Infotrans

Hysterectomy/ovariectomy

Who can undergo the surgery?

According to the recommendations reported in the bibliography section, people who match the following criteria can undergo hystero-adnexectomy surgery:

  • Gender incongruence is marked and sustained;
  • Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention in regions where a diagnosis is necessary to access health care;
  • Demonstrates capacity to consent for the specific gender-affirming surgical intervention;
  • Understands the effect of gender-affirming surgical intervention on reproduction and they have explored reproductive options;
  • Other possible causes of apparent gender incongruence have been identified and excluded;
  • Mental health and physical conditions that could negatively impact the outcome of gender-affirming surgical intervention have been assessed, with risks and benefits have been discussed;
  • Stable on their gender affirming hormonal treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated).

In Italy, the following criteria have also to be matched:

When the necessary criteria for carrying out the surgery are met (see above), the person concerned must:

  • Identify a specialized clinical center (Infotrans.it offers a list of public or public-private partnership structures, present on the national territory, able to provide this type of services in the section "Service Map")
  • schedule a medical consultation with the health provider for inclusion in the operating list. The person will then be called to perform the pre-operative examinations, the consultation with the anesthesiologist and the signing of the informed consent to the intervention. On this occasion, the date of the surgery will be set and, if necessary, you will be asked to stop taking hormones.

In general, if you are taking any prescription medication, you should discuss it with your specialist. It may be necessary to stop taking it several days before the surgery. Drug therapy may be resumed at the doctor's discretion.

The hysterectomy/ovariectomy is a surgical procedure that has the aim of removing the uterus, as well as fallopian tubes and ovaries. In most cases, the surgery is performed laparoscopically. This technique involves the use of small incisions on the abdomen through which the tools necessary for the surgeon are introduced to remove the uterus and ovaries which will then be removed through the vagina. At the end of the procedure, a drain is usually placed (a thin tube that allows liquids to escape from the abdominal cavity to a bag connected to it) which will then be removed in the ward in the following days. The hysterectomy/ovariectomy definitively compromises the person's fertility. Laparoscopic surgery is usually associated with a better postoperative course which is less painful and shorter than surgery performed laparotomically (i.e. with a large incision on the abdomen). The latter technique is used only in the case of voluminous masses affecting the internal genital organs or in the case of medical contraindications to laparoscopy.
The laparoscopic hysterectomy/ovariectomy lasts about 60-90 minutes, the laparotomic surgery takes about 2 hours, both take place under general anesthesia.
The hysterectomy/ovariectomy and t the chest surgery can be performed together in the same operating session.

The hospitalization for the hysterectomy/ovariectomy is two days, if performed together with that of chest surgery it lasts an average of 3-4 days, depending on the characteristics of the person and the post-operative recovery.

Generally, at least one month of abstention from work is recommended when hysterectomy/ovariectomy and chest surgery are performed in the same session. The surgeon will provide more precise indications for the postoperative period based on the technique used and the course following the operation.

Complications, although rare, include:

  • localized or systemic hematomas or infections
  • post-operative scars
  • sensitivity disorders such as hyperalgesia (increased sensitivity to pain) or tingling in the incision areas
  • imperfect wound healing
  • thromboembolism (formation of blood clots which can block blood vessels) which may be increased due to hormone therapy. For more information on what a "thrombus" is, you can visit the ISSalute.it site under "Clot, thrombus, embolus"
  • lesions of the intestine and urinary tract resulting in the formation of fistulas (abnormal channels that connect two adjacent and normally separate anatomical structures)
  • conspicuous blood loss which may require transfusion.

National Health Service (NHS): no cost.
Freelance: at the discretion of the health provider.

 

Coleman E, Radix AE, Bouman W,  et al. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health. 2022; Sep 6;23(Suppl 1):S1-S259.
Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-3903. Erratum in: J Clin Endocrinol Metab. 2018; 103(2): 699. J Clin Endocrinol Metab. 2018; 103(7): 2758-2759.