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—except in extremely rare casesexternal link, opens in a new tab where an embryo implants outside the uterus—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, in which case, you still need regular screening for cervical cancer) 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!) Your risk of needing an open incision can increase if you have a condition like fibroids or endometriosis, so discuss your medical history and expectations in detail.
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 choiceexternal link, opens in a new tab.
When your uterus is removed, you may request the removal of your fallopian tubes and/or your ovaries—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. Discuss the risks and benefits of these options with your surgeon.
Some patients may also consider a vaginectomy (removal of the vagina) or colpocleisis (closure of the vaginal canal). If these are options you are interested in, discuss them with your surgeon.
Once you lose your ovaries, your body’s estrogen production will go way down, and you would go into menopause without hormone replacement therapy. If you’re already on testosterone therapy, you’ll need to continue for life. 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 or period underwear for a little while. (Tampons and other insertables are a no-go during surgical recovery.) If you had a transvaginal or laparoscopic hysterectomy, you can probably leave the same day. 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 are considering phalloplasty, you may want to consult with a surgeon who performs that procedure ahead of time. Depending on current medical best practice, a surgeon’s experience, and facility requirements, you may need to have a hysterectomy before a phalloplasty, or might be able to have both procedures at the same time. Incidentally, the medical literature says there aren’t big differencesexternal link, opens in a new tab between people who space the procedures out and those who get them at the same time. If you’re not sure about phalloplasty, it may still be helpful to talk with a surgeon just to make sure you have all the info you need, but know that getting a hysterectomy now shouldn’t affect your ability to get phalloplasty in the future.
This section is part of a larger piece, Trans Summer School: The Wide World of Surgical Transition.
