Supracervical or Subtotal Hysterectomy – should I have my cervix removed?

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When you’re having a hysterectomy, one of the first decisions to make is whether to keep your cervix.    If you elect to keep your cervix, the operation is called a Supracervical or Subtotal Hysterectomy.

If you have your cervix removed, it is called a Total Hysterectomy. It’s a common misconception that a Total Hysterectomy involves the removal of the ovaries as well, but this is not correct.  Removal of the ovaries is an oophorectomy.  When both are removed, along with the fallopian tubes, it is called a Bilateral Salpingo-Oopherectomy (BSO).

But back to the decision at hand – should you keep your cervix?

There are a range of pros and cons, and it’s a personal decision. It doesn’t affect the complexity or recovery of the surgery majorly, but the best option for you will depend on your individual circumstances.

I was initially scheduled for a hysterectomy due to heavy, painful periods which I’d been suffering for decades and almost daily double-you-over pelvic pain.  I’d already had an Endometrial Ablation and the bleeding had recurred, so hysterectomy was the last option available.

As part of the pre-op, I needed a Pap smear, and luck would have it, the test came back with pre-cancerous cells.  So for me, keeping my cervix wasn’t an option, it needed to be removed.  My pre-cancerous cells were the type that would become cancer, no question.  Just a matter of time.

But before I knew about the pre-cancer of the cervix, I looked at all the options and had decided to remove my cervix anyway.  Below are the pros and cons and my reasons for choosing to have my cervix removed, and also how that turned out, 10 weeks post-op.

 

Reasons to keep your cervix

 

Better sexual function.  Removal of the cervix means a shorter vagina and removal of some sensory tissue, and some surgeons believe this will mean less sexual sensation and less intense orgasms.  The studies don’t back this up and I can say personally, there is no absolutely no difference in sexual function or feeling for me now that my cervix is gone.  In fact, it’s better.  Honestly, I believe that might have more to do with the Hormone Replacement Therapy (HRT) I’m taking, than anything surgical. But for me, removal of my cervix hasn’t changed any sexual sensation or pleasure.

Lower risk of Prolapse.  The cervix is seen by some surgeons as a kind of ‘scaffolding’ to hold up your pelvic organs, and reduce the risk of prolapse later.  Sometimes after hysterectomy, your bladder and/or intestines can ‘drop’ into the vaginal area.  Some surgeons, including mine, believe that leaving the cervix makes this less likely to happen.  I read several studies and the research doesn’t back this up, but anecdotally it does seem to have some backing.  My surgeon was very pro keeping the cervix, and seemed vaguely annoyed that I wanted it removed.  The Pap result made the point moot, but it’s too soon to say if prolapse will ever be a problem for me. I considered the risk low and worth the benefits of removing the cervix.

Lower risk of Incontinence.  Similarly, some surgeons believe that keeping the cervix makes incontinence, or urine leakage on coughing, sneezing or exercise less likely.  Again, the studies don’t back this up.  I’ve had no problems with incontinence, but again, it’s early days. I consider the risk low, however.

 

Reasons to remove your cervix

 

No more pap smears ever.  Except if you’re like me, and you have pre-cancerous cells.  Then, even after your cervix is removed, you need to have the pap smears for an additional five years (assuming they all come back clear).  When you don’t have a cervix, they are called ‘Vault smears’ and the procedure is exactly the same, it’s a simple, if not particularly enjoyable, procedure done in your doctor’s office.

But for most people, those who don’t have pre-cancer or cancer, you never have to have a Pap test again, and you never have to worry about cervical cancer again.  That’s a pretty huge benefit, particularly if you have a family history of gynaecological cancers.

No more bleeding.  If you keep your cervix, there is the possibility of still having periods, albeit far lighter than a ‘normal’ period.  Personally I didn’t see the point of going through such a major surgery and still possibly having periods.  My periods were extremely heavy, and the chances of me still having significant bleeding were significant.  Some women go back for a second surgery to have their cervix removed, due to the bleeding still being heavy enough to be problematic.  I didn’t want to risk that, preferring one surgery and one recovery.

And that’s about it.

For me, even before it was taken out of my hands, the decision was fairly simple.  I didn’t want to go through such a major surgery and still possibly have bleeding and pain, or have to go through another surgery down the track.  And never having to worry about cervical cancer again was a big plus, as was never needing another Pap smear.

Turned out I DO have to worry about cervical cancer for another five years still, but the risk is very low. It’s not exactly on my mind. Ever.  My GP has reminders set and will tell me when I need to come in. I’ll need checks in six months, then a year, then every year after that for five years (assuming all the tests are clear.  If any tests are abnormal, we go back to six monthly).

The hysterectomy (hideous complications aside) was a success and I no longer have any bleeding, pelvic pain (which was severe) or the cyclical mood swings (mid cycle and PMS).  I recovered from the surgery well, and relatively quickly.  Ten weeks out I have no pain, and haven’t had for many weeks. I do have a few numb spots on the front of my thighs, but I had an open surgery and it was a large incision and having some nerve damage is not unusual, it should go back to normal in time.  Even if not, it’s not a big deal.

So while my surgeon’s post op care was appalling and negligent, her surgical skills are sound and I actually wish I’d had the hysterectomy years ago.  I just wish I hadn’t gone to the surgeon I did.

NOTE:  I can’t mention her name here, but if you’re in the Canberra area, and you want to know who I personally would not recommend, send me an email.

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