Hysterectomy and adnexectomy are the surgical techniques to remove the womb and ovaries. The purpose is to prevent the female hormonal effects of the ovaries, as well as possible diseases occurring in the female internal genitals, whose risk seems to be increased by consuming male hormones. Furthermore, it forms the basis for subsequent gender reassignment surgery.
During their appointments, patients must explain honestly to their surgeon and/or gynaecologist what they expect of the procedure and to listen to their opinion and advice.
Patients are admitted on the day of their operation. The hysterectomy and adnexectomy are performed under general anaesthetic. The Gender Unit’s medical team will carry out the procedure choosing the most appropriate technique for each individual case. There are three main ways of tackling the operation:
Abdominal: involves making a small incision in the lower abdomen which will subsequently be hidden by the pubic hair. The womb and ovaries are then removed through this incision. This is the quickest method and the one with fewer possible complications.
Laparoscopy: this technique requires three separate incisions, through which a gas (carbon dioxide) is pumped to insufflate the abdomen.
There are many possible side effects of this technique, both due to the use of the gas and to the need to insert a number of sharp trocars into the abdomen. Theoretically, the technique allows for speedier recovery but, in the Gender Unit’s experience, there is little appreciable difference in recovery rate, especially when the procedure is combined with a bilateral subcutaneous mastectomy.
Via the vagina: This technique is very complex in transsexual patients and not normally used, since it can only be employed in those women whose vaginas have been dilated by childbirth, which allows greater options for the procedure.
Once the abdominal cavity has been accessed, the womb and ovaries are carefully removed.
When this procedure is carried out by an experienced surgeon, the area can be prepared for subsequent gender reassignment surgery. This will reduce subsequent complications and guarantee a more satisfactory result.
The day after the operation, patient can begin to eat, get up and walk (remaining in bed or lying down for many hours can delay recovery and even lead to complications). Discomfort in the area is commonplace, but can be well controlled by normal medication. Follow your doctor’s advice and recovery will be swifter and less troublesome.
For some months, the area around the scar will suffer from sensitivity issues that will reduce over time. The pubic hair will grow back quickly, covering the area of the incision and leaving the fine scar completely hidden.
As with any surgery, the wound may become infected or reopen, requiring treatment. Also, but exceptionally, blood vessels which coagulate during the procedure may accidently bleed, and so careful monitoring is required. A blood transfusion or even a second operation may be required. The operation and remaining in bed increases the risk of deep vein thrombosis and pulmonary embolism: to counter this, during and subsequent to the operation, prophylactic measures are taken.