A vaginal hysterectomy involves removing the uterus through the vagina. In most cases, this is the preferred approach, as it avoids a skin incision. Without an abdominal cut, patients generally experience less postoperative pain and regain mobility more quickly. This route is offered whenever it is safely possible.

The procedure can be performed under either a spinal or general anaesthetic. During surgery, stirrups are used to allow safe and comfortable access. The bladder is emptied and a catheter is inserted. The cervix (the mouth of the womb) is gently held and infiltrated with local anaesthetic, which helps define the tissue layers and improve pain control.

A circular incision is made around the cervix. The bladder is carefully moved away from the upper surface of the uterus, and the rectum from the lower surface. The peritoneum, which is the membrane lining the abdominal cavity, is then opened. This exposes the supporting ligaments and blood vessels on either side of the uterus. These structures are carefully clamped and sutured in three to four steps on each side to safely release the uterus.

The ovaries are inspected during the procedure, and biopsies may be taken if necessary. The fallopian tubes may also be removed where appropriate. To ensure long-term support and stability, a vault repair is performed using the remnants of the cardinal ligaments, helping to keep the vaginal vault secure.

A small corrugated drain and a soft vaginal pack are placed overnight to support healing. In some cases, particularly if you have had previous surgery such as a caesarean section, a cystoscopy (a small camera examination of the bladder) may be performed to ensure everything is intact and healthy.

Hospital stay is usually two nights.