Masculinisation: Hysterectomy
Possible operations
Uterus (womb) removal in combination with other operations
Uterus (womb) removal is closely linked to other gender-affirming surgeries. The medical term for uterus removal is hysterectomy. Your gynaecologist at Gender Clinic can tell you more about the order of operations and how they can be combined.
Option 1: hysterectomy (uterus removal)
A hysterectomy simultaneously removes the Fallopian tubes. The Fallopian tubes are attached to the uterus (womb) and no longer serve a purpose once the uterus is removed. Removing the Fallopian tubes also reduces your risk of developing ovarian cancer. To be clear: your Fallopian tubes will be removed, but you can choose to leave your ovaries intact. Removing your Fallopian tubes does not affect your fertility.
Option 2: hysterectomy in combination with oophorectomy (removal of ovaries)
You can choose to have your ovaries removed at the same time as your uterus (womb). As this option means you will be infertile post-operation, you should carefully consider whether you want to have biological children in the future. This combined operation uses the same surgical technique as a conventional hysterectomy. The length of the operation, risks and recovery time are also the same.
Option 3: hysterectomy in combination with mastectomy (removal of breast tissue)
You can choose to have your breasts (subcutaneous mastectomy) removed along with your uterus (and, if desired, your ovaries). This is a joint operation carried out by the plastic surgeon and the gynaecologist. The advantage of this option is that you only need to be anaesthetised once and only have one recovery period. The recovery period for the single and combined operation is the same.
However, the waiting time for a combined breast and uterus (and, if desired, ovary) removal may be longer than the waiting time for each procedure separately.
Option 4: hysterectomy in combination with colpectomy (removal of vagina)
Gender Clinic does not perform this operation. You can choose to have your vagina removed (colpectomy) along with your uterus (womb). Your vagina is removed if you intend to have phalloplasty (penis reconstruction) in the future. This combination may use a robot-assisted laparoscopy to remove your vagina and uterus (womb). If you wish to have this surgery, you will be referred to our partners at Amsterdam UMC’s Gender Team (location VUmc). You can also choose to have your ovaries removed during this robot-assisted operation. However, you cannot have your vagina, uterus (womb) and breasts removed in one operation, as the procedure would take too long.
Pre-operation
Preliminary consultation with the gynaecologist at Gender Clinic
You will discuss which operation is right for you and how it may affect your fertility in the future. The gynaecologist will explain the laparoscopy (keyhole surgery) in detail, possible complications, and what usually happens after the operation. It is important to be aware that this operation will damage your hymen (if it is intact before the operation).
You will also have a pelvic ultrasound to measure the size of your uterus (womb) and assess whether it can be removed through your vagina during the laparoscopy.
Screening by the anaesthetist
After your preliminary consultation with the gynaecologist, you will have a telephone health screening with the anaesthetist. The anaesthetist will decide whether you can have an operation at Gender Clinic. Prior to the screening, you must complete a health questionnaire, request an up-to-date medicine list from your pharmacist, and take a blood test to measure the Hb (haemoglobin) value in your blood. Please read the Anaesthesia Information Folder in preparation for your health screening.
Hysterectomy reimbursement
At the time of publication, health insurers in the Netherlands provide reimbursement for hysterectomies. Please be aware that this may change, as health insurers are entitled to amend their terms and conditions. When in doubt, please contact your health insurer.
Operation location
The operations (options 1, 2 and 3) take place at Gender Clinic’s clinic in Bosch en Duin. However, you may be operated at Amsterdam UMC’s VUmc location if there are medical or psychological grounds to do so. This may be because you have a heightened risk of complications from anaesthesia, a BMI of 30 or above, or want to have a laparotomy (surgical incision) rather than a laparoscopy.
The operation
Your uterus (womb) can be removed in three ways:
- Laparoscopy (keyhole surgery)
- Robot-assisted laparoscopy
- Laparotomy (incision into your stomach)
Gender Clinic performs laparoscopies. You will find a more detailed explanation below. If you are having a robot-assisted laparoscopy or laparotomy and will be hospitalised for longer than one day, you will be referred to Amsterdam UMC, location VUmc.
Laparoscopy (keyhole surgery)
This surgical technique is used to remove your uterus (womb) only or both your uterus and ovaries. The gynaecologist will make three to four small incisions (cuts) in your abdominal wall (see figure 1). A tube is fed into your stomach through an incision below your belly button. Surgical instruments are inserted into the abdomen cavity through other incisions to detach your uterus (womb). If applicable, your ovaries will also be removed. Your uterus will be removed through an incision at the top of your vagina. The top of your vagina will then be sewn back up.
How long will I be hospitalised?
You will stay at Gender Clinic for two days. You will remain at the clinic on the day of the operation and be discharged around 7:30 AM the following morning.
What will happen on the day of the operation?
Please follow the rules on eating and drinking on the day of the operation. If you have eaten before the surgery, we will not be able to operate. You are expected to arrive at Gender Clinic on the day of the operation. Please arrive on time – if your operation is scheduled in the early morning, set off early to avoid the morning rush hour. The nurse will greet you at the clinic. The nurse, gynaecologist and anaesthetist will ask you some questions. You will receive information about your stay and operation. You will also have a blood test and be given an injection of Fraxiparine to prevent deep vein thrombosis (DVT). You must remove any jewellery, piercings or dentures or dental implants and take off your glasses. You will receive detailed information about eating and drinking before the operation. Please follow any instructions given.
Risks and possible complications
Our gynaecologist knows what steps need to be taken to minimise complications. However, we cannot fully exclude complications. The likelihood of complications arising depends on your health, the surgical technique used and the complexity of the operation. Most of these complications are mild, but some can be severe. The likelihood of complications from a laparoscopic hysterectomy is small.
Post-operation
Immediately after the operation
After the operation, you will be moved to the recovery room to come round from the anaesthetic. You may ask the gynaecologist to call your contact person to tell them how the operation went. Once you are awake, you will notice that you have a urinary catheter (a tube used to empty your bladder and collect urine). This will be removed later on the same day or the following morning. The gynaecologist will visit you to tell you how the operation went. You may go home the morning after the operation around 7:30 AM.
You may experience pain after the operation, but rest assured that you will be given painkillers.
Follow-up appointments
We will schedule a follow-up appointment six weeks after the operation. This is usually a telephone consultation, so you won’t have to travel to the clinic. However, you may need to visit the clinic if you are suffering from complaints. If so, please call the outpatient clinic to arrange a consultation.
Lifestyle advice and rules post-operation
- Swimming, baths, sauna: Do not use baths or saunas or swim in the first six weeks post-operation. Showering is allowed.
- Exercise and sport: To help the wound heal, we advise you to avoid high-intensity sport or physical exertion (lifting over 10 kilograms) for the first six weeks after the operation. You can progressively increase your regular exercise depending on how sore you feel and your energy levels. You may cycle, walk and go shopping.
- Stitches, plasters, bandages and gauzes: The surgeon will usually apply dissolvable stitches. As these stitches can take a while to fully dissolve, you may ask your GP to remove external stitches on your stomach a week after the operation if they are causing itchiness or irritation. You should apply a plaster or gauze until the wounds stop leaking. You can stop once the wounds are dry. You may see a stitch coming away from your vagina after a couple of weeks – this is normal and nothing to worry about.
- Urinary problems: Uterus (womb) removal can sometimes lead to problems urinating, such as incontinence (when urine leaks out). This is because your bladder becomes detached from the uterus during the operation. These problems almost always go away on their own.
- Sexual activity: We advise you to avoid sexual activity and tampon use for the first six weeks post-operation. This advice does not extend to sexual arousal or masturbation.
- Medication and painkillers: If we advised you to stop taking certain medicines before the operation, you may now resume taking them (unless instructed otherwise). You will be given paracetamol and diclofenac (if you do not have an allergy) as painkillers. You may be given additional medicine at Gender Clinic to protect your stomach.