C O N T I N U I N G P R O F E S S I O N A L D E V E LO P M E N T

Women’s health

By reading this article and writing a practice profile, you can gain Hysterectomy 47-53

ten continuing education points (CEPs). You have up to a year to Multiple-choice questions
and submission instructions 54
send in your practice profile and guidelines on how to write and
Practice profile
assessment guide 55
submit a profile are featured immediately after the continuing
Practice profile 25
professional development article every week.

Hysterectomy In brief

Author
Hilary Walsgrove RGN, DPSN,
NS84 Walsgrove H (2001) Hysterectomy. Nursing Standard. 15, 29, 47-53. Date of
BSc(Hons), Nurse Practitioner,
acceptance: January 29 2001.
RCN NP Dip, is Nurse
Practitioner/Lecturer
Aims and intended learning outcomes five women can expect to undergo this surgery Practitioner, Women’s Health
by the age of 60 (Wood and Maher 1997). Unit, Royal Bournemouth
The aim of this article is to improve your knowl- In recent years, there has been a small reduction Hospital/Bournemouth
edge and understanding of the care of women in the incidence of hysterectomy, because of the University.
undergoing hysterectomy and enable you to offer introduction of new medical and surgical proce-
them effective and sensitive care, so that they can dures (Wood and Maher 1997). However, it Summary
make the best possible recovery from surgery. remains an important alternative when conserva- Hysterectomy is often thought
After reading this article you should be able to: tive treatments have failed, are not the best of as a last resort, but it is a
■ Describe the different procedures of hysterec- course or are not possible. In most cases, hys- common operation and there
tomy and list potential complications associated terectomy is a successful operation in terms of are many reasons why it is
with the operation. relieving women of their presenting symptoms, carried out. The author looks
■ Outline the main reasons for carrying out and high levels of satisfaction are reported by at these and discusses the
hysterectomy. patients (Wood and Maher 1997). For women different surgical procedures
■ Describe alternatives to hysterectomy. with cancer, it can be a life-saving procedure: and nursing care for patients
■ Describe the care of a woman undergoing approximately 15 per cent of hysterectomies are undergoing hysterectomy.
hysterectomy, with particular reference to carried out for cancer of the uterus, ovaries or
emotional and psychological aspects. cervix (Brown 2000). Keywords
■ Provide patients with information about ■ Hysterectomy
TIME OUT 1
recovery from hysterectomy. ■ Women’s health
■ Describe the role of hormone replacement Review the anatomy and
therapy (HRT) and alternatives to HRT follow- physiology of the female These key words are based
ing hysterectomy. reproductive tract using Fig. 1 on subject headings from the
and an up-to-date text.
British Nursing Index. This
Consider how you might describe
Introduction article has been subject to
this to a patient in your care.
double-blind review.
Hysterectomy is the surgical removal of the
uterus (womb). Various types of surgical proce- Types of hysterectomy
dure can be carried out (Box 1) and it is important Online archive
that the patient knows which one she is having. Total hysterectomy This involves removal of the
This will usually depend on the reason for carry- uterus and cervix through a horizontal, midline For related articles visit our
ing out the hysterectomy. Normally an elective incision (Pfannenstiel or bikini line) just above the online archive at:
operation, it is one of the most common proce- pubic bone. Alternatively, if the uterus is bulky, www.nursing-standard.co.uk
dures carried out by a gynaecologist. More than for example, if the patient has fibroids or cancer, and search using the key
1,000 hysterectomies are carried out every is overweight or has a previous scar, a vertical words above.
week in the UK and it is estimated that one in incision can be used on the lower abdomen.

Downloaded from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. No other uses without permission.
Copyright © 2015 RCNi Ltd. All rights reserved.
C O N T I N U I N G P R O F E S S I O N A L D E V E LO P M E N T

Women’s health

Fig. 1. Cross-section of the uterus menopausal symptoms. There should be careful

consideration of the removal of healthy ovaries,
if hysterectomy is chosen as the treatment
method (Rhodes 1996).
Ovarian conservation If hysterectomy is
performed before the menopause and the
ovaries are left intact, hormones will still be
produced. This means that menstrual cycle
symptoms might continue at certain times of the
month, such as breast tenderness, bloating,
irritability or depression (Haslett and Jennings
1998). It has been shown, however, that with
ovarian conservation, there might be a decrease
in hormonal function in pre-menopausal
women, possibly due to the blood supply being
compromised during surgery (Clark 1993).
Radical/Wertheims hysterectomy This is an
extended hysterectomy where the uterus, ovaries,
Fallopian tubes, broad ligaments, surrounding
tissue, pelvic lymph glands and upper third of
the vagina are removed, for cancer of the cervix
or endometrium (inner lining of the uterus). In a
more extensive Wertheim’s hysterectomy, the
pelvic fascia and further lymph tissue will be
removed. The ovaries might be conserved in
younger women. Some patients will require
further intervention, in the form of radiotherapy
Subtotal hysterectomy This is removal of the and/or chemotherapy.
Box 1. Types of hysterectomy uterus without removal of the cervix. The cervix Vaginal hysterectomy This refers to removal of
is the narrow entrance at the base of the uterus the uterus through the vagina, usually with
Abdominal route and consists of a ring of muscle that relaxes and conservation of the ovaries. Contraindications to
■ Total hysterectomy opens during labour to allow a baby to pass vaginal hysterectomy include a bulky uterus
■ Subtotal hysterectomy through the vagina. Leaving the cervix intact (larger than a 14-week pregnancy) and
■ Total hysterectomy and might reduce the risk of infection and the malignancy. Genitourinary prolapse is defined as
bilateral salpingo- chance of decreased sexual response after a herniation of the genital tract structure
oophorectomy (BSO) hysterectomy, as for some women the cervix is (Barclay 1998). The vaginal walls and vault,
(removal of Fallopian tubes
implicated in orgasm (Hufnagel 1990). However, uterus or any of these in combination can be
and ovaries)
this factor remains a controversial and a involved. Vaginal hysterectomy requires a small
■ Subtotal hysterectomy and
BSO subjective one. For women who have had a amount of uterine prolapse and, therefore, if
■ Radical/Wertheims subtotal hysterectomy, there remains a risk of this is not evident then the vaginal route is not
hysterectomy cervical cancer. Therefore, these patients will still possible. Vaginal hysterectomy is often
need to attend for regular cervical smear tests accompanied by vaginal repair surgery, which
Vaginal route and this needs to be reinforced. involves strengthening and repairing the vaginal
■ In case of uterine prolapse Bilateral salpingo-oophorectomy (BSO) This walls affected by the prolapse.
and/or if uterus is not bulky is the removal of Fallopian tubes and ovaries
■ Vaginal hysterectomy and is often performed at the same time as total TIME OUT 2
■ Laparoscopically assisted or subtotal hysterectomy. This is likely to be Familiarise yourself with
vaginal hysterectomy
carried out where there is evidence of disease or pelvic floor exercises. Discuss
■ Might be combined with
where the woman is approaching the menopause with a physiotherapist the
vaginal repair, as required
or is already post-menopausal. Oophorectomy different treatment options he
(removal of ovaries) prevents ovarian cancer or she might be able to offer a
Laparoscopic hysterectomy
from occurring in the future, as well as the woman with symptoms of prolapse.
development of benign ovarian cysts or tumours
and any other disease of the ovaries or Fallopian Laparoscopically assisted vaginal hysterectomy
tubes. In pre-menopausal women, an attempt is This operation begins with a keyhole procedure
made to conserve the ovaries if they are healthy, in which three small incisions (1-2cm long) are
as a sudden decrease in oestrogen might cause made: one just underneath the umbilicus and

Downloaded from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. No other uses without permission.
Copyright © 2015 RCNi Ltd. All rights reserved.
 C O N T I N U I N G P R O F E S S I O N A L D E V E LO P M E N T

Women’s health

two on either side of the lower abdomen. The or painful periods. In 75 per cent of women who Box 2. Reasons for
upper part of the operation is carried out are affected, the cramping pains are of minor or hysterectomy
through the keyhole incisions and the rest is moderate severity, but in the remaining 25 per
performed as a vaginal hysterectomy. The cent they are severe and incapacitating (Llewelyn- ■ Dysfunctional uterine
ovaries might also be removed via this method. Jones 1994). Any of the above disorders might bleeding, menorrhagia and
Laparoscopic hysterectomy The entire be indications for hysterectomy, depending on other disorders of
operation is carried out through the keyhole the severity of the symptoms experienced by the menstruation
■ Leiomyomas (fibroids)
incisions, and the uterus is removed piecemeal individual.
■ Endometriosis and
through one of the incisions. The cervix is not Leiomyomas (fibroids) Uterine fibroids are
adenomyosis
usually removed when this method is used. found in approximately 20 per cent of women ■ Pelvic inflammatory disease
Studies have shown that the laparoscopic over the age of 40 (Llewelyn-Jones 1994). They (PID)
approach is associated with fewer complications, are benign, oestrogen-dependent growths of ■ Gynaecological cancers of
less analgesic requirements, shorter hospitalisation fibrous and muscular tissue, which can be single the cervix, endometrium,
and more rapid recovery than a traditional but are more commonly multiple and can vary Fallopian tubes or ovaries
abdominal hysterectomy (Raju and Auld 1994). from the size of a pea to a 10kg mass. Their ■ Uterine prolapse
However, the increased time needed for the aetiology is unknown, but they begin as tiny ■ Occasionally, hysterectomy is
operation, the fact that it is more expensive in multiple seedlings scattered throughout the performed as an emergency:
terms of instrumentation and the lack of suitably myometrium and grow slowly but progressively – due to post-partum
haemorrhage
trained surgeons reduces the likelihood of this over a number of years. The symptoms depend
– following gynaecological
approach being a viable option for some women. on the size and position of the fibroids;
procedure where
sometimes associated with menorrhagia and haemostasis cannot be
TIME OUT 3 pressure symptoms in the pelvis. maintained
Look at the different types of Endometriosis and adenomyosis Endometriosis
hysterectomy described in this denotes the presence of ectopic (‘out of place’)
article and consider what endometrial tissue outside the uterus, which is
differences there might be in under the same hormonal control as the
relation to the nursing care of endometrium inside the uterus. The blood
individual patients. released from the endometriotic deposits during
menstruation is unable to escape and is
Reasons for hysterectomy reabsorbed into the bloodstream. The inflamm-
ation that arises causes scarring, which can be
There are a number of major reasons for carry- extensive and might form adhesions that distort
ing out a hysterectomy, which are summarised the normal pelvic anatomy (Andrews 1997). The
in Box 2. It is often considered once other endometrial deposits, particularly when located
options have been tried and have proved unsuc- on the ovary, can be seen as small black spots or
cessful, and therefore it remains an important larger cysts known as ‘chocolate cysts’. When
alternative treatment (Mittal 1997). the endometrial deposits are located between
Dysfunctional uterine bleeding, menorrhagia the muscle fibres of the myometrium, this is
and other disorders of menstruation referred to as adenomyosis.
Menorrhagia refers to regular, heavy menstrual Endometriosis is a disease about which little is
loss. The average amount of loss is about 150ml known, although a number of different theories
over the whole period, and menorrhagia is exist (Olive and Schwarz 1993). The clinical fea-
where this amount is significantly increased. It tures of endometriosis are often non-specific.
might be due to an organic cause, but in most Some women might not have any symptoms.
cases it is dysfunctional, due to an alteration in Even in severe endometriosis, symptoms can be
the endocrine or local endometrial control of mild, whereas those with minimal disease might
menstruation. In some cases, the abnormal have a great deal of pain (Llewelyn-Jones 1994).
bleeding is due to a disorder of haemostasis, Pelvic inflammatory disease (PID) This is an
such as von Willebrand’s disease and idiopathic inflammatory condition that can affect any of
thrombocytopenia, or to a condition such as the internal genital organs and might involve
hypothyroidism. In metrorrhagia, the bleeding is more than one organ. It is thought that a great
irregular in quantity, acyclical and often prolonged. many cases of PID are caused by chlamydial
This condition is usually due to a pathological infection. Some are caused by gonorrhoea and
condition in the uterus or other internal genital in some cases the cause is unclear, but might be
organs. Polymenorrhoea refers to a shortened polymicrobial (Llewelyn-Jones 1994). Other
menstrual cycle of less than 21 days. The menstrual causes might be surgery, such as a termination
period might be accompanied by dysmenorrhoea, of pregnancy or hysteroscopy, appendicitis or a

Downloaded from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. No other uses without permission.
Copyright © 2015 RCNi Ltd. All rights reserved.
C O N T I N U I N G P R O F E S S I O N A L D E V E LO P M E N T

Women’s health

Fig. 2. Location of fibroids in the uterus Box 3. Alternatives to hysterectomy –

some treatment options

Dysfunctional uterine bleeding and

menorrhagia
■ Treatment of underlying cause, if present
■ Hormonal treatments, such as
norethisterone, oral contraceptives, danazol
■ Levonorgestrel coil
■ Transcervical resection of endometrium

Endometriosis and adenomyosis

■ Non-steroidal anti-inflammatory
medication
■ Hormonal treatments, such as oral
contraceptives on a continuous regimen to
suppress menstruation, gonadotrophin-
releasing hormone (GnRH) agonists to
suppress menstruation, danazol
■ Surgical treatment to eliminate implantation,
such as diathermy, ovarian cystectomy

Leiomyomas (fibroids)
■ Progesterone and GnRH agonists
■ Embolisation of fibroids
■ Surgical removal of fibroids (myomectomy)

Uterine prolapse
■ Ring pessary

blood-borne infection, such as tuberculosis. A Obstetric complications Hysterectomy can be

woman with acute PID might have general a life-saving procedure for life-threatening
malaise, pyrexia, headache, lower abdominal complications of pregnancy, for example, major
pain, vaginal discharge, dyspareunia and haemorrhage associated with uterine rupture,
abnormal bleeding. After an initial attack, the placental abruption, placenta praevia and post-
woman is more susceptible to further episodes partum haemorrhage.
and the condition can become chronic, with
further problems such as pain, menstrual TIME OUT 4
problems, periods of ill health and fertility Consider what you have read
problems (Storey 2000). In PID cases where the so far and write brief notes
patient’s quality of life is severely affected, on the reasons for
hysterectomy is the treatment of choice. hysterectomy and the type of
Cancer of the endometrium, Fallopian hysterectomy that might be
performed, dependent on these reasons.
tubes, ovaries or cervix Malignant tumours
can occur in any of these structures and usually
hysterectomy is an essential part of treatment, Complications of hysterectomy
sometimes in conjunction with radiotherapy
and/or chemotherapy. Hysterectomy is a major operation and can bring
Uterine prolapse A vaginal prolapse might occur with it complications common to all major surgical
on its own, but uterine descent always brings with techniques. Hysterectomy is characterised by low
it some part of the upper vagina. Utero-vaginal mortality, but significant morbidity. It is estimated
prolapse is categorised in three degrees of that about half of women who have a hysterec-
increasing severity: first, second and third degree, tomy will experience some problems, which can
the latter being where the whole of the uterus is usually be resolved quite quickly and successfully
outside the vulva (procidentia). It is most (Coltart and Smart 1992). Such problems
commonly caused by damage to the supporting include pyrexia, haemorrhage and infection.
tissues and pudendal nerve during childbirth, but However, more long-term sequelae might occur,
a small number of nulliparous women are affected such as premature onset of ovarian failure even
by some sort of prolapse (Fisher and Glenn 2000). when the ovaries are conserved, psychological

Downloaded from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. No other uses without permission.
Copyright © 2015 RCNi Ltd. All rights reserved.
 C O N T I N U I N G P R O F E S S I O N A L D E V E LO P M E N T

Women’s health

problems, and urinary and bowel symptoms the prerequisites for informed consent and pro- Box 4. Factors that might
(McPherson and Waller 1997). Research shows vide the basis for a pre-admission appointment. determine the impact of
hysterectomy
that women might experience physical side Patients might have worries about anaesthesia,
effects for up to a year after surgery, and fatigue hospitalisation, the emotional and physical con-
■ Severity of pre-operative
is identified as one of these problems (Scriven sequences of the operation and the length of
symptoms and their effect
and Tucker 1997). Other studies demonstrate time it will take to return to normal life afterwards
on quality of life
that up to a third of women experience some (Hunter 1994). However, a woman’s awareness ■ Physical/emotional/
urinary complications, such as infection, although that hysterectomy is being carried out for a psychological state
there might be more serious damage to the bladder good reason and can bring a much-needed cure pre-operatively
or ureter (Clark 1993). Unfortunately, certain is important in helping her through her hospital ■ Age, home and employment
conditions, such as adhesions, pelvic inflamma- experience and recovery. issues
tion and endometriosis might even recur (Clark Any means of reducing pre-operative anxiety ■ Current relationships and
1993). and fear for a woman having a hysterectomy social support systems
Hysterectomy is usually carried out as a last can improve her post-operative adjustment and ■ Cultural and religious factors
resort, once more conservative treatments have recovery (Bailey and Clarke 1989). This is sup- involving hysterectomy
■ Whether the patient has
failed (Mittal 1997) (Box 3). For conditions such ported by Scriven (1994), who found that women
had children
as dysfunctional uterine bleeding, endometriosis who were given appropriate information expe-
■ Circumstances surrounding
and fibroids, a variety of different hormonal rienced less post-operative anxiety and were the decision to go ahead
treatments are available, which might control or discharged home earlier than those who were with hysterectomy
even alleviate a woman’s symptoms (Chamberlain not. Levels of psychological distress surrounding ■ Expectations and beliefs
1995). Minor surgical procedures might be con- hysterectomy have been found to be higher than about hysterectomy and its
sidered, such as local ablative treatments to would be expected in normal population samples consequences
endometriosis and endometrial resection/ablation (Wood and Maher 1997) and, therefore, careful ■ Knowledge about and
for dysfunctional uterine bleeding (Rymer et al attention needs to be paid to the woman’s psy- preparation for the
1997). Myomectomy is a more major operation chological care (Mazmanian 1999). Box 4 lists operation
and involves removal of fibroids, leaving the some factors that might determine the impact ■ Surgical approach and
whether or not ovaries are
uterus intact (Chamberlain 1995). For the of hysterectomy on the individual.
retained
woman with a uterine prolapse, a ring pessary As hysterectomy is such a common, routine
might be introduced vaginally to prevent operation, one might assume that caring for a
descent of the vaginal walls and uterus woman who undergoes such surgery would also
(Llewelyn-Jones 1994). be routine. However, this is often not the case,
due to the sensitive nature of the surgery and
TIME OUT 5 the many misconceptions about hysterectomy
Before reading the rest (Llewelyn-Jones 1994). Each woman’s experience
of the article, think about will be unique, from how long it takes to recover,
how a woman might feel to the impact it has on her life.
about having a hysterectomy. All major surgery has implications for altered
body image and hysterectomy is no exception.
Removal of the uterus can alter a woman’s self-
Psychological and emotional aspects of care image and perceived femininity. Hysterectomy
has been described as a: ‘...surgical disruption to
A woman undergoing hysterectomy is likely to the concept of femininity’ (Wilson-Barnett and
be exposed to the same anxiety as any other Fordham 1982) and can, therefore, cause psy-
surgical patient. A lot of clinical areas now pro- chological distress (Andrews 1997). A woman
vide a pre-admission service for patients, which might fear the removal of her uterus and might
is likely to help minimise the anxieties associated have difficulty in coming to terms with the loss
with admission to hospital for surgery. The pre- of this important body part (Morse and Johnson
admission appointment offers an ideal opportunity 1991). The uterus is a symbol of reproduction
to explore issues of concern, as well as to give and without it, and the associated menstruation,
practical advice and specific information and to a woman might feel she is no longer a sexual
dispel myths and misconceptions associated being and that she has lost something that
with hysterectomy. makes her female (Scambler and Scambler 1993).
Patients need to have information about the Certain cultural beliefs are likely to have an
operation, including the anaesthetic, pre- and impact on a woman having a hysterectomy.
post-operative care, the expected benefits and Some West Indians view menstruation as a
risks of the procedure and possible alternative cleansing act, ridding the body of impurities, and
treatments (Wood and Maher 1997). These are following hysterectomy, a woman might be seen

Downloaded from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. No other uses without permission.
Copyright © 2015 RCNi Ltd. All rights reserved.
C O N T I N U I N G P R O F E S S I O N A L D E V E LO P M E N T

Women’s health

Box 5. Menopausal symptoms as less of a woman in the eyes of a man. two. A drain might be inserted around the wound
Hysterectomy can be devastating for Muslim site at the time of the operation, but this is usual-
■ Hot flushes and night women, as their cultural role is dependent on ly removed two to three days after surgery. With
sweats fertility (Andrews 1997). In Western societies, vaginal surgery, sutures are usually dissolvable and
■ Insomnia where youth and beauty are highly valued, sometimes a vaginal pack is in place for a couple of
■ Formication (sensation of reaching the menopause is generally seen as a days. Following hysterectomy, the patient might
ants crawling over the skin) sign of ageing and decline and women having a experience some vaginal bleeding and/or discharge
■ Mood swings, anxiety and hysterectomy might feel this is happening to while sutures dissolve and tissues heal. The patient
irritability them (Hunter 1994). Social expectations can be is mobilised as soon as possible, which is likely to
■ Poor concentration and
great and a young woman could be afraid that be the first or second day post-operatively. Deep
memory
she will be unable to fulfil adult roles, such as breathing and leg exercises are encouraged as
■ Loss of libido, dyspareunia,
sexual dysfunction that of a mother, even if she never wanted to soon as the patient awakes from the anaesthetic.
■ Vaginal atrophy, recurrent have children (Corney et al 1992, Hawkridge Most hysterectomy patients recover physically
vaginitis 1989). She might also fear social isolation or relatively quickly after surgery and are likely to
■ Bladder symptoms feel that she is different and no longer a ‘real’ be discharged home by around five days post-
■ Aches and pains woman (Webb 1985). operatively.
■ Long-term osteoporosis There are numerous myths and misconceptions
■ Cardiovascular disease surrounding hysterectomy, such as masculinisation TIME OUT 6
■ Possibly Alzheimer’s disease and the end of sexual life, which can cause Devise a care plan for a
groundless fears for the patient. She might be 36-year-old divorced woman
afraid of gaining weight and of being unattractive with two young children, who
to, or even rejected by, her partner, and feel that is admitted for abdominal
she will be altered sexually (Andrews 1997). In hysterectomy and bilateral
salpingo-oophorectomy for fibroids and
fact, there is evidence to show that sexual activity
recurrent ovarian cysts.
improves in some cases as the devastating
effects of menorrhagia and dysmenorrhoea are
removed (Webb 1983). Whatever the woman’s Recovery following discharge home
age or circumstances, removal of the uterus can
be traumatic and its significance needs to be Activity and rest Healing rates vary from a few
understood by those around her. She should be weeks up to a year, with the average about 10-12
offered appropriate emotional support, discussion weeks (Clark 1993). It is important to stress this to
REFERENCES
Abernethy K (1997) The menopause and and counselling (Corney et al 1992). patients as they might feel pressurised if they
hormone replacement therapy. cannot keep up with a recovery rate that they feel
Nursing Standard. 11, 31, 49-53.
Post-operative care is expected of them. Generally, progress is in
Andrews G (1997) Women’s Sexual
Health. London, Baillière Tindall. stages and patients can aim to do a little bit
Bailey R, Clarke M (1989) Stress and Hysterectomy is a major surgical procedure and, more each week, but should be advised against
Coping in Nursing. London, Chapman
therefore, these patients will require similar nursing driving themselves to the point of exhaustion
and Hall.
Barclay C (1998) Obstetrics and care to any patients having major surgery. Strong (Coltart and Smart 1992). For the first couple of
Gynaecology in General Practice. pain relief is usually required for the first 24 weeks, the patient is likely to be tired and have
Wiltshire, Quay Books.
hours or so, and can be in the form of a patient- little energy, and might have days when she
Brown K (2000) Management Guidelines
for Women’s Health Nurse controlled analgesia (PCA) or epidural, or might be feels low in spirits and tearful, often for no
Practitioners. Philadelphia PA, FA administered intramuscularly or per rectum. PCA obvious reason. She should be encouraged to
Davis.
is an intravenous infusion of a strong analgesic, pay attention to her body and to rest when she
Chamberlain GVP (1995) Gynaecology by
Ten Teachers. 16th edition. London, such as morphine, which the patient can admin- needs to, but to gently mobilise and exercise
Edward Arnold. ister herself by pressing a button attached to the regularly, as recommended by a physiotherapist
Clark J (1993) Hysterectomy and the
infusion. Patients undergoing vaginal surgery tend (Haslett and Jennings 1998). Once she has
Alternatives. London, Virago Press.
Coltart T, Smart F (1992) The Woman’s not to require as much pain relief as those having regained some energy, she can gradually
Guide to Surgery. London, Thorsons. abdominal surgery. Intravenous fluids are often increase her activity level, but should avoid
Corney R et al (1992) The care of
necessary for approximately 24 hours, until the lifting or causing any strain on the abdominal
patients undergoing surgery for
gynaecological cancer: the need for patient can tolerate a good fluid intake. These and pelvic floor muscles. By about six weeks
information, emotional support and patients are usually able to recommence light diet post-operatively, she can reintroduce activities
counselling. Journal of Advanced
and fluids within a couple of days of surgery. such as driving, swimming and housework.
Nursing. 17, 6, 667-671.
Fisher P, Glenn K (2000) Uterine prolapse. One common complaint following hysterectomy is Sporting activities of a more vigorous nature
Practice Nurse. 11, 3, 27-30. of flatulence, which can be extremely uncomfort- should be discouraged for two to three months.
Haslett S, Jennings M (1998)
able, and constipation is also common. Some Tenderness and discomfort It is usual for a
Hysterectomy and Vaginal Repair.
Fourth edition. Beaconsfield, patients require catheterisation immediately post- woman to continue to experience slight discomfort
Beaconsfield Publishers. operatively, but this is usually only for a day or and tenderness and sometimes bruising, internally

Downloaded from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. No other uses without permission.
Copyright © 2015 RCNi Ltd. All rights reserved.
 C O N T I N U I N G P R O F E S S I O N A L D E V E LO P M E N T

Women’s health
Hawkridge C (1989) Understanding
and abdominally or vaginally, even when she goes produced by the ovaries, causes a range of Endometriosis. London, MacDonald
home from hospital. This might continue for a menopausal symptoms (Holmes 1996) (Box 5). and Co.
number of weeks, for which she can be advised The long-term effects of oestrogen deficiency Hillard A (1998) Managing the
menopause: health and the
to take analgesia, if required. If there is an take time to appear, but they have the potential menopause. Nursing Standard. 12,
abdominal wound, she might experience to cause a great impact on a woman’s health 27, 49-54.
numbness around the wound, which can take (Abernethy 1997). Holmes S (1996) Hormone replacement
therapy and its role in the
weeks or months to resolve. The two main indications for the use of HRT menopause. Nursing Times. 92, 28,
General health education If the patient has following oophorectomy are to relieve meno- 34-36.
stopped smoking since admission to hospital, pausal symptoms and to provide long-term Hufnagel V (1990) No More
Hysterectomies. Wellingborough,
she should be encouraged to maintain this by protection of the skeletal and cardiovascular Thorsons.
emphasis on the long-term health benefits. A systems. Progesterone preparations are usually Hunter M (1994) Counselling in
healthy, well-balanced diet and plenty of fluids not required for hysterectomy patients. Oestrogen Obstetrics and Gynaecology. Leicester,
BPS Books.
should be maintained and the patient should be replacement is given on a continuous basis via Llewelyn-Jones D (1994) Fundamentals of
warned of the risks of developing constipation various routes (oral, transdermal, subcutaneous Obstetrics and Gynaecology. London,
and putting on weight, especially while she is and vaginal), with a variety of doses available. Mosby.
Mazmanian CM (1999) Hysterectomy:
less active than usual. It might be advisable for The ovary also produces small amounts of holistic care is key. Registered Nurse.
the patient to adapt her diet accordingly. testosterone (an androgen), thus oophorectomy 62, 6, 32-35.
Vaginal bleeding/discharge A small amount of removes this source. This might result in loss of McPherson A, Waller D (1997) Women’s
Health. Fourth edition. Oxford, Oxford
bleeding and discharge is common following libido and energy levels; testosterone implants University Press.
hysterectomy and might continue for up to six can help restore this deficiency (Hillard 1998). Mittal S (1997) Women and their Health.
weeks. The patient is advised to use sanitary Esher, Clarewood Publishers.
Morse J, Johnson J (1991) The Illness
pads rather than tampons, to reduce the risk of Alternatives to HRT Experience. Newbury Park CA, Sage.
infection, and should avoid the use of vaginal Olive DL, Schwartz LB (1993)
douches, feminine deodorants, talcs and so on. ■ Phyto-oestrogens, which are oestrogen ana- Endometriosis. New England Journal
of Medicine. 328, 24, 1759-1769.
Sexual activity Most women are able to resume logues found in food products such as yams Purdie DW (1997) Selective oestrogen
sexual activity at around six weeks after and soya. receptor modulation: HRT
hysterectomy, which is about the time they are ■ Selective oestrogen receptor modulators, a replacement therapy? British Journal
of Obstetrics and Gynaecology. 104,
likely to have a post-operative follow-up new group of drugs, which appear to be of 10, 1103-1105.
appointment. The vault of the vagina might take benefit in reducing the risk of osteoporosis Raju KS, Auld BJ (1994) A randomised
this length of time to heal and, therefore, sexual and cardiovascular disease (Purdie 1997). prospective study of laparoscopic
vaginal hysterectomy versus
activity is best avoided until then. Patients and Alternative therapies to HRT also include home- abdominal hysterectomy each with
their partners are likely to be anxious about this opathy, herbal therapies, reflexology, acupuncture BSO. British Journal of Obstetrics
subject and might appreciate advice and and relaxation therapy. and Gynaecology. 101, 12,
1068-1071.
reassurance. Patients should be reassured that Rhodes P (1996) Gynaecology for
the operation should not interfere with sexual Conclusion Everywoman. Cheshire, Haigh and
responses and that there is no reason why they Hochland.
Rymer J et al (1997) Gynaecology.
should not resume usual sexual activities once This article has provided an overview of hyster- Edinburgh, Churchill Livingstone.
they feel ready to do so. It might be advisable to ectomy and outlined the care of a patient being Scambler A, Scambler G (1993)
take things gently at first and the use of a admitted to hospital for this major operative Menstrual Disorders. London and New
York, Routledge.
vaginal lubricant might help if they feel tense procedure, with an emphasis on the psycholog- Scriven A (1994) Information needs of
and apprehensive. ical and emotional aspects involved. Although hysterectomy patients. Nursing
Return to work Most employers will grant up this is a routine, relatively straightforward oper- Standard. 9, 7, 36-37.
Scriven A, Tucker C (1997) The quality
to three months’ sick leave after hysterectomy. ation, it brings with it a plethora of sensitive and and management of written
However, the amount of time required will emotive issues that need to be addressed information presented to women
depend on the individual. Women whose jobs through effective and empathetic nursing care, undergoing hysterectomy. Journal of
Clinical Nursing. 6, 2, 107-113.
require lifting, high levels of physical activity or beyond meeting physical care needs, if patients Storey M (2000) Chlamydia: the stealth
are particularly stressful might require the full are to make a successful recovery following STI. Nurse to Nurse. 1, 5, 18-19.
three months. hysterectomy Webb C (1985) Sexuality, Nursing
and Health. Chichester, J Wiley and
Sons.
Webb C (1983) Hysterectomy: dispelling
Menopause and HRT TIME OUT 7 the myths. Nursing Times. 79, 30,
52-54.
Women who have their ovaries removed at the Now that you have completed
Wilson-Barnett J, Fordham M (1982)
time of hysterectomy are likely to experience a the article, you might like to Recovery from Illness. Chichester,
premature menopause, the consequences of think about writing a practice J Wiley and Sons.
profile. Guidelines to help you Wood C, Maher PJ (Eds) (1997) Clinical
which might be greater than following a ‘normal’ Obstetrics and Gynaecology:
write and submit a profile are
menopause (Abernethy 1997). The reduced Hysterectomy. London, Baillière
outlined on page 55. Tindall.
availability of the hormone oestrogen, which is

Downloaded from RCNi.com by ${individualUser.displayName} on Nov 24, 2015. For personal use only. No other uses without permission.
Copyright © 2015 RCNi Ltd. All rights reserved.