LAVH - Potential Issue? (Narrow vagina, never given birth - anyone else?)

Hi
I was moved in December to a different surgeon who does laparoscopic surgery. I had a call with him and he only said it was laparoscopic but when I received the follow up letter it said it was laparoscopic vaginal hysterectomy. I am also having removal of 7cm fibroid and 6cm cyst and lots of endo.

I have read that a LAVH is not always recommended for women who haven't had children and I know I have a narrow vagina from issues with intercourse and at Pap smear tests.
I am sure if it was an issue he would have said something?
Am I worrying unnecessarily - I have been waiting for an operation since October and really just want to get on with it.

P.S. I wasn't sure how to title this post!

Hi Florrie2-

I would recommend that you relay your concerns and previous doctor's experiences with the specific procedures to your new surgeon. Also tell him about your intercourse problems. I assume you also completed a medical history where you stated that you have never given birth. Has he examined you? Has he done a pelvic exam? The more information you provide him the better decisions he can make regarding your case.

If he knows all of the above, and he is still recommending LAVH for your surgery, then he thinks it will work.

Thank you.

He knows I haven’t given birth. All of my exams have been done through the abdomen only. I haven’t physically met him due to covid so it has been video calls - but I do like him and have confidence in him. I physically met the first surgeon who only felt for the fibroid by pressing my stomach. Everything else has been different types of scans.

Yes I need to raise my concerns. I’m possibly more psychologically worried due to my issues. I had to have a hymenectomy when I was 25 because I couldn’t have intercourse and can’t use tampax so the thought of all this stuff being pulled out through a little used area is a bit daunting! Even if I am knocked out by the anaesthetic.I realise I forgot to tell him about the hymenectomy.

I am so stressed out waiting for this surgery as it is.

Hello dear sister,

I can certainly see why you are stressed about surgery. But better to raise questions now before you proceed

Because you mention having “lots of endo”, I just want you to know there are specialists that handle this intricate part of surgery. I say this not to add to your worries, but so that you know all your options. If the endo is not completely removed, you can have issues down the road.

Please read this article: Reasons to find an Endo Specialist

You may wish to discuss this matter with your surgeon and see what his experience is.

Please take care and keep us posted.
We are here to help you if we can.

Hugs
❤️

P S - Questions to Ask of a Specialist

Thank you Marciamae.
I was actually moved to this surgeon because he is a laparoscopic endometriosis specialist. Hmm good point - he is highly trained with many years experience in laparoscopic surgery so he very much knows what he is doing.

I had fibroids and was referred to a laparoscopic fibroid specialist. He had originally planned to do an LAVH, because he was concerned about future cervical fibroids, among other things. I successfully pushed for a supracervical approach because my research, which was corroborated by subsequent talks with my family doctor, indicated that a vaginal approach would not be appropriate in my individual situation because I had a small vagina and had never had children, not to mention that my cervix was perfectly healthy and I was concerned about the potential consequences of having it removed. Subsequent discussions with other sisters indicated that if we'd stuck with doing an LAVH, it most likely would have had to be converted to an abdominal procedure. Your surgeon may know endo and he may know laparoscopic surgery, but as one well-known TV doctor once said, "you are the world expert on your own body," so if your knowledge and your instincts are telling you that a vaginal approach will not work for you, as mine were telling me, then I recommend that you pay attention to that, do your research, and maybe seek out a second opinion, so you can be sure that you're deciding on what's right for you. Best wishes for whatever you decide!

That's a very good question and one I shall have to ask my doctor before my surgery. I never had a childbirth either although I adopted two boys who have been the joys of my life. I am scheduled to undergo a robotic hysterectomy where everything is coming out of my vagina as well.

Just as I promised, I asked my doctor this question. Her nurse emailed me back an answer that may help you.

"Yes, it is possible to remove everything vaginally if you have not had vaginal deliveries and with Lichen Sclerosis. Being under anesthesia makes it tolerable for you and Dr will be mindful and cause the most minimal amount of trauma to the area. By doing exams on you in the past, Dr. knows what to expect and will operate accordingly to best accommodate you."

Thank you! I’ve actually emailed my consultant asking him and am waiting for a reply.

That is the best thing you can do for yourself. Your question was something I hadn't thought about so I was quick to ask. I was glad to get the answer so I don't have to think about it. I hope the same happens for you quickly.