HYSTERECTOMY
A hysterectomy is a type of surgery during which the uterus is removed [1]. Often, the cervix is removed as well [1]. You can also choose whether or not to have your fallopian tubes removed (salpingectomy) and one or both ovaries removed (oophorectomy).
You may want to look into fertility preservation options if you are planning on getting a hysterectomy, because if you have your uterus and/or ovaries removed, you will have limited or no options for using your own body/reproductive material to create a child.
Image from: https://my.clevelandclinic.org/health/treatments/4852-hysterectomy
There are a few different ways a hysterectomy can be done:
Vaginal hysterectomy: The uterus is removed through the vaginal canal. There are no external incisions.
Laparoscopic hysterectomy: A camera and surgical tools are inserted through small incisions in the lower abdomen. An incision is made inside the vaginal canal to remove the organs.
Abdominal hysterectomy: One long incision is made through the lower abdomen to remove the organs. This procedure is less commonly done for gender-affirming hysterectomies, since it is the most invasive with the longest healing time.
You can talk to your surgeon about which technique is best for you.
If you’re planning on getting a vaginectomy, your surgeon will likely require you to get a hysterectomy. Some surgeons will do a vaginectomy at the same time as genital surgeries [2]. Others will ask you to get a hysterectomy beforehand, usually at least 3 months before you have another surgery. The reason a hysterectomy is required if you are getting a vaginectomy is that the uterus is no longer accessible via the vaginal canal, so if menstruation occurs, the menstrual blood has no way to exit the body.
If you do not wish to get a vaginectomy, you can still get a hysterectomy if you would like to.
POST-HYSTERECTOMY/OOPHORECTOMY CONSIDERATIONS
Once your uterus is removed, you will no longer have the ability to become pregnant.
If you have your ovaries removed, your body will no longer be able to create an adequate amount of sex hormones on its own, as ovaries produce most of the body’s estrogen [3]. This means that you will have to take some kind of exogenous hormone (either testosterone or estrogen) for the rest of your life in order to mitigate the negative effects caused by lack of adequate sex hormones in your body. These side effects can include [3,4]:
Weak bones/osteoporosis
Depression, anxiety, and other mental health concerns
Genitourinary atrophy
Hot flashes
Low libido/sex drive
Note about preventative care post-hysterectomy: Pap smears are no longer necessary after your cervix is removed. You will want to double-check this information with your surgeon, as this vary on a case-by-case basis, but generally speaking - if you do not have a cervix, you do not need to get a pap smear.