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Hysterectomy during POP repair or not?
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Hysterectomy during POP repair or not?

I was diagnosed with stage 3 POP last week, and have lived for at least several years with many of the symptoms without realizing how bad the prolapses have gotten, or that I really had prolapse yet.  So I'm kind of reeling from the diagnosis.  While my urogyn did not push surgery, I did schedule it for the end of May because my urinary incontinence is so bad and my sex life has been negatively affected as well.  I am also having pelvic pain several times a month now.  I am still having periods, even though I turned 50 last November.  

The surgeon recommended a hysterectomy when she did the other repairs.  How advisable is this?  What are the pros and cons?
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The type of POP surgery you have will depend on the exact type(s) of POP you have, there are many different procedures utilized for these kinds of repair. A urogyn will try to save the uterus if possible but often women have more than one kind of POP and it could be you have uterine prolapse. When procedures are done properly there is no problem with having a hysterectomy, the complications occur when a woman has a hysterectomy and organs/tissues are not properly anchored and women end up with vaginal vault prolapse. I encourage you to discuss the pros/cons of hysterectomy with your physician as well as ask the exact reason why he/she wants to include this as part of your surgery. In general as long as the ovaries are left intact, removal of the uterus if it is prolapsed should eliminate discomfort you've been experiencing. Without knowing what kinds of POP you have it is difficult to address the pros/cons. Ask your physician exactly what kind of prolapse is being repaired and what type of procedure being used so you can research it and know the right questions to ask. Once you know what is being repaired, send another post in and we can dig into it deeper.

I wouldn't worry about the hysterectomy being included if you are comfortable with the idea (often women are not, some feel a loss of sexual identity), do confirm however that your ovaries will remain intact-if not you'll want to know about impact to hormone fluctuation and how it will be addressed.

Good luck with your surgery, I'm glad you are being treated by a urogyn for your POP-this is the best path.

Sher
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Thanks for the prompt reply.  I have uterine prolapse as well as a cystocele and rectocele.  When I asked about the reasons for recommending the hysterectomy, she said that it would make the repairs easier.  I did ask\ about the ovaries and they would remain intact, which I do wish to keep.  

I know there is a lot of controversy (and unknowns) about whether or not the uterus is involved in sexual functioning (physically, not psychologically), so that is why I was questioning it.  The doc just mentioned that then I wouldn't be "bothered" anymore with periods.  While that's fine (at 50 I'm ready to not have to deal with that), my sexual functioning has already been compromised enough by the POP that I don't want any additional loss.

Also, does adding a hysterectomy to all the other procedures being done in the repair increase the recovery time?  And does it affect the length of time the repair might last?

Jill
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Sinde you have uterine prolapse, it makes perfect sense to to a hysterectomy at the same time as doing the cystocele and rectocele. You truly don't need to have any of the POP issues surgically repaired but it is likely that the degree of POP will progress with any of them not addressed and although there are treatments available for POP, when you have more than one type and it is progressive (grades 3 and 4), your discomfort, pain, and ability to have intimate relations will all continue to degrade. I had POP surgery for cystocele, rectocele, and enterocele (had a hysterectomy 14 years prior to my POP dx; having the enterocele makes my path a bit different from yours so check with your dr for specifics in  your case) and I'm truly happy about the outcome of my procedure-often women have one type addressed and end up having repeat surgery down the road, a path you don't want to go down. Women are often happy to have get away from periods, but the bigger pic is they are happy to regain a level of intimacy with their partners again. I never felt a loss of intimate sensation from my hysterectomy at 40 but there will be a heal curve with sensation after having POP surgery. Typically there are nerves cut through and nerves take a while to heal. I was able to regain my ability to orgasm but it does take longer to get there-however the intensity of sensation is great. My base heal curve was 12 weeks (check with your dr on this, it will depend on what procedures he is using (at 2 weeks I was pretty much up and about as normal, by 6 weeks you will probably be back to normal work pattern), but would say it was close to a year b/4 I felt all was back to normal sensation wise. Resumed sexual relations at 3 months.

I don't think adding the hysterectomy will add to the recovery time; I've got to say if I had to do it over I would opt for the same path I took-all at once. Yes the heal curve takes a bit of time but it is a one time operation, in my eyes worth it.

Having all done at once should not impact time repair lasts, since this is being done by urogyn all 3 repairs should "stick". Most procedures that need redos are done by physicians who are not urogyns-it truly takes a specialist to get POP procedures right. Does not mean the other drs are not good drs, it's just that the pelvic cavity is an intricate place, lots of structural proponents that have to be tied up correctly-truly takes a specialist. We don't have a primary care dr do our heart surgery, POP should not be any different.

Good luck with your surgery!
Sher
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Thanks for all the info!  I talked to my family doc yesterday and she reassured me that this is the best path as well.  She also seemed to think that I should be able to handle a light work schedule after two weeks, especially because I can sit (I'm a community college professor).

Another perk of having the surgery:  had to go to the doc yesterday for yet another UTI.  I never used to have these, but now they are an every-other-month nuisance.
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2 weeks seems a bit fast to me but since I don't know the specifics and each of us is different, it's good that at least she is giving you some guidelines. I'm glad you have a sitting job, that will make returning to work a bit easier. Food for thought, icing is SO BENEFICIAL post surgery to reduce swelling those first few days, pick up some premie diapers, rip open one end, fill them with ice and reseal-they fit perfectly in the crotch and across the abdomen and if you wear pants to work make sure to test it out at home b/4 you wear them to work.

It will be nice to not have to deal with the UTI stuff, that's for sure!
Good luck with procedure and please keep me in the loop with how things go!
Sher
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I highly recommend you read Sherrie's book  "Pelvic organ Prolapse The Silent Epidemic" and you will be so happy you did.  I had stage III POP and my surgery was in Jan 2011 this year.  I had cystocele, rectocele and a mid-urethral sling repair.  I'm recouping very well and the only side effects so far has been a bad itching episode early after the surgery and mild UTI.  My story is posted on this site under MCFOR  and has "MUST READ" in the title.  It's a synopsis of my journey to find answers and how I stumbled upon Sherrie on the internet and eventually purchased her book.  I call it the POP Bible.  It was/is a Godsend for me.  I'm responding because I'm concerned about the 2 weeks recovery period just like Sherrie.  My recovery period was 6-8 weeks. I was up and about in 2 weeks and able to drive by then, but the fatigue was difficult and I was not allowed to lift anything over 5lbs during that period. These are the must read chapters before surgery: Chapter 10 (What to ask your doctor prior to surgery); Chapter 11(What to expect with POP surgery); and Chapter 12 (WHAT TO HAVE ON HAND PRIOR TO SURGERY).  You won't regret the purchase.
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