Hysterectomy: Womb Removal Surgery Explained for African Women

By: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health). Medically reviewed by A. Odutola, MB.BS, PhD, FRCSEd.

December 5, 2025.

A Black female doctor in a white lab coat is counselling a Black couple wearing sky-blue tops about uterine fibroids and the possible need for a hysterectomy. Google AI generated image. Click on image to enlarge.
 

Highlights

• The womb holds deep emotional and cultural value for many African women.

• A hysterectomy is the surgical removal of all or part of the uterus.

• It can be done for benign or cancerous conditions, sometimes as an emergency.

• Types of hysterectomy differ by surgical route, extent, and timing.

• Proper preparation, counselling, and postoperative care are key to recovery.

• Though generally safe, a hysterectomy carries possible risks and complications.
  
   

Introduction

Close up view of a cartoon illustration of the  uterus (womb) in a human female. Click on image to enlarge.

 

The womb (uterus) is the signature organ in a woman. It is highly treasured because of its role as the home for the unborn child. In many African societies, it carries deep emotional and cultural value because of its link to fertility and motherhood. For this reason, the last thing most women want to hear is that their womb needs to be removed, even when they are done with childbirth

That’s why Mrs. Felicia declined the surgery when it was first recommended at her previous hospital. She wanted a second opinion and visited another hospital to confirm whether there was truly no alternative.

 

What Is a Hysterectomy?

A hysterectomy is an operation that involves the removal of all or part of the womb (uterus) [1]. It is a major surgery and an irreversible procedure, so the decision to go ahead with it is usually well thought out. 

While it is often a planned (elective) operation, it can also be done as an emergency in life-threatening situations. The reasons for a hysterectomy range from benign (non-cancerous) conditions like fibroids to cancerous diseases affecting the reproductive organs.

Hysterectomy is one of the most commonly performed women's reproductive organ (gynaecologic) surgeries worldwide. In the United States alone, 2021 data show that more than 14% of women aged 18 and above have had the procedure.

In a hospital in Cameroon, a study found that about 15 out of every 100 women who had gynaecologic surgery underwent a hysterectomy. 

Despite the benefits of hysterectomy in the treatment of certain diseases, it is still a procedure that many African women find difficult to accept. This is mainly because fertility and childbearing are highly valued, and the thought of losing the womb can feel like losing a part of one’s identity or social standing as a woman.

In this article, you will learn why a hysterectomy may be recommended, the different types and surgical approaches, how to prepare for the procedure and what to expect during the recovery process.

 

Types of Hysterectomy

There are different types of hysterectomy, and the choice depends on several factors [1].

According to the route of surgery:

• Abdominal hysterectomy: performed through an incision (cut)  in the lower abdomen
• Vaginal hysterectomy:  performed through the vagina without an external cut

According to the extent of surgery

• Simple hysterectomy: only the womb (uterus) is removed
• Radical hysterectomy:  the womb and surrounding structures, such as part of the cervix, upper vagina, and nearby tissues, are removed

In some cases of hysterectomy, the ovaries and fallopian tubes are removed as well 

Illustration showing the different types of hysterectomy Silhouetted areas indicated parts of the womb and surrounding structures (as relevant) that are removed in each type  

 

According to the amount of tissue removed:

• Total hysterectomy: the entire uterus, including the cervix, is removed
• Subtotal (partial) hysterectomy: the upper part of the uterus is removed, leaving the cervix in place

According to the type of surgery:

• Open hysterectomy: done through a larger incision in the abdomen
• Laparoscopic hysterectomy: done using small cuts and a camera (a minimally invasive method)

According to the timing:

• Emergency hysterectomy: done urgently to save life, such as in severe bleeding after childbirth
• Elective hysterectomy: planned after careful evaluation

Your doctor will consider several factors before deciding which type of hysterectomy is most suitable for you. 

These include:

• The size of your womb
• The reason for the surgery
• Any previous operations you may have had
• The experience and expertise of the surgeon
• The facilities and equipment available at the hospital

In Africa, the abdominal hysterectomy is still the most commonly performed type. In many Western countries, however, laparoscopic hysterectomy is now more common because it is less invasive and allows for faster recovery [2].

 

Reasons Why a Hysterectomy Is Done

Illustration listing some reasons for hysterectomy. The commonest in Africa is uterine fibroid* Click on image to enlarge.

 

You may need a hysterectomy for several reasons [1, 3]. 

These reasons can be:

• Benign (non-cancerous)
• Malignant (cancerous).

Benign (Non-cancerous) conditions

• Uterine fibroids: These are non-cancerous growths of the womb
• Abnormal uterine bleeding: Persistent or heavy vaginal bleeding that does not respond to other treatments
• Uterovaginal prolapse: When the womb and part of the vagina drop down and may protrude through the vaginal opening
• Endometriosis: A condition in which the tissue that normally lines the womb grows outside it, causing pain and other symptoms
• Chronic pelvic pain: Ongoing pain in the lower abdomen that has not improved with other treatments for more than 6 months
• Severe pelvic infection: In rare cases, a hysterectomy may be required to control an infection that threatens life or damages pelvic organs
• Excessive bleeding during or after childbirth: Sometimes done as a life-saving procedure

Malignant (Cancerous) conditions

• Cervical cancer (Cancer of the mouth of the womb)
• Endometrial (uterine/womb) cancer
• Ovarian or fallopian tube cancer

In many hospitals across Africa, uterine fibroid is the leading reason for hysterectomy, especially among women who have completed childbearing [3, 4].

 

Preparing for a Hysterectomy

Counselling:

 A hysterectomy is a permanent surgical procedure, so your doctor will take time to discuss it with you in detail. You may be encouraged to bring a close relative or caregiver along for these discussions, as their support can be helpful before and after surgery. Feel free to ask all your questions and make sure you understand every step of the process before giving your consent.

Blood donation: 

Because a hysterectomy can sometimes lead to blood loss, your doctor may ask you to arrange for blood to be available for transfusion. This can be done at the hospital’s blood bank or through family donors.

Consent: 

Before surgery, you will be asked to sign a consent form. This document shows that you understand the procedure and agree to go ahead with it. Take your time to read it carefully, and do not hesitate to ask questions about anything you don’t understand.

Payment: 

You may be required to make a payment for the surgery ahead of time, unless you are covered by health insurance or the hospital offers free care.

Admission:

 Most hospitals will admit you one or two days before the operation to complete all necessary checks and preparations.

Fasting: 

You will be asked not to eat or drink anything on the morning of your surgery. Your last meal should be the night before the operation. This helps prevent complications during anaesthesia.

Catheter/Preparation of the surgical site: 

Before surgery, a nurse will insert a catheter (a small tube) into your bladder to help drain urine. In some cases, the area around the operation site may also be shaved; this is usually done in the operating room.

Pre-surgery review: 

Before the operation, the anaesthetist, the doctor responsible for giving anaesthesia (the medication that makes you sleep and feel no pain during surgery) will come and review you on the ward. They will check your medical history, examine you and make sure you are fit for surgery.

 

How a Hysterectomy Is Done

Anaesthesia:

There are two main types of anaesthesia used for hysterectomy. The type that you receive will depend on what you and your doctors consider better for your circumstances.

• Spinal or combined spinal–epidural anaesthesia:

This involves an injection given in your lower back. It numbs pain and sensation from your waist down, including your legs. You will remain awake but will not feel any pain during the surgery.

• General anaesthesia:

With this option, you will be completely asleep during the operation. The medicine is given through a vein or as a gas through a face mask. You will not feel, see, or remember anything until the surgery is over.

Types of Surgery

The way a hysterectomy is performed depends on the type of surgery your doctor chooses. 

The most common types include:

• Abdominal hysterectomy:

Your surgeon makes a cut on your lower abdomen to reach the womb. The cut may be vertical (up and down) or horizontal (side to side), depending on the size of your womb and other factors. The womb is carefully separated from surrounding organs and removed, and the wound is then closed with stitches.

• Laparoscopic hysterectomy:

In this type, your surgeon makes a few small cuts on your abdomen. A tiny camera and surgical instruments are passed through these openings to remove the womb. The womb may be taken out through the vagina or cut into smaller pieces and removed through the small openings, a process called morcellation. This method usually allows faster healing and leaves smaller scars.

• Vaginal hysterectomy:

Here, there is no cut on your abdomen. The surgeon reaches your womb through the vagina by making a small incision at the top of it. Through this opening, the womb is detached from its attachments and removed completely. This approach is less invasive and often leads to quicker recovery.

 

Recovery after Hysterectomy

• After a hysterectomy, you will usually stay in the hospital for about 3 to 5 days if you had an open (abdominal) surgery. However, if your surgery was done laparoscopically or vaginally, you may be discharged the next day.

• In most cases, antibiotics are given just before the surgery to prevent infection. Your doctor may also continue antibiotics for a few days after the operation. You will also be given painkillers and, in some cases, blood thinners after the surgery.

• Your doctor will let you know when to start eating after the surgery. This usually happens within 24 hours. The nurses will guide you on the type of meals to start with, usually light and easy-to-digest foods.

• The catheter is usually removed the next day after the surgery.

• You will be encouraged to start moving within a few hours after surgery. This helps to prevent the formation of blood clots in your legs. If you are at a higher risk, your doctor may ask you to wear compression stockings or give you a special injection (low-molecular-weight heparin) to help prevent clot formation.

• You can usually return to your normal activities after 6 to 8 weeks if you had an open hysterectomy, but recovery is faster after a laparoscopic or vaginal hysterectomy, often within 2 to 4 weeks.

• Your doctor will schedule a follow-up appointment after the surgery to check your recovery. Make sure to keep this appointment and report any unusual symptoms such as fever, excessive bleeding, severe abdominal pain, or foul-smelling vaginal discharge.

 

What Are the Complications of Hysterectomy?

Illustration listing some of the complications of hysterectomy. Click on image to elarge.

 

A hysterectomy is generally a safe procedure, but like any surgery, it carries some risks and possible complications. This is why your doctors will carefully determine the best and safest approach for your surgery.

Some possible complications include [5. 6]:

• Problems related to anaesthesia
• Bleeding during or after surgery
• Injury to nearby organs such as the bladder, ureter, or vagina
• Infections at the surgical site or within the pelvis
• Adhesions which occur when internal organs or tissues stick together. This is more common with the intestines and may lead to intestinal obstruction
• Fistula formation (an abnormal connection between two organs). The most common is a vesicovaginal fistula (a connection between the bladder and the vagina)
• Blood clots forming in the legs (deep vein thrombosis)
• Surgical menopause, which occurs if your ovaries are removed along with your uterus

The risk of complications is usually higher with abdominal hysterectomy compared to laparoscopic or vaginal hysterectomy.

 

Conclusion

The decision by your doctor for you to have a hysterectomy is not usually a light one because it involves the removal of a vital part of your body.

However, a hysterectomy can bring relief from long-standing pain and illness when it’s medically necessary. It’s important to understand its emotional and physical implications. With proper counselling, preparation, and care, your recovery can be smooth and steady.

 

Frequently Asked Questions (FAQs)

What happens to my hormones after a hysterectomy?

If your ovaries are not removed during the hysterectomy, your hormone levels will remain normal, unless you are already in menopause. However, if your ovaries are removed, your hormone levels will drop, leading to symptoms of menopause such as hot flashes and mood changes.

Can a hysterectomy affect sex?

If a total hysterectomy is done, there is a chance that the vagina may become slightly shorter, which could affect sexual intercourse. However, this is not common, and most women are still able to enjoy a satisfying sex life after recovery.

 

References

1. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. In brief: Hysterectomy (surgical removal of the womb) [Updated 2025 Feb 25]. Available from here. 

2. Rudnicki M, Shayo BC, Mchome B. Is abdominal hysterectomy still the surgery of choice in sub-Saharan Africa? Acta Obstet Gynecol Scand. 2021 Apr;100(4):715–7. Available from here

3. Chale GJ, Salim RM, Leshabari KM. Clinical indications for total abdominal hysterectomy among women seen in Dar es Salaam regional referral hospitals, Tanzania: a prospective, observational hospital-based study. Pan Afr Med J. 2021 Jan 6;38:10. Available from here

4. Egbe TO, Kobenge FM, Arlette MMJ, Eta-Nkongho E, Nyemb JE, et al. (2018) Prevalence and Outcome of Hysterectomy at the Douala General Hospital, Cameroon: A Cross-Sectional Study. Int J Surg Res Pract 5:092. doi: 10.23937/2378-3397/1410092. Available from here.

5. Settnes A, Moeller C, Topsoee MF, Norrbom C, Kopp TI, Dreisler E, et al. Complications after benign hysterectomy, according to procedure: a population-based prospective cohort study from the Danish hysterectomy database, 2004-2015. BJOG. 2020 Sep;127(10):1269–79. Available from here.

 6. Michael D, Mremi A, Swai P, Shayo BC, Mchome B. Gynecological hysterectomy in Northern Tanzania: a cross-sectional study on the outcomes and correlation between clinical and histological diagnoses. BMC Women’s Health. 2020 Jun 12;20(1):122. Available from here. 

 

Related: Myomectomy – The Fibroid Surgery African Women Need to Know

 

 

Published: December 5, 2025

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