What is a vaginal cuff?

If you have a total or radical hysterectomy, your cervix and uterus will be removed. More extensive than a total hysterectomy, a radical hysterectomy also involves removal of the upper part of the vagina and additional tissue adjacent to the uterus. The top part of your vagina — where your upper vagina or cervix used to be — will be sewn together as part of this procedure. This is called closing the vaginal cuff.

If you’re having a partial hysterectomy, also called subtotal hysterectomy, your cervix won’t be removed. You won’t need a vaginal cuff in this case.

Keep reading to learn what you can expect after a vaginal cuff procedure, tips for recovery, symptoms to watch for, and more.

What to expect from vaginal cuff recovery

Vaginal cuff recovery usually takes at least eight weeks, though it often takes longer. Some women heal more slowly than others and find that complete recovery takes multiple months.

During this time, you’ll have regular check-ups with your doctor so that they can monitor your progress and recommend steps to speed up your recovery.

Your doctor may prescribe a vaginal estrogen cream if you’re postmenopausal in order to help encourage faster tissue healing. If there is any oozing near the vaginal cuff suture site associated with excess healing tissue (granulation tissue), you doctor may apply a small amount of silver nitrate to address this.

During the first 8-12 weeks postsurgery, you should abstain from anything that will put pressure on the vaginal cuff incision:

You should

  • abstain from sexual intercourse
  • maintain healthy bowel movements
  • control hard, chronic coughing
  • get plenty of bed rest
  • avoid lifting anything over 10 to 15 pounds
  • refrain from any strenuous activity, particularly if it puts pressure on your lower abdomen, or pelvic region

Following these recommendations will allow the vaginal cuff to become stronger. It will also help you avoid tearing the area where the ends of your vagina were stitched together to create the cuff.

Is it possible for a vaginal cuff to tear?

A vaginal cuff tear at the area where it was closed is a rare, but severe, complication of hysterectomy. It occurs if the incision used to make the vaginal cuff rips open and causes the edges of the wound to separate. The tear can be full or partial.

If the tear is large or there are additional complications, bowel evisceration may occur. When this happens, the bowel begins to push out of the pelvic cavity through the open wound into the vaginal cavity.

Vaginal cuff tears occur in less than 1 percent of women who have a hysterectomy. Women who have a total laparoscopic or robotic hysterectomy are at greater risk than those who have vaginal or abdominal hysterectomies. This may be due to the types of suturing or cutting techniques used in each surgery.

Other risk factors include:

  • having sexual intercourse during the healing process
  • weak pelvic floor muscles, which can result in pelvic floor prolapse
  • uncontrolled diabetes mellitus
  • vaginal atrophy
  • vaginal hematoma
  • history of radiation therapy in the pelvic region
  • smoking cigarettes
  • infection or an abscess in the pelvic region
  • immunosuppressant therapy
  • chronic conditions that cause pressure on the incision, such as coughing, obesity, and constipation

How to identify a vaginal cuff tear

A vaginal cuff tear is a medical emergency. You should seek immediate medical attention if you begin experiencing any of the following symptoms:

  • pelvic pain
  • abdominal pain
  • vaginal discharge
  • vaginal bleeding
  • rush of fluid out of the vagina
  • feelings of pressure in the vaginal or lower pelvic region
  • feeling a large mass in the vaginal or lower pelvic region

A vaginal cuff tear can occur any time after a total or radical hysterectomy, even years after the procedure has taken place, especially in women who are postmenopausal.

What to expect from vaginal cuff repair

Vaginal cuff repair is done surgically. If you have a partial tear with no complications, the surgery may be done through the vagina (transvaginal).

Several complications might require laparoscopic or open abdominal surgery. These include:

In addition to intravenous fluid hydration, those requiring this type of corrective surgery are typically given intravenous antibiotic therapy to treat or prevent infection.

If you experience complications affecting your bowel’s ability to properly function, you’ll remain in the hospital until your bowel function returns to normal.

Your recuperation time after a total or radical hysterectomy will be at least two to three months. During this time, your doctor will stress the need to avoid sexual intercourse. You’ll have to take special care to avoid putting strain or pressure on the new incision. You must avoid any activity, such as lifting heavy objects, that does so.

What’s the outlook?

Vaginal cuff tears are a rare complication of hysterectomy. Taking preventive measures to avoid a tear are very important. If a tear does occur, it’s considered a medical emergency and must be repaired surgically.

It typically takes at least six weeks to three months to recover from a vaginal cuff repair procedure. After the vaginal cuff has fully healed, your doctor will most likely give you the green light to resume your usual activities, including sex.