One of the many patent medicines, for the “treatment” of hysteria, which was once thought to be the uterus wandering about the body.
This post is part of an on-going series, Trans 101 for Trans People. If you have additional questions about medical transition, hormones, surgeries, or seeking health care, check out the full page!
For some trans men the very fact that he has ovaries, uretus, cervix and vagina is a source of dysphoria. For trans men who aren’t ready or able to have genital surgery (i.e., metoidioplasty or phalloplasty), there are options similar to orchiectomy for trans women: hysterectomies, oophorectomies, and vaginectomies.
That’s a lot of -ectomies. What exactly are you talking about?
Let’s go through a bunch of the options one by one…
- A hysterectomy is the removal of the uterus, and only the uterus. There’s a common misperception that a hysterectomy is the same thing as removing all the bits. It’s not. A hysterectomy may or may not involve the removal of the cervix.
- An oophorectomy is the removal of an ovary. A bilateral oophorectomy is the removal of both ovaries. A bilateral salpingo-oophorectomy is the removal of both ovaries and both fallopian tubes (aka oviducts).
- A vaginectomy is the removal of the vagina. If a cervix was still present, it would also be removed.
So why get one of these surgeries?
Reasons are of course very personal. Reasons also vary depending on which surgery is involved, but some men have cited the following:
- Reduction of dysphoria. For some men, just knowing that a uterus and ovaries are present is distressing. Removal can reduce that distress
- Eliminating the need for pelvic examinations and pap smears (for paps, only if the cervix is removed)
- Eliminating the risk for some reproductive cancers, including ovarian cancer, cancer of the fallopian tubes, endometrial cancer, and cervical cancer
- No more menstruation. Ever. Woohoo!
Cis women get these surgeries too, right?
Yup. They can be done for conditions as benign as polycystic ovarian syndrome or fibroids, or for conditions as potentially deadly as cancer. Hysterectomies and oophorectomies are far more common than vaginectomies.
Because these aren’t trans-specific surgeries, finding a surgeon and getting insurance coverage isn’t as difficult as it is for a meta or phallo. It gets even easier if you have a condition (like fibroids) where surgery is recommended in cis women. As your primary care provider for ways you can get the surgery covered. Also note that while many surgeons do perform these, it might be difficult to find one who will treat you in a way that affirms your gender. Be ready to call in your primary care physician or others to support you.
Can these surgeries all be done at once?
Some of them, definitely. So much so that there’s a medical acronym: TAHBSO. Yes, it totally looks like the word “tabasco”. It’s one of my favorite acronyms so far because of that. TAHBSO stands for Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy. It’s the removal of the uterus, oviducts/fallopian tubes, and ovaries all at once through a cut in the abdomen.
I don’t know for sure whether a vaginectomy could be performed at the same time. As your potential surgeon.
What variations in techniques are there?
The biggest variation is in where and how the cuts are made to remove the organs. Vaginectomy is simple – it’s done vaginally.
But hysterectomies and oophorectomies vary. The oldest technique for those is the abdominal incision – a horizontal or vertical cut is made (not too unlike a cesarean section) on the abdomen. This technique is the most traumatic for the body, leaves a scar, and has a longer recovery time.
Two other techniques for hysterectomy and oophorectomy have emerged fairly recently. Laparoscopic surgery is where multiple small cuts are made, and the surgery is performed through those cuts by means of long…uh… sticks basically, with cameras and grasping ends. Lastly, sometimes a hysterectomy can be performed through the vagina, leaving no outward scar at all.
You should discuss the pros/cons of each technique with your potential surgeon to determine which is best for you. A second opinion is important here too.
What should I do if my surgeon says s/he isn’t willing to do a specific technique for me?
Be aware that not all surgeons use all techniques. Some simply have more experience with one over the other. They may well say (or be thinking): “I don’t have a lot of experience doing vaginal hysterectomies, and I don’t want to risk harm, so if you have your hysterectomy with me I want to use the technique I’m best at to minimize your risks.”
Or there could easily be other reasons. Ask your surgeon why!
Can you tell me more about the surgeries? Do they require full anesthesia? How long would I be in the hospital? What kind of recovery time am I looking at?
These surgeries are all “major” surgery, meaning the main body cavity is penetrated. They absolutely will be done under general anesthesia (would you really want to be conscious through that?).
Recovery time will vary depending on what you have done, and how it is performed. It can be as little as two weeks (vaginal hysterectomy) to 6-8 weeks (TAHBSO). Unless you have a complication, even for a TAHBSO you probably won’t spend more than a few days at the most in the hospital.
What are the possible risks?
Risks are mostly the ones associated with any major surgery, including infection, a bad reaction to anesthesia, and the risk of a blood clot. Remember: any surgery can end up resulting in death – the chances may be very small, but still present. There’s also the chance that some of the organs nearby may be accidentally nicked or damaged. Your surgeon will do their best to avoid such damage but it’s a possibility.
If you use your vagina for sex, it may alter some of your sexual responses. Some cis women report pain with intercourse after a hysterectomy, for example.
Your surgeon will go through all the possible risks with you.
What are the possible long-term health effects?
Depends on what was removed.
If you had an oophorectomy, your own biggest source of sex hormones will be gone. You’ll still have a tiny amount from your adrenal glands but not much. This makes it super important to stay on a sex hormone to prevent osteoporosis. There may be other changes too, even if you’re regular with your testosterone – check in with the trans male community/communities to see what else they’ve noticed.
Removal of your ovaries makes you permanently infertile. If having genetic children is important to you, either have them before an oophorectomy or store your eggs. Remember, too, that testosterone is not a contraceptive and also that some trans men can become pregnant and successfully deliver happy healthy babies after being on T for years.
Would these surgeries affect my future ability to have a metoidoplasty or phalloplasty?
They shouldn’t. Some or all of these surgeries may even be the first step in a meta or phallo!
Any health conditions that mean I can’t get any of these surgeries?
As far as I know, only the health conditions which would prevent anyone from having any surgery. As always, to maximize your recovery you’ll want to quit tobacco use and get as fit as you can before your surgery.
Any other thoughts?
As always, communicate with your primary health care provider. He or she will be best able to help you figure out whether a hysterectomy, oophorectomy, or vaginectomy is right for you.