The cervix is the lowest, narrow end of the uterus, often described as the neck of the womb, which extends into the top of the vagina. It acts as a gateway, permitting the passage of menstrual fluid and sperm, and providing a barrier to the rest of the reproductive tract. The cervix plays a significant role during childbirth, as it must dilate to allow the baby to pass through the birth canal. Removal of the cervix is a procedure that can be performed, though it is usually done in conjunction with the removal of the uterus. This type of surgery is typically reserved for cases where serious disease or medical conditions necessitate the removal of the structure.
Surgical Procedures for Cervical Removal
The most common method for removing the cervix is a total hysterectomy, where the entire uterus and the cervix are removed together. This procedure is a definitive treatment for various gynecological conditions, permanently ending menstruation and eliminating the risk of cervical cancer. A more extensive version, the radical hysterectomy, is generally reserved for treating cancer and involves removing the uterus, cervix, surrounding tissues, and the upper part of the vagina.
In contrast, a supracervical or subtotal hysterectomy removes only the upper part of the uterus while purposefully leaving the cervix intact. Retaining the cervix means the procedure does not address any cervical pathology, and patients must continue routine cervical cancer screening. The decision to remove or retain the cervix depends heavily on the specific medical condition being treated and the patient’s preferences.
A separate and less common surgical option is the radical trachelectomy, which involves removing the cervix and a small portion of the upper vagina while preserving the main body of the uterus. This approach is highly specialized and is primarily used for women with early-stage cervical cancer who wish to maintain their ability to carry a pregnancy. Surgeons use various techniques, including traditional open abdominal surgery, or minimally invasive approaches such as laparoscopic, vaginal, or robotic-assisted surgery. Minimally invasive methods generally offer a faster return to normal activity.
Primary Medical Indications for Removal
The decision to remove the cervix is driven by specific medical conditions, most notably the presence of cancer or precancerous changes. Cervical cancer, including both the common squamous cell carcinoma and the less frequent adenocarcinoma, is a clear indication for surgical removal. This often requires a total or radical hysterectomy to ensure all cancerous tissue is eliminated. For very early-stage cancers, a radical trachelectomy may be an option to preserve fertility.
High-grade precancerous lesions, medically known as Cervical Intraepithelial Neoplasia Grade 3 or CIN 3, are also a reason for removal when less invasive treatments have failed or are not appropriate. These lesions carry a significant risk of progressing to invasive cancer if left untreated. Removing the cervix, usually alongside the uterus, eliminates the tissue where these high-risk cells originate.
In cases where women require a total hysterectomy for severe uterine conditions, the cervix is removed along with the uterus as a standard part of the procedure. These conditions include large, symptomatic uterine fibroids, severe endometriosis, or persistent, abnormal uterine bleeding. Cervical removal is also often performed during a total hysterectomy to treat uterine or pelvic organ prolapse, which helps provide better structural support for the vaginal vault.
Long-Term Health and Lifestyle After Removal
A major consequence of cervical removal as part of a total hysterectomy is the permanent loss of fertility because the uterus is also removed. Patients who undergo a radical trachelectomy retain their uterus and may still be able to become pregnant. This often requires assisted reproductive technologies and a cervical cerclage to maintain the pregnancy. A substantial portion of women who attempt pregnancy after a trachelectomy are successful in conception and delivery.
Regarding sexual function, sensation and satisfaction are generally maintained or may even improve after the procedure, especially when the surgery resolves painful symptoms. After a total hysterectomy, the top of the vagina is surgically closed with sutures to create a structure known as the vaginal cuff. While a small number of patients may experience changes like vaginal shortening or decreased lubrication, the removal of the cervix itself does not typically diminish sexual function.
The removal of the cervix alone does not induce menopause, as this hormonal transition is triggered by the cessation of estrogen production from the ovaries. If the ovaries are left in place during the surgery, the patient will continue to produce hormones and will not experience surgical menopause. In some instances, however, hysterectomy can affect the blood supply to the ovaries, potentially leading to an earlier onset of natural menopause.
The need for future cancer screening is determined by the extent of the surgery and the underlying reason for removal. If the cervix was removed as part of a total hysterectomy for a benign condition, routine Pap smears are generally no longer required. If the removal was due to cancer or high-grade precancerous changes, doctors typically recommend continued screening in the form of a vaginal vault smear for up to 20 years to monitor for any recurrence in the upper vagina.