Vaginal hysterectomy

Summary

A vaginal hysterectomy removes the womb through the vagina, with no cuts on the abdomen at all. It is most often chosen when the womb has descended (prolapse), and it is usually combined with repair of the weakened pelvic floor supports in the same operation.

• There is no abdominal wound, so there is no abdominal scar and less wound pain than after any other route.
• It is normally done under spinal anaesthesia; a general anaesthetic is used only if a spinal is not possible or unsuitable.
• The operation usually takes about an hour, longer when a pelvic floor repair is done with it.
• The ovaries are usually left in place unless there is a reason to remove them; periods stop permanently and pregnancy is no longer possible.
• Recovery is quicker than after open surgery, but the internal healing still needs care — heavy lifting and straining are avoided for 4 to 6 weeks.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

In a vaginal hysterectomy the surgeon works entirely through the vagina. The cervix and womb are freed from their supporting ligaments and blood vessels, removed through the vagina, and the top of the vagina (the vault) is closed with dissolvable stitches. The same ligaments are then used to support the vaginal vault, so it stays in position afterwards.

Because the pelvic floor is already being worked on, this operation is often combined with:

• Anterior repair — tightening the support between the vagina and the bladder, where the bladder has bulged forwards
• Posterior repair — the same at the back, where the bowel has bulged into the vagina
• Vault support — extra stitches to hold the top of the vagina up, reducing the chance of it descending in later years. Where it is indicated, this is done as a sacrospinous fixation: the vault is anchored to a strong ligament deep in the pelvis (the sacrospinous ligament)

Which of these you need is decided from your examination, and is discussed before surgery.

There are three routes for removing the womb — vaginal, laparoscopic (keyhole) and open. Where several are possible, published guidance places the vaginal route first, because it avoids the abdomen entirely; the keyhole route comes next. See our laparoscopic hysterectomy guide for that comparison.

Why it is performed

A vaginal hysterectomy is considered when the womb needs to be removed and the vaginal route is suitable — which depends on the size and mobility of the womb, the roominess of the vagina, and your previous surgery. As a guide, a womb enlarged beyond about the size of a 14-week pregnancy is better removed by keyhole surgery instead — either laparoscopically assisted vaginal hysterectomy or total laparoscopic hysterectomy. Common reasons:

• Prolapse of the womb — the commonest reason: a feeling of something coming down, dragging or heaviness, sometimes with a lump that can be felt or seen
• Heavy or painful periods that have not responded to medicines, the hormonal coil or lesser procedures
• Fibroids, where the womb is not enlarged beyond about the size of a 14-week pregnancy
• Persistent abnormal bleeding, or pre-cancerous changes in the lining of the womb

The operation ends periods permanently and pregnancy is no longer possible afterwards — so it is offered only where your family is complete.

Benefits

• No abdominal cuts. Nothing is cut on the abdominal wall, so there is no abdominal scar, less wound pain, and no risk of a wound hernia later.
• Prolapse symptoms are corrected at the same time. The dragging, heaviness or lump settles once the womb is removed and the supports are repaired.
• No general anaesthetic needed. A spinal anaesthetic is normally enough, which matters when general anaesthesia carries extra risk.
• Heavy bleeding is cured — periods stop permanently.
• Compared with open surgery: less pain, a shorter stay and a faster return to normal life.

Alternatives

• No treatment now. Mild prolapse that does not trouble you needs no operation.
• Pelvic floor physiotherapy — supervised pelvic floor muscle training helps mild to moderate prolapse and its symptoms.
• A vaginal pessary (ring) — a support device placed in the vagina to hold the prolapse up; changed periodically in clinic. A good option when surgery is best avoided or not wanted.
• Prolapse repair keeping the womb — the supports can be repaired and the womb lifted and kept (hysteropexy), which some women prefer.
• For bleeding rather than prolapse — the hormonal coil (LNG-IUS), medicines, endometrial ablation, or removal of fibroids or polyps.
• Another route for hysterectomy — laparoscopic or open surgery, when the vaginal route is not suitable.

Preparing for surgery

Before the operation you will have a pre-operative assessment: blood tests, blood pressure, and a review of your medicines and general health. A vaginal examination decides the route and which repairs are needed. Tell the team about all medicines you take — blood thinners may need adjusting — and any previous surgery or anaesthetic problems.

• Cervical screening and any bleeding investigation should be up to date and complete before surgery.
• Smoking: stopping even a few weeks before surgery reduces chest and healing complications. Treating a chronic cough or constipation before surgery also protects the repair.
• Fasting: exact instructions are given; typically no food from 6 hours before, water up to 2 hours before.
• At home: arrange help for the first two weeks, and plan for no heavy lifting — that includes carrying water, wet washing and grandchildren.

The day of surgery

You are usually admitted on the day of surgery. The team confirms your identity and the planned operation, and you meet the anaesthetist and the surgeon. This is the time for last questions — nothing is too small to ask.

You will be asked to sign the consent form, which records the operation, its intended benefits and its risks as they apply to you — including which repairs are planned, whether the ovaries are to be left or removed, and what should happen if unexpected findings are encountered. You can still change your mind at this point. Compression stockings are usually fitted to reduce the risk of blood clots.

During the operation

The operation is normally done under spinal anaesthetic — an injection near the spine numbs you from the waist down, and a general anaesthetic is used only if a spinal is not possible or unsuitable. Either way you feel nothing. You are positioned with the legs supported, and the bladder is emptied.

Working through the vagina, the surgeon makes a circular incision around the cervix, separates the bladder in front and the bowel behind, and divides and secures the supporting ligaments and blood vessels in turn. The womb and cervix are then delivered through the vagina. The ligaments are attached to the top of the vagina to support it, and the vault is closed with dissolvable stitches. Any anterior or posterior repair is done at the same sitting. A urinary catheter is left in place; a vaginal pack is not used.

The operation usually takes about an hour, longer when repairs are added. Very rarely, if the womb proves too fixed to remove safely through the vagina, the operation is completed through the abdomen for your safety; because the route is chosen carefully beforehand, this almost never happens in practice.

After the operation

You will wake in the recovery room. There is no abdominal wound, so most discomfort is a deep pelvic ache rather than wound pain.

• Pain relief: regular simple painkillers control most discomfort; stronger medication is available if needed.
• The catheter: no vaginal pack is used. The catheter is removed once you are moving about — usually within 12 hours, as after a caesarean. Occasionally the bladder is slow to start working again and it stays a little longer; this settles.
• Eating and drinking: usually the same day, starting with fluids.
• Moving: up and walking the same day or the next morning — early walking speeds recovery and protects against clots.
• Bleeding: light vaginal bleeding and a brownish discharge for a few weeks is normal as the internal stitches dissolve.
• Going home: usually the day after surgery, sometimes the second day when repairs have been done.

Recovery at home

• Week 1: rest with gentle activity — short walks indoors and light household tasks. Tiredness is normal.
• Weeks 2 onwards: build up steadily; most women manage their normal day-to-day routine.
• Heavy lifting and straining: avoided for 4 to 6 weeks, so the repair and the vaginal vault heal soundly. Treat constipation early — straining works against the repair.
• Driving: once you can brake hard without hesitation — commonly around 2 weeks.
• Sex: after about 6 weeks, once bleeding and discharge have stopped and the vault has healed.
• Bathing: showers as normal; avoid swimming and immersing baths until the discharge has stopped.
• Periods and fertility: periods stop permanently and pregnancy is not possible. If the ovaries were left, they keep working, so surgical menopause does not follow. Cervical screening is no longer needed once the cervix has been removed — confirm this at your follow-up.
• Pelvic floor exercises: usually recommended once healing allows, to protect the repair long term.

This guidance covers what is usual; the advice given to you personally takes precedence.

Risks and complications

Every operation carries risk. The figures below are averages from published UK guidance (RCOG); your individual risk depends on your age, weight, other health problems, previous surgery and the repairs performed, and will be discussed with you.

Expected, temporary effects

• A deep pelvic ache and tiredness in the first days
• Light vaginal bleeding and brownish discharge for some weeks as stitches dissolve
• Some difficulty starting to pass urine after the catheter is removed

Complications

• Bleeding heavy enough to need a blood transfusion (uncommon), or a collection of blood at the vault requiring drainage (uncommon).
• Infection — of the urine, chest or the vaginal vault; antibiotics are given during surgery to reduce this, and most cases are minor (common but usually minor).
• Injury to the bladder, bowel or ureters — recognised injuries are repaired (rare).
• Blood clots in the leg or lung (VTE) — preventive measures are routine (uncommon).
• Difficulty passing urine needing the catheter to stay longer, or a urinary infection afterwards (uncommon).
• Vault granulation or a stitch problem causing persistent discharge or spotting — treated simply in clinic (uncommon).
• Conversion to abdominal surgery during the operation, for safety (very rare).
• Prolapse of the vaginal vault in later years — the supports can weaken again; further treatment is occasionally needed (uncommon).
• Changes in bladder, bowel or sexual function — most women notice improvement, but symptoms can occasionally persist or be new; this is part of the discussion before surgery.
• Anaesthetic risks — serious anaesthetic complications are rare.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Heavy vaginal bleeding — bright red, or soaking a pad in an hour
• Foul-smelling vaginal discharge
• Fever (38 °C or higher) or feeling increasingly unwell
• Worsening pelvic or abdominal pain not controlled by your painkillers
• Burning on passing urine, or being unable to pass urine
• A painful, swollen or red leg

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing to surgery you should feel you understand why this route is recommended for you, which repairs are planned, and which risks matter most in your case. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. Royal College of Obstetricians and Gynaecologists. Vaginal hysterectomy, with or without repair — consent advice. London: RCOG. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/consent-advice/ [last checked 28 July 2026].
2. National Institute for Health and Care Excellence. Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline NG123. Available from: https://www.nice.org.uk/guidance/ng123 [last checked 28 July 2026].
3. National Institute for Health and Care Excellence. Heavy menstrual bleeding: assessment and management. NICE guideline NG88. Available from: https://www.nice.org.uk/guidance/ng88 [last checked 28 July 2026].
4. National Health Service (UK). Hysterectomy. Available from: https://www.nhs.uk/conditions/hysterectomy/ [last checked 28 July 2026].

Patient information from our own clinics

We do not yet have a Sugabi or vog.lk article on vaginal hysterectomy. Related reading:

1. Sugabi Clinic Ragama. Laparoscopic hysterectomy — the keyhole route. https://sugabi.lk/surgery-guide/laparoscopic-hysterectomy/