Vaginal hysterectomy steps risks complications and results

Vaginal hysterectomy has become one of the most common and safest surgical options for women who need treatment for conditions such as heavy menstrual bleeding, fibroids, or uterine prolapse.
What makes this technique special is that it’s performed without opening the abdomen, which means less pain, fewer complications, and a much faster recovery.In this Daleely Medical guide, we’ll cover everything you need to know—from the advantages and limitations of the procedure, to how it’s performed, what to expect during the recovery period, the normal symptoms after surgery, and essential tips to prevent infections—so you can have all the information clearly and easily in one place.

What Is Vaginal Hysterectomy?

A vaginal hysterectomy is a surgical procedure in which the uterus is removed—either partially or completely—through the vagina, without the need for an abdominal incision.
It is commonly used to treat conditions such as:

Heavy menstrual bleeding
Uterine fibroids
Uterine prolapse

Who Is a Good Candidate for the Procedure?

This procedure is suitable for women who have:

A normal or moderately sized uterus
Uterine prolapse or weakened pelvic support
No severe adhesions or large pelvic masses

How Long Does Recovery Take?

Most women notice significant improvement within 4–6 weeks
Full recovery may take 2–3 months, depending on individual health

When Can Sexual Intercourse Be Resumed?

Usually after 6 weeks
Only after the doctor confirms proper vaginal healing

Is Watery Discharge After Surgery Normal?

Yes. Clear discharge or light spotting is normal during the first few weeks.

Warning: If the discharge has a foul smell, unusual color, or becomes excessive, you should contact your doctor immediately.

Is the Surgery Dangerous?

The procedure is generally very safe, especially when performed vaginally or laparoscopically.
Risks decrease significantly with an experienced surgeon and proper pre- and postoperative care.

What Is the Difference Between Vaginal Hysterectomy and Open Surgery?

Vaginal hysterectomy: performed through the vagina, with no abdominal incision
Open abdominal surgery: requires a cut in the abdomen
Vaginal surgery results in less pain and faster recovery

Can the Ovaries Be Removed During Surgery?

Yes. The surgeon may remove the ovaries and fallopian tubes along with the uterus, especially if there are tumors or if the patient is close to menopause.

Does Hysterectomy Affect Sexual Life?

Generally, no.
With proper healing, intercourse can be resumed after about 6 weeks.
Some women may experience temporary vaginal dryness if the ovaries are removed.

What Uterus Size Is Suitable for Vaginal Removal?

This method works best for a normal or moderately sized uterus.
If the uterus is very large due to fibroids or severe enlargement, another method (laparoscopy or open surgery) may be required.

How Long Does the Surgery Take?

Typically 1–2 hours, depending on the patient’s condition and uterus size.

How Long for Full Recovery After Vaginal Hysterectomy?

Most women recover within 4–6 weeks
Complete internal healing takes 2–3 months

Can You Exercise After Surgery?

Light movement and early walking are encouraged to prevent blood clots
Avoid heavy lifting or intense exercise for at least 6 weeks

When Should You See a Doctor After Surgery?

Seek medical attention if you experience:

Persistent bleeding or unusual discharge
Severe abdominal pain or swelling
Fever or signs of infection

How Long Does Vaginal Hysterectomy Take?

Usually 1–2 hours, depending on uterus size and surgical difficulty.

When Is Sex Allowed After Hysterectomy?

1. Recommended Time

Typically 6 weeks after surgery
Longer if there is delayed healing or late bleeding

2. Signs the Body Is Ready

Bleeding or discharge has stopped
Vaginal tissue is fully healed
No pain during walking, sitting, or light pressure

3. Tips for Resuming Intercourse

Start gently and gradually
Use a water-based lubricant if there is dryness (especially if ovaries were removed)
Communicate openly with your partner about any discomfort

Reasons for Watery Discharge After Hysterectomy

1. Normal Post-Surgery Vaginal Discharge

After the uterus is removed, the vagina and internal tissues need time to heal.
Clear, yellowish, or slightly bloody discharge is normal for 1–2 weeks.

2. Healing Fluids From the Surgical Site

These are natural healing secretions and decrease gradually over time.

3. Light Bleeding or Spotting

Caused by healing small blood vessels.
It is normal unless the bleeding becomes heavy or persistent.

4. Signs of Infection

Seek medical help if discharge becomes:

Excessive
Foul-smelling
Green or dark yellow
Accompanied by itching or pain

5. Rare Complications

Watery discharge may indicate leakage from the bladder or bowel, especially if the surgery was complicated.
A doctor can diagnose this through examination and tests.

Benefits of Vaginal Hysterectomy

This method is one of the preferred choices because it is safe, minimally invasive, and offers faster recovery. Key advantages include:

No external incision
- No abdominal scars
- Less postoperative pain
Faster recovery
- Early return to daily activities
- No healing of a large abdominal wound
Less pain after surgery
- Easier movement during the first week
Shorter hospital stay
- Many patients go home the same day or the next
Lower complication rates
- Reduced risk of bleeding, infection, and blood clots
Better cosmetic results
- No visible scars on the abdomen
Earlier mobility
- Walking improves circulation and reduces clot risk
Suitable for many cases
- Normal or moderately sized uterus
- Minimal adhesions
- Uterine prolapse

1. Difficulty With a Large Uterus

Large fibroids or significant uterine enlargement can make removal through the vagina difficult.
In such cases, laparoscopy or open surgery may be required.

2. Severe Pelvic Adhesions

Previous surgeries or chronic pelvic infections can cause strong adhesions.
This increases the risk of injury to nearby organs such as the bladder or colon.

3. Limited Visibility for the Surgeon

Because vaginal surgery is performed without a camera, it can be challenging in complex cases that require precise visualization of tissues and blood vessels.

4. Difficulty Removing Side Masses

Large ovarian cysts, complex adnexal masses, or growths on the cervix may not be easily removed vaginally.

5. Limited Control Over Heavy Bleeding

Severe bleeding can be harder to manage compared to open or laparoscopic surgery.

6. Suspicion of Cancer

When uterine or cervical cancer is suspected, open surgery or laparoscopy is preferred for safe removal.

7. Severe Obesity

Excessive obesity can make surgical access more difficult and increase the complexity of the procedure.

8. Very Severe Pelvic Organ Prolapse

Complicated prolapse may require additional surgical techniques that cannot be done vaginally alone.

How Is Vaginal Hysterectomy Performed?

A vaginal hysterectomy is performed entirely through the vagina, without any abdominal incision. This makes the surgery less painful and allows for faster recovery. The main steps include:

1. Preoperative Preparation

Blood tests, imaging, and evaluation of overall health
Reviewing medical and surgical history
Stopping blood-thinning medications before surgery
Proper vaginal cleansing and preparation

2. Anesthesia

General or spinal anesthesia is typically used, depending on the patient’s condition.

3. Vaginal Incision

The surgeon makes an incision at the top of the vagina around the cervix.
The cervix is gently separated from the vagina while protecting the bladder and intestines.

4. Separating the Uterus

The supporting ligaments (uterosacral, cardinal, and others) are cut and tied off.
Major blood vessels are tied before cutting to prevent bleeding.

5. Removing the Uterus

After separating all ligaments and vessels, the uterus is removed through the vagina.
If it is large, the surgeon may divide it into smaller sections.

6. Treating the Ovaries and Fallopian Tubes (If Needed)

In some cases, the ovaries and fallopian tubes are removed along with the uterus.

7. Closing the Vagina

The vaginal wall is stitched with absorbable sutures.
No external incision is needed.

8. Postoperative Care

Hospital stay: 1–2 days
Monitoring bleeding, pain, and vaginal healing
Instructions about early movement, hygiene, and avoiding heavy lifting

Risks and Complications of Vaginal Hysterectomy

Although it is generally safe, potential complications include:

1. Bleeding

May occur during or after surgery; rarely, a blood transfusion is needed.

2. Infection

Vaginal or pelvic infections can occur; proper hygiene and antibiotics reduce the risk.

3. Injury to Nearby Organs

There is a small risk of injury to the bladder, bowel, or blood vessels.

4. Pain or Discomfort

Mild pelvic or vaginal pressure is common for a few days.
The pain is much less compared to open surgery.

5. Hormonal Changes

If the ovaries are removed, symptoms of early menopause may appear:

Hot flashes
Vaginal dryness
Mood changes

6. Changes in Sexual Function

Some women may experience temporary dryness or changes in sensation.
Rarely, vaginal prolapse may occur later.

7. Anesthesia Complications

General or spinal anesthesia may cause nausea, low blood pressure, or rare complications.

8. Recovery Time

Even though recovery is faster, full return to heavy activities requires several weeks.

Types of Vaginal Hysterectomy

1. Subtotal / Supracervical Vaginal Hysterectomy

Description: The body of the uterus is removed but the cervix is left in place.
Advantages: Fewer urinary complications and quicker recovery.
Disadvantage: The cervix still requires routine follow-up and may cause future bleeding.

2. Total Vaginal Hysterectomy (TVH)

Description: Complete removal of the uterus and cervix.
Advantages: Resolves bleeding issues and lowers cervical cancer risk.

3. Vaginal Hysterectomy With Bilateral Salpingo-Oophorectomy

Description: Removal of the uterus, ovaries, and fallopian tubes.
Indications: Ovarian diseases or approaching menopause.
Disadvantage: Sudden onset of menopausal symptoms if ovaries are removed.

4. Vaginal Hysterectomy With Pelvic Floor Repair

Description: Removal of the uterus along with repair of pelvic support tissues.
Indication: Severe uterine prolapse.
Benefit: Long-term correction of prolapse.

Diagnosis and Evaluation Before Vaginal Hysterectomy

1. Clinical Examination

Pelvic exam of the vagina, cervix, and uterus
Assessing uterine size and fibroids
Checking prolapse and pelvic support

2. Laboratory Tests

Blood tests (hemoglobin, kidney/liver function, clotting)
Urine tests to rule out infection

3. Imaging

Ultrasound: to evaluate uterine size, fibroids, and ovarian cysts
MRI or CT: for complex cases or large tumors/adhesions

4. Evaluation of Ovaries and Tubes

The doctor assesses whether they should be removed during surgery.

5. General Health Assessment

Blood pressure, heart, and lung evaluation
Chronic diseases like diabetes or clotting disorders
Review of previous abdominal or pelvic surgeries

6. Discussing Surgical Options

Explaining procedure types, advantages, risks, and expected outcomes.

Postoperative Care After Vaginal Hysterectomy

1. Hospital Stay

Usually 1–2 days.
Vital signs, bleeding, and vaginal healing are monitored.

2. Pain After Surgery

Pain is usually mild.
Simple painkillers are often enough.

3. Activity and Movement

Early walking is important to prevent blood clots
Avoid heavy lifting and strenuous activity for 4–6 weeks

4. Vaginal Care

Keep the area clean
Use sanitary pads, not tampons
Avoid intercourse for 6 weeks

5. Diet

High-fiber foods to prevent constipation
Plenty of water
Healthy meals to support healing

6. Follow-Up

A visit after 2–4 weeks to check healing and detect any complications.
Hormone therapy may be considered if ovaries were removed.

7. Warning Signs

Heavy bleeding
Fever
Severe abdominal pain
Difficulty or burning during urination

8. Emotional Support

Some women may feel emotional changes after hysterectomy.
Support from family and spouse helps with mental and physical recovery.

Precautions After Vaginal Hysterectomy

1. First Two Weeks at Home

Rest and gradually increase activity
Expect light bleeding or spotting for 1–2 weeks
Use pads, not tampons
Internal stitches dissolve naturally

2. Gradual Activity Increase

Weeks 1–2: Only light activities, no lifting heavier than 1.5 kg
Weeks 3–4: Light housework, still no heavy lifting
Weeks 4–6: Gradually increase lifting of light items
After 8 weeks: Normal lifting (shopping bags, laundry basket)
Exercise: Daily walking; return to normal sports like swimming or cycling after 4–6 weeks

Post-Hysterectomy Diet

1. High-Fiber Foods

Prevent constipation which puts pressure on the vagina.
Examples: spinach, arugula, apples, pears, oranges, oats, brown rice, whole-grain bread.

2. Proteins

Promote tissue healing.
Examples: eggs, chicken, fish, lean meat, lentils, beans, chickpeas.

3. Fluids

Plenty of water daily to prevent constipation and improve circulation.
Light herbal teas and natural juices without sugar.

4. Healthy Fats

Support wound healing.
Examples: olive oil, avocado, raw nuts.

5. Iron-Rich Foods

Replace blood loss after surgery.
Examples: lean red meat, spinach, lentils, iron-fortified cereals.

6. Avoid Certain Foods and Drinks

Fatty or heavily fried foods, as they slow digestion and cause bloating.
Carbonated drinks and excessive caffeine, because they can lead to constipation and dehydration.
Spicy foods, especially if they cause stomach irritation or sensitivity.

7. Nutritional Supplements

In some cases, the doctor may recommend iron supplements or Vitamin C to strengthen immunity and improve tissue healing.

When Do Results of Vaginal Hysterectomy Appear?

1. The First Few Days After Surgery (Day 1–Week 1)

Mild pain compared to open surgery.
Light vaginal discharge or spotting is normal.
Early walking is important to reduce the risk of blood clots.

2. Weeks 2–4

Pain gradually decreases.
Vaginal discharge becomes lighter.
Ability to resume some simple daily activities improves.

3. Weeks 4–6

Most women feel a significant improvement in energy and mobility.
Vaginal healing is almost complete.
Abnormal bleeding or unusual discharge usually disappears.

4. After About 6 Weeks

The body is almost fully recovered.
Sexual intercourse can be resumed only after medical approval.
You can return to normal daily activities, with caution when doing intense physical work or lifting heavy objects.

5. Full Recovery

Complete physical and psychological recovery may take 2 to 3 months, depending on the patient’s condition and the extent of surgery.
If the ovaries were removed along with the uterus, symptoms of early menopause may appear and require medical follow-up.

Medications After Vaginal Hysterectomy

After the surgery, the doctor usually prescribes several medications to support recovery and reduce complications. The most common are:

1. Pain Relievers

Purpose: To reduce mild to moderate postoperative pain.
Examples: Paracetamol, Ibuprofen, or stronger medications under medical supervision.
Typically used for several days to a week depending on pain severity.

2. Anti-inflammatory Medications

To reduce swelling and inflammation around the surgical area.
They may be taken along with pain relievers or be combined in the same medication.

3. Antibiotics

To prevent postoperative infections.
Usually prescribed for 5–7 days, depending on the patient’s condition and surgical details.

4. Anti-constipation Medications

Constipation can increase pressure on the vagina and delay healing.
Examples: Mild laxatives, suppositories, or stool softeners.

5. Hormonal Medications (In Some Cases)

If the ovaries are removed, symptoms of early menopause may occur.
The doctor may prescribe estrogen or combined hormone therapy to balance hormone levels.

6. Medications That Support Healing & Immunity

Iron supplements if blood loss occurred during surgery.
Vitamin C and Zinc to accelerate tissue healing.

Important Tips When Taking Medications

Follow the exact dose and duration prescribed by the doctor.
Do not stop any medication without medical advice.
Report any side effects—such as nausea, rash, or severe pain—to your doctor immediately.