A hysterectomy is a surgical procedure involving the removal of the uterus, an organ located in the female pelvis. This procedure addresses various gynecological conditions. When considering a hysterectomy, patients frequently encounter a significant decision: whether to also remove the cervix. This choice holds implications for a patient’s health and future medical care.
Understanding the Hysterectomy Options
A hysterectomy can be performed in different ways, with two primary types distinguishing how the cervix is handled. A total hysterectomy involves the removal of the entire uterus along with the cervix. This means the lower, narrow part of the uterus that connects to the vagina is also removed.
In contrast, a supracervical hysterectomy, sometimes called a subtotal or partial hysterectomy, removes only the upper part of the uterus while leaving the cervix intact. The choice between these two approaches depends on a patient’s specific medical situation and health goals.
Arguments for Cervical Removal
Removing the cervix during a hysterectomy offers several medical advantages, primarily eliminating the risk of future cervical pathologies, including cervical cancer development. Conditions such as human papillomavirus (HPV)-related issues or cervical intraepithelial neoplasia (CIN), which are abnormal cell changes that can progress to cancer, are addressed by cervical removal.
Removing the cervix also means that future cervical screenings, such as Pap tests, are no longer necessary. This can reduce the need for ongoing medical appointments and alleviate concerns about abnormal screening results. For some specific medical conditions, such as severe endometriosis or extensive dysplasia, complete removal of the uterus and cervix may be medically indicated to ensure full disease eradication. This prevents recurrence of the condition in the cervical stump.
Arguments for Cervical Retention
Retaining the cervix during a hysterectomy is an option that some patients and surgeons consider for various perceived benefits. One common belief is that the cervix might offer better pelvic floor support, potentially reducing the risk of pelvic organ prolapse in the future.
Some individuals also believe that retaining the cervix could have a positive impact on sexual function or sensation post-surgery. However, recent studies indicate there may not be a significant difference in sexual function between total and supracervical hysterectomies. A supracervical hysterectomy can also lead to a less extensive surgical procedure for some patients, potentially reducing certain surgical complications like shortening of the vagina. If the cervix is retained, however, continued Pap smears are necessary to screen for cervical cancer.
What to Discuss With Your Surgeon
When considering a hysterectomy, a thorough discussion with your healthcare provider is important for deciding on cervical removal. Your individual health history, including any prior abnormal Pap smears or cervical conditions, must be reviewed. The specific medical conditions necessitating the hysterectomy, such as fibroids, endometriosis, or abnormal bleeding, will influence the surgical recommendation.
You should discuss potential risks and complications associated with both options. If the cervix is retained, a small risk of continued cyclical bleeding, often referred to as “cyclic spotting,” exists in about 5% to 20% of women. The ongoing need for Pap smears is also a consideration. If the cervix is removed, potential for vaginal shortening or specific surgical risks related to the deeper dissection should be discussed. Understanding all implications of each approach allows for an informed decision tailored to your personal preferences and lifestyle.