A hysterectomy is the surgical removal of the uterus, usually done by a gynecologist. The two common surgical approaches to performing a hysterectomy are either via a laparotomy or trans-vaginally. Reasons for a hysterectomy include cancer of the cervix or uterus and excessive vaginal bleeding, especially in a woman who has either already had all the children she wants or is post-menopausal. Hysterectomies have had a controversial past; during the 19th century, women were given hysterectomies as a treatment for psychological problems since hysteria was thought to originate in the uterus.