Understanding the procedure

Surgery to remove a uterus is called a hysterectomy A gender-affirming lower surgery to remove all or part of the uterus and sometimes the ovaries and/or fallopian tubes. . It includes the removal of the uterus (usually including the cervix) and the fallopian tubes. Surgery to remove ovaries is called an oophorectomy A gender-affirming lower surgery to remove the ovaries. . You may have one or both of the ovaries removed.

People choose to have the surgery in order to reduce dysphoria, prevent monthly bleeding Menstrual bleeding or period. , eliminate the need for regular Pap tests (or HPV self- screening Process of checking for signs of a health issue or medical condition before symptoms appear. ) and allow you to lower your dose of testosterone. (A lower testosterone dose may reduce unwanted side effects and risks.) This surgery may also be a required step prior to some genital reconstruction surgeries. In B.C., this surgery is done by an obstetrician and gynecologist (OBGYN).

About the surgery

The steps involved in removing the uterus and ovaries include:

• Making 3–5 tiny incisions in a person’s abdomen
• Pumping a small amount of gas into the abdomen to inflate it
• Inserting a very small telescope into one of the incisions so the surgeon can see inside the abdomen
• Inserting long, narrow instruments through the incisions to detach the uterus including cervix, fallopian tubes and one or both ovaries.
• Removing the all the organs through the vagina An internal organ located between the legs. A person may be born with a vagina or have one surgically created. When referring to genitals, the Trans Care BC website uses "internal genitals (vagina)" for trans people assigned female at birth (AFAB), and "vagina" or "vagina with vaginoplasty" for trans people assigned male at birth (AMAB), but there are many different terms that individuals may use. (internal genitals)
• Closing the area at top of the vagina where the cervix was with stitches that will dissolve over time
• Releasing the gas from the abdomen

Risks & complications 

All medical interventions have potential risks and benefits. It’s important that you understand the risks of having surgery so you can decide whether the potential benefits outweigh the potential risk of surgical complications. This list is not intended to scare you or dissuade you from having surgery but rather to help you make an informed decision. 

General risks associated with surgery 

Anesthesia issues — Some people experience a negative reaction to anesthesia.

Cardiovascular issues — Such as blood loss, blood clots and artery blockages. 

Hematoma — This is when blood collects in the surgical site, causing pain, swelling and redness. Drains Thin tubes placed in the body during surgery to remove excess fluid or blood. and compression bandages are used to prevent hematomas. Smaller hematomas can be sucked out, but larger ones require removal through surgery. 

Seroma — This is when clear fluid accumulates in the surgical site. Your surgeon will manage this complication. The ways in which it might be managed include monitoring, clinical exam, ultrasound or possibly drainage.  

Infection — This is when microorganisms such as bacteria get inside the body. Infection can occur at different locations such as the surgical site or bladder and are generally treated with antibiotics. 

Abscess formation — This is a collection of pus caused by a bacterial infection. It can be treated with antibiotics or drained by the surgeon. 

Wound separation — This is when there is a partial or complete opening of incisions along the sutures Sterile medical threads, also called stitches, used to close surgical incisions. . 

Nerve damage and pain — There is a wide range of possible experiences related to how nerves heal after surgery. Some changes are short term and some are long term or permanent. Some changes are mild and inconvenient, while others are painful and distressing. Changes can include numbness, increased sensitivity, burning sensations and nerve displacement (sensation may feel like it’s occurring in one place but the stimulus is in another part of the body). Speak with your surgical team about any concerns you have about sensation or pain management. 

Scarring — Scarring can be reduced by following your surgeon’s advice, which may include activity restrictions, avoiding sun, seeing a physiotherapist or massage therapist and doing massage exercises (if recommended). Severe scarring may require medical or surgical intervention. 

Postoperative regret — Regret can happen for several reasons, such as experiencing significant complications or being dissatisfied with the outcome of surgery.  

Risks specific to uterus and ovary removal 

Accidental damage — This can include damage to surrounding tissues such as piercing the bowel, injury to bladder, rectum or other internal organs. It also can include accidental damage to blood vessels which may be needed for future phalloplasty A gender-affirming lower surgery to create a penis and scrotal sac (phase 1) followed by testicular implants and implants to obtain rigidity/erection (phases 2 and 3). .  

Urinary tract injury or infection 

Vaginal prolapse — This is when the vaginal vault (top of the vagina) sags and falls into the vaginal canal. 

Fistulas — This is an abnormal connection that develops between two structures, which allows fluids or solids to pass between them. This can include connections between: the bladder and vagina, the rectum and vagina or the anus and vagina. 

Changes in sexual sensation — This may include decreased intensity of orgasm.

Decreased libido 

Ovarian remnant syndrome — If some ovarian tissue is left behind, it can cause pain and bleeding. 

Vaginal cuff bleeding — The vaginal cuff is the closure made at the top of the vagina when you have a hysterectomy. Bleeding from this area can occur. 

Hot flashes, night sweats — These symptoms can occur if you have your ovaries removed and do not take hormones.  

Please note 

This list is not comprehensive and you should have a detailed discussion of risks with your surgeon.