Total Vaginal Hysterectomy to treat CIN-2

My History & Decision Making Process

Back in April 2003, I was diagnosed with my first abnormal PAP smear (LGSIL, confirmed with CIN-1 on biopsy) due to high risk HPV at age 29. I went deep with research, and took a good amount of control over my medical care and decisions. I was sure that I could defeat this thing with a good diet, supplements and some traditional chinese herbs. After a year, I started to notice spotting after intercourse, and went in for a second biopsy which revealed my dysplasia had progressed to CIN-2/moderate. I relented and opted for a LEEP procedure. Since my gyn only does the procedure at the surgery center, I had him do a laproscopic tubal ligation at the same time - as I had long ago made the decision to be childfree by choice.

I had actually inquired about the possibility of a hysterectomy to treat it, and my gyn was supportive of the idea but was pretty confident I could not get my insurance to pay for it without trying a LEEP first.

For almost 3 years after I had both normal PAP smears and negative HPV results, I truly thought HPV was a thing of my past.

Then in May 2007 during my routine exam, I had another low-grade abnormal PAP smear. Knowing the routine and what to expect, I put off a biopsy until I returned from a 7-month road trip across the country in my small solar powered teardrop trailer (it was an amazing adventure). I went to Burning Man, and asked the playa for healing from HPV.

When I returned to my home in Florida in December, my PAP was still showing abnormal and I went back to my previous gyn for a colopscopy/biopsy which revealed CIN-2 again. My gyn recommended another LEEP (under general anesthesia again). I brought up the idea of a hysterectomy again, and he was quite receptive to the idea and said it was a reasonable path to take. But he still recommended a LEEP first to rule out cancer. I talked with him further, and got him to agree to doing the LEEP as a frozen section STAT biopsy to confirm the absence of cancer while I was still under, and then to proceed to a hysterectomy if it was all clear. If it wasn't, then he had my permission to wake me up and refer me to a gyn oncologist.

My doctor also did not think that a TVH would be possible, as I had not had kids and would probably not be stretchy enough for him to perform the surgery - so an abdominal approach was likely.

My partner and I took my choices home - another LEEP or an abdominal hysterectomy. I gave myself a week to make a decision.

We researched. We considered our current life situation. We considered the future impacts of each. It was a decision that was difficult to make, considering I've never had any other gyn problems. My periods are light and pretty much non-events. I have no history of endo, fibroids or any other conditions that so many of my females friends have had. I was considering this only to deal with HPV and a condition that I wouldn't know I had if it weren't for looking at my tissue under a microscope, which brings about its own set of emotions with dealing with a very common STD that so many people dismiss as not being worth worrying about.

And in the end, the hysterectomy was a clear choice to me. But my research had shown me that a TVH actually probably was feasible, so I talked with many of my doctor friends on the best way to approach my gyn with this information without insulting him. I actually made the choice over a beer that carries the same name as my gyn (which he got a chuckle out of.)

Pre-Op

When I gave my answer to my gyn, he decided to do an internal exam to see if a TVH was possible - even without me bringing it up. I was thrilled.

He poked around, examined me.. made note that my uterus felt 'slightly enlarged' but even so I was a good candidate for trying a TVH. He could always convert to a TAH if he felt it necessary. We also opted to keep my ovaries as there was no indication of problems with them, or any family history of ovarian cancer. But I gave him permission to remove them if they looked even a bit unhealthy when he got inside.

I waited a few days for the call from the gyn's office to set the surgery date. At first, she offered a date almost two months away, which disappointed me (I'm the type that once I've made a decision, I'm ready now!). She then realized she was looking at the wrong month and then offered a date less than 3 weeks away. It was likely sooner than I was anticipating, but I took it.

I had only 3 weeks to really feel the emotions of it, and prepare my life for possibly 6 weeks down. I had good days and bad days. I would be doing just fine, and then suddenly walk into a wall of emotions of being scared, angry and such.

My partner was extremely supportive.. he was with me every step of the way. Offering an ear to rant to, a shoulder to cry on. He expressed his own worries and fears, and reassured me of how much he loves me and wasn't going to let me go through any of this alone, and how he wishes he could hold my hand even during the surgery. My closest friends came to my side, and gave me ample space and opportunity to talk things out.

I even started a blog on a select filter for my friends who were open to letting me have 'me space' to express my journey. It gave me an outlet to let out all of my fears and anger, and it really helped.

Other things I did included asking a pro-level photographer friend of mine to do a nude photo shoot with me to capture my pre-op body, especially if a TAH was a possibility. We made some beautiful art together from that photo shoot, and it was incredibly liberating to do. I also took a digital copy of the surgery pictures from the laproscopic tubal ligation and photoshopped out my uterus (imagine cutting out an ex from old vacation photos) to give myself very real visualization. This helped me, and made some of my friends fall out of their chairs in laughter. Humor is an amazing emotion.

The Night Before Surgery

The day of surgery, my partner and I decided to take a visit to the Kennedy Space Center (we live just a few miles away). That was likely my most emotional day, I was sick to my stomach with anticipation.. and despite my doctor not ordering bowel preps, my bowels seemed to want to completely empty anyway. I also had my last period end that day. I was a nervous wreck, and could barely function.

And then, somewhere around 7 or 8pm that evening, a calmness overtook me. It's like that wonderful calm after a storm, a peacefulness of knowing you are a survivor and you will excel.

I slept peacefully that night, awaking at 4am to start the journey to the hospital for my 7:30a surgery time.

A thunderstorm and the arms of my love cradled me as I slept.

The day of Surgery

When we went out to the car, the storm had passed and the sky was clear. Stars twinkled down on us. It was a beautiful moment.

We got to the hospital. I was surprised with how un-nervous I was. I was ready. I had let myself feel the emotions. Everyone was so friendly to me at the hospital - from the folks who checked in me, to my pre-op nurse. My love and my parents sat by my side as they prepped me for surgery. BP checks, IVs, going over my medical history a million times. And my pre-op nurse was a hoot, we laughed and told stories.

After my gyn came to see me and my family and go over things one last time.. they injected the Versed into my IV. I don't remember too much after this, but my family tells me I was delightful and witty. I had pre-programmed myself to try to consciously remember a few events despite the versed - and those memorable moments were:

- Kissing my love as I was wheeled away
- Being rolled into the OR room, I took note of the room itself
- Telling my surgery staff how much I appreciated them all
- Waking up to hear my doctor tell me how things went


When I woke up in the recovery (which seemed like the blink of an eye), my gyn was holding my hand and told me how well things had went. I had been under 1.5 hours, no signs of cancer, and the TVH went smoothly. Best case scenario. I was thrilled.


I was wheeled into my room, which I was delighted to find out it was both a private room and that my love was already waiting there for me.

They showed me how to operate the pain pump, and my nurse and CNA were amazingly helpful and friendly. I started nibbling on crackers and such, pumped my pain button a couple times and was generally in and out for most of the afternoon.

In the evening, I had several visitors - family and friends. It was delightful to see everyone. My love stayed with me at the hospital until around midnight, and then came back around 6am - Valentines morning.

Post-Op

In the morning, my nurse removed my catheter and my IV was unhooked, which meant no more pain pump. They switched me percoset, which worked quite well on me. I was up walking the halls in no time and peeing on my own without any difficulty. My gyn stopped by at lunch time and was amazed with how well I was doing - and told me that my surgery went so much easier than he was anticipating. My uterus was really small (I thank having just had my period), and it slipped right on out. And he said there was hardly any bleeding during surgery, and hadn't had a drop post-op either. He released me to go home.

The discharge nurse read me my orders, and it took me a moment to realize that I misheard her when she said 'light housework' as 'lighthouse work' - which are two entirely different things.

The most painful part was the wheelchair ride to the car - the transportation technician thought there was a race or something. The ride home was uncomfortable, we stopped by the pharmacy to pick up my script for pain pills and then it was in bed for me.

I slept for pretty much 36 hours straight with just brief awake moments for food, drugs, visitors and using the bathroom.


I took myself off the percoset and switched to Advil 2-days post op. The pain was really quite absent, I was just feeling tender. My bowels were moving smoothly. By day 5, I was no longer even needing the Advil. I was walking up to a mile a day at a slow pace, and generally doing regular stuff. I was even back to working part time hours (I work from home doing computer stuff) by the first week.

All and all, I'd say recovery has been a breeze. There are stretches of time where I completely forget I had major surgery, and I'm only 5 weeks post-op at this point. I have to consciously hold myself back to not over do it. I had pretty constant low grade fatigue for the first several weeks, which has mostly lifted by now. And I do hit walls of exhaustion. I force myself to lay down for a couple hours every day (usually watching 'Buffy the Vampire Slayer' on DVD that a friend loaned me) just to get the extra rest my body needs.

An unexpected feeling I've had is feeling more whole, as a woman without a uterus. I've pretty much always known I didn't want children of my own, but being a woman who doesn't even have the parts to create them just feels so right to me. I feel like I'm now so much more in the body I was meant to be in.


My thanks to HysterSisters


This support forum has been an amazing resource for me. It's been a great place to know that I'm not alone, and to support others as they go through similar things. I have to say tho, those with problems seem to post more (afterall, they rightfully need more support and this is a support forum) - which can be scary to those new coming into this fearing the worst case scenarios are a normal outcome.

For me, it was the seemingly rare success stories that inspired me and gave me the confidence that I could get through this and that the outcome didn't have to be the horror stories you might tend to hear. So, for that reason I will continue to relay my experience here as an example that things can go smoothly, and hope that other women can go into their procedure with confidence. Because I really do think that a positive attitude going in helps immensely with the healing process.


All my best to all of you.