopic techniques. You may stay a couple of nights in the hospital. Recovery time is generally longer than laparoscopic surgery done through the abdomen but shorter than abdominal hysterectomies done without laparoscopy.
Abdominal hysterectomies are generally done via a horizontal incision at the bottom of the abdomen/top of the groin. This incision goes through skin and muscle to reach the uterus and takes longer to heal. Expect to stay in the hospital for a couple of days, and have more restrictions on activity during recovery.
If you’re a smoker, your surgeon may want you to quit a few months prior to surgery.
If you have diabetes, your blood sugars should be well-controlled.
Plan for two to eight weeks off of work, depending on the type of surgery you have and the type of work you do. If you have a physical job that requires the use of your abdominal muscles, you will likely need more healing time before you can safely return to work. People with desk jobs can often return to work sooner.
You’ll have lifting restrictions for several weeks and restrictions on strenuous exercise for a couple of months.
Hysto.net is a good place for more information about gender-affirming hysterectomies. However, they do state that a hysterectomy is required for individuals who also want metoidioplasty or phalloplasty: this is no longer true. Hysterectomy is required if vaginectomy is also desired. Hysterectomy may also be a stage of nullification surgery.
If hysterectomy is the first step in a planned metoidioplasty or phalloplasty, talk to your surgeon about your plans and how they’d like to you to time your surgeries. Some surgeons will do a hysterectomy at the same time as another procedure, and some want several months of healing in between procedures.
How: Common Surgeon and Insurance Requirements
Like other gender affirming surgeries, you may need two letters from a mental health provider for your surgeon, along with a letter from your surgeon and/or hormone provider for insurance. They may require hormone use for a certain period of time or want documentation for why hormones were not part of your journey. The current WPATH SOC 8 recommendations state that only one letter is necessary and “at least six months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated.” (1)
Some insurance policies may require that you document your support and housing plans during recovery. If you’re a smoker, most surgeons will require you to stop smoking for a few months before surgery. If you have diabetes, your blood sugars will need to be well-controlled. Your surgeon or hormone provider will do a wellness exam prior to surgery to ensure that your health is optimized and you have the best chances for good healing and recovery.
Why: Some Things To Think About
In this blog series, we usually talk about Form and Function.
Having a hysterectomy will:
- stop periods, if you have them
- end your ability to get pregnant
- can change how your innards fit together and feel
- working with a physical therapist who specializes in pelvic floors can help
If you want to have a biological child, talk about fertility preservation options prior to hysterectomy.
If you have one or both ovaries removed:
- your testosterone dose may change
- you may experience menopausal symptoms
If you have both ovaries removed, you’ll need to take either testosterone or estrogen. Your body needs some sex steroid hormones for bone and cardiovascular health (and they play a role in healing and all sorts of other processes.)
Where: Surgeons Who Offer Hysterectomy
Very many surgeons offer hysterectomies, as they are a common procedure for people with uteruses and are done for many reasons. You may have an overall better experience with providers who are explicitly gender affirming or who have clearly stated that they support reproductive autonomy. Finding the right surgeon for you may be more or less difficult due to insurance and financial restrictions. Your hormone provider or primary care provider may be able to refer you to someone they know and trust.
Some other directories of surgeons include
- WPATH Provider Directory
- OutCare Health
- The r/TransSurgeries wiki on Reddit
We recommend talking to others in your communities to get recommendations, too.
- Coleman, E., Radix, A. E., Bouman, W.P., Brown, G.R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F.L., Monstrey, S. J., Motmans, J., Nahata, L., … Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(S1), S1-S260. Appendix D
Download our Questions To Ask Your Surgeon handout.