Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Vaginal hysterectomy

Lori R Berkowitz, MD
Caroline E Foust-Wright, MD, MBA
Section Editor
Howard T Sharp, MD
Deputy Editor
Kristen Eckler, MD, FACOG


Hysterectomy (ie, surgical removal of the uterus) can be performed vaginally, laparoscopically, or abdominally. It is also possible for two surgical routes to be combined in one operation, such as a laparoscopically assisted vaginal hysterectomy or a laparoscopic hysterectomy with a minilaparotomy to remove the uterus. When selecting a route for hysterectomy, the surgeon balances the medical indication, patient profile, risks and benefits, safety, and cost-effectiveness of each surgical approach. As vaginal hysterectomy is among the safest and most cost-effective routes for hysterectomy, it is the first-line approach whenever possible.

This topic will review the preoperative considerations, procedure, nuances, and complications of vaginal hysterectomy. Review of related topics can be found separately:

(See "Choosing a route of hysterectomy for benign disease".)

(See "Abdominal hysterectomy".)

(See "Laparoscopic hysterectomy".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Sep 28, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Aarts JW, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2015; :CD003677.
  2. Committee on Gynecologic Practice. Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign Disease. Obstet Gynecol 2017; 129:e155.
  3. Zimmerman CW. Vaginal hysterectomy. In: TeLinde's Operative Gynecology, 11, Howard W. Jones III, John A. Rock (Eds), Wolters Kluwer, Philadephia 2015. p.715.
  4. Doucette RC, Sharp HT, Alder SC. Challenging generally accepted contraindications to vaginal hysterectomy. Am J Obstet Gynecol 2001; 184:1386.
  5. Schmitt JJ, Occhino JA, Weaver AL, et al. Outcomes of Vaginal Hysterectomy With and Without Perceived Contraindications to Vaginal Surgery. Female Pelvic Med Reconstr Surg 2017.
  6. Hesselman S, Högberg U, Jonsson M. Effect of remote cesarean delivery on complications during hysterectomy: a cohort study. Am J Obstet Gynecol 2017; 217:564.e1.
  7. Friedman AJ, Barbieri RL, Doubilet PM, et al. A randomized, double-blind trial of a gonadotropin releasing-hormone agonist (leuprolide) with or without medroxyprogesterone acetate in the treatment of leiomyomata uteri. Fertil Steril 1988; 49:404.
  8. Carr BR, Marshburn PB, Weatherall PT, et al. An evaluation of the effect of gonadotropin-releasing hormone analogs and medroxyprogesterone acetate on uterine leiomyomata volume by magnetic resonance imaging: a prospective, randomized, double blind, placebo-controlled, crossover trial. J Clin Endocrinol Metab 1993; 76:1217.
  9. Minaguchi H, Wong JM, Snabes MC. Clinical use of nafarelin in the treatment of leiomyomas. A review of the literature. J Reprod Med 2000; 45:481.
  10. Favero G, Miglino G, Köhler C, et al. Vaginal Morcellation Inside Protective Pouch: A Safe Strategy for Uterine Extration in Cases of Bulky Endometrial Cancers: Operative and Oncological Safety of the Method. J Minim Invasive Gynecol 2015; 22:938.
  11. Shiota M, Kotani Y, Umemoto M, et al. Indication for laparoscopically assisted vaginal hysterectomy. JSLS 2011; 15:343.
  12. Lash AF. A method for reducing the size of the uterus in vaginal hysterectomy. Am J Obstet Gynecol 1941; 42:452.
  13. Kovac SR. Intramyometrial coring as an adjunct to vaginal hysterectomy. Obstet Gynecol 1986; 67:131.
  14. Stone DE, Malik SA, Doerhman P, Videla FL. Döderlein-Krönig vaginal hysterectomy: an alternative to the traditional Heaney hysterectomy. Int Urogynecol J 2015; 26:769.
  15. Doderlein A, Kronig S. Die Technik Der Vaginalen Bauchhohlen-Operationen. Verlag Von S Hirzel, Leipzig, 1906.
  16. Ballard LA, Walters MD. Transvaginal mobilization and removal of ovaries and fallopian tubes after vaginal hysterectomy. Obstet Gynecol 1996; 87:35.
  17. Davies A, O'Connor H, Magos AL. A prospective study to evaluate oophorectomy at the time of vaginal hysterectomy. Br J Obstet Gynaecol 1996; 103:915.
  18. Sheth SS. The place of oophorectomy at vaginal hysterectomy. Br J Obstet Gynaecol 1991; 98:662.
  19. Robert M, Cenaiko D, Sepandj J, Iwanicki S. Success and Complications of Salpingectomy at the Time of Vaginal Hysterectomy. J Minim Invasive Gynecol 2015; 22:864.
  20. Antosh DD, High R, Brown HW, et al. Feasibility of prophylactic salpingectomy during vaginal hysterectomy. Am J Obstet Gynecol 2017; 217:605.e1.
  21. Afifi R, Sayed AT. Posthysterectomy vaginal vault prolapse. The Obstetrician & Gynecologist 2005; 7:89.
  22. DeLancey JO. Anatomic aspects of vaginal eversion after hysterectomy. Am J Obstet Gynecol 1992; 166:1717.
  23. Dällenbach P, Kaelin-Gambirasio I, Dubuisson JB, Boulvain M. Risk factors for pelvic organ prolapse repair after hysterectomy. Obstet Gynecol 2007; 110:625.
  24. American College of Obstetricians and Gynecologists. ACOG Committee Opinion. Number 372. July 2007. The Role of cystourethroscopy in the generalist obstetrician-gynecologist practice. Obstet Gynecol 2007; 110:221.
  25. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180. Reaffirmed 2016.
  26. Siedhoff MT, Clark LH, Hobbs KA, et al. Mechanical bowel preparation before laparoscopic hysterectomy: a randomized controlled trial. Obstet Gynecol 2014; 123:562.
  27. Ballard AC, Parker-Autry CY, Markland AD, et al. Bowel preparation before vaginal prolapse surgery: a randomized controlled trial. Obstet Gynecol 2014; 123:232.
  28. Arnold A, Aitchison LP, Abbott J. Preoperative Mechanical Bowel Preparation for Abdominal, Laparoscopic, and Vaginal Surgery: A Systematic Review. J Minim Invasive Gynecol 2015; 22:737.
  29. Kroft J, Selk A. Energy-based vessel sealing in vaginal hysterectomy: a systematic review and meta-analysis. Obstet Gynecol 2011; 118:1127.
  30. Elhao M, Abdallah K, Serag I, et al. Efficacy of using electrosurgical bipolar vessel sealing during vaginal hysterectomy in patients with different degrees of operative difficulty: a randomised controlled trial. Eur J Obstet Gynecol Reprod Biol 2009; 147:86.
  31. Levy B, Emery L. Randomized trial of suture versus electrosurgical bipolar vessel sealing in vaginal hysterectomy. Obstet Gynecol 2003; 102:147.
  32. American College of Obstetricians and Gynecologists Women's Health Care Physicians, Committee on Gynecologic Practice. Committee Opinion No. 571: Solutions for surgical preparation of the vagina. Obstet Gynecol 2013; 122:718.
  33. Balgobin S, Hamid CA, Carrick KS, et al. Distance From Cervicovaginal Junction to Anterior Peritoneal Reflection Measured During Vaginal Hysterectomy. Obstet Gynecol 2016; 128:863.
  34. Kho RM, Magrina JF. Round Ligament Technique and Use of a Vessel-sealing Device to Facilitate Complete Salpingectomy at the Time of Vaginal Hysterectomy. J Minim Invasive Gynecol 2015; 22:1084.
  35. Wood C, Maher P, Hill D. Bleeding associated with vaginal hysterectomy. Aust N Z J Obstet Gynaecol 1997; 37:457.
  36. Cavkaytar S, Kokanali MK, Topcu HO, et al. Effects of horizontal vs vertical vaginal cuff closure techniques on vagina length after vaginal hysterectomy: a prospective randomized study. J Minim Invasive Gynecol 2014; 21:884.
  37. Vassallo BJ, Culpepper C, Segal JL, et al. A randomized trial comparing methods of vaginal cuff closure at vaginal hysterectomy and the effect on vaginal length. Am J Obstet Gynecol 2006; 195:1805.
  38. Harris WJ. Early complications of abdominal and vaginal hysterectomy. Obstet Gynecol Surv 1995; 50:795.
  39. Dicker RC, Greenspan JR, Strauss LT, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization. Am J Obstet Gynecol 1982; 144:841.
  40. Gilmour DT, Das S, Flowerdew G. Rates of urinary tract injury from gynecologic surgery and the role of intraoperative cystoscopy. Obstet Gynecol 2006; 107:1366.
  41. Ibeanu OA, Chesson RR, Echols KT, et al. Urinary tract injury during hysterectomy based on universal cystoscopy. Obstet Gynecol 2009; 113:6.
  42. Daly DW. Injury to the ureter during gynecologic surgical procedures. Surg Gynecol Obstet 1988; 167:19.
  43. Bright TC 3rd, Peters PC. Ureteral injuries secondary to operative procedures. Report of 24 cases. Urology 1977; 9:22.
  44. Ghezzi F, Cromi A, Uccella S, et al. Immediate Foley removal after laparoscopic and vaginal hysterectomy: determinants of postoperative urinary retention. J Minim Invasive Gynecol 2007; 14:706.
  45. Schindlbeck C, Klauser K, Dian D, et al. Comparison of total laparoscopic, vaginal and abdominal hysterectomy. Arch Gynecol Obstet 2008; 277:331.
  46. van der Vaart CH, van der Bom JG, de Leeuw JR, et al. The contribution of hysterectomy to the occurrence of urge and stress urinary incontinence symptoms. BJOG 2002; 109:149.
  47. Brown JS, Sawaya G, Thom DH, Grady D. Hysterectomy and urinary incontinence: a systematic review. Lancet 2000; 356:535.
  48. de Tayrac R, Chevalier N, Chauveaud-Lambling A, et al. Is vaginal hysterectomy a risk factor for urinary incontinence at long-term follow-up? Eur J Obstet Gynecol Reprod Biol 2007; 130:258.
  49. Thakar R, Ayers S, Clarkson P, et al. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med 2002; 347:1318.
  50. Miller JJ, Botros SM, Beaumont JL, et al. Impact of hysterectomy on stress urinary incontinence: an identical twin study. Am J Obstet Gynecol 2008; 198:565.e1.
  51. Committee on Gynecologic Practice. Committee opinion no. 619: Gynecologic surgery in the obese woman. Obstet Gynecol 2015; 125:274. Reaffirmed 2017.
  52. George EM, Burke WM, Hou JY, et al. Measurement and validation of frailty as a predictor of outcomes in women undergoing major gynaecological surgery. BJOG 2016; 123:455.
  53. Chand M, Armstrong T, Britton G, Nash GF. How and why do we measure surgical risk? J R Soc Med 2007; 100:508.
  54. Saxton A, Velanovich V. Preoperative frailty and quality of life as predictors of postoperative complications. Ann Surg 2011; 253:1223.
Topic Outline