A hysterectomy is a common surgical procedure involving the removal of the uterus, typically performed to treat conditions like fibroids, endometriosis, or heavy bleeding. While many hysterectomies remove the entire uterus and the cervix, some procedures intentionally leave the lower part of the uterus, known as the cervix, intact. This retained tissue is medically referred to as a cervical stump.
Defining the Cervical Stump
The cervical stump is the remaining portion of the cervix after a subtotal or supracervical hysterectomy. This procedure involves removing the main body of the uterus while intentionally leaving the cervix—the narrow, lower part of the uterus connecting to the vagina—in place. The surgeon separates the uterus from the cervix near the internal opening.
The cervical stump is located at the top of the vagina, acting as the closed-off base where the uterus once was. This differs from a total hysterectomy, where the top of the vagina is sutured closed, forming a vaginal cuff. The retained stump still contains the tissue layers of the cervix, including glandular cells and the transformation zone, which are monitored for pre-cancerous changes.
Reasons for Retaining the Cervix
Retaining the cervix is based on several perceived benefits related to surgical ease and patient recovery. The supracervical hysterectomy is technically simpler and typically involves less extensive surgical dissection around the bladder and ureters. This reduced complexity can lead to a shorter operative time and potentially less blood loss during the procedure.
Historically, a primary rationale was the theoretical preservation of pelvic floor support and function. Some practitioners believed the cervix acts as a structural anchor, lowering the risk of future pelvic organ prolapse or issues with urinary control. While preservation was also argued to positively impact sexual function, current medical evidence suggests no significant difference in sexual outcomes compared to a total hysterectomy. The quicker recovery time associated with the less invasive nature of the procedure remains a consistent advantage.
Potential Health Implications
While the cervical stump is generally benign, its presence carries a distinct set of potential health implications that patients must be aware of following surgery. The most common complication is the occurrence of cyclic bleeding, sometimes referred to as “mini-periods,” which happens in an estimated 5% to 20% of women. This bleeding occurs because microscopic amounts of endometrial tissue, which lines the uterus, may have remained within the cervical canal and continue to respond to hormonal fluctuations.
The retained cervical tissue also means that the risk of developing cervical cancer is not eliminated, unlike in a total hysterectomy. Though the overall reported risk of cancer developing in the stump is low, accounting for about 1% to 3% of all women who undergo this procedure, the tissue remains susceptible to the human papillomavirus (HPV) infection. Other potential issues include cervicitis (inflammation or infection) and the development of benign lesions like fibroids or cysts.
Post-Operative Monitoring and Management
The most important aspect of care following a supracervical hysterectomy is the continuation of regular cervical cancer screening. Since the tissue at risk remains, patients with a cervical stump must continue to receive Pap smears and HPV testing according to standard guidelines. Failing to maintain this routine screening can lead to a delayed diagnosis.
If the cervical stump causes persistent problems, such as chronic cyclic bleeding, recurrent infection, or the detection of high-grade pre-cancerous cells, a secondary surgical procedure may be required. This procedure, known as a cervical stump excision or trachelectomy, involves the complete removal of the remaining cervical tissue. The excision effectively converts the original subtotal hysterectomy into a total hysterectomy and is generally reserved for managing significant long-term complications.