supracervical

[Guest guest]

Sometimes the cervix is removed in hysterectomy because it is diseased, but

usually this is an optional procedure (as hysterectomy itself often is - we in

this group know that there are usually other ways to deal with gynecological

problems). Recently there was an interesting item in the Woman's Diagnostic

Cyber Newsletter. concerning the pros and cons of subtotal hyst, total hyst and

total hyst plus oophorectomy (removing ovaries). The " Reader submitted Q & A -

Ovary, cervix removal at 50 " seems on balance to be in favour of total

hysterectomy and, with women that age, oophorectomy. The woman has both fibroids

and adenomyosis and wonders if she can have her uterus removed without losing

her cervix and ovary. The doctor says this is indeed possible but that total

hyst & bhs would lessen her risk of future cancers. Dr Jelovsek also writes:

" Most gynecologic surgeons who are old enough to

have performed moderate numbers of both total and

subtotal hysterectomies will tell you that more

women in the years post follow-up regret not

having the ovary or ovaries removed (over age 45)

and not having the cervix removed, than regret

having them removed. I do not think these doctors

are perceiving these complaints erroneously. "

I'm not convinced by that one. The doctors are going to hear from the women who

keep their parts and then have further problems and require additional surgery.

The women who have total hysterectomy are hardly likely to return and say, " I

wish I could have my cervix back " .

But the doctor does present an interesting case of a woman who has been having

sexual problems related to her subtotal hysterectomy. Here is the relevant

paragraph in its entirety:

" The main negative from removing the cervix is that

orgasm with intercourse can change. It is not

noted as less pleasurable but the fine uterine

contractions that are sometimes present with

orgasm either change or go away. A recent patient

of mine was concerned about this and asked for

just a subtotal hysterectomy. Unfortunately

postoperatively she actually complained of a new

pain with intercourse after her subtotal

hysterectomy. I do not know the cause of the pain

but it is reproducible by moving the cervix on

pelvic exam. It may be because of adenomyosis of

the cervix or perhaps the stitches that are

suspending the cervix to keep it from prolapsing

may be putting a stretch on the ligaments that the

woman is not used to. I only relate this to you

as an example that we still do not have all the

answers about how surgery affects each individual

person and there can be other disadvantages to

leaving the cervix in. Truthfully, no one yet

knows whether the chance of painful intercourse is

higher after removal of the cervix with

hysterectomy or higher after a subtotal

hysterectomy. "

see the entire item in the Woman's Diagnostic Cyber Newsletter - December 16,

2001

http://www.wdxcyber.com/emsample.htm

(also see Nov 18, 2001 issue for an item on uterine fibroids)

[Guest guest]

Sometimes the cervix is removed in hysterectomy because it is diseased, but

usually this is an optional procedure (as hysterectomy itself often is - we in

this group know that there are usually other ways to deal with gynecological

problems). Recently there was an interesting item in the Woman's Diagnostic

Cyber Newsletter. concerning the pros and cons of subtotal hyst, total hyst and

total hyst plus oophorectomy (removing ovaries). The " Reader submitted Q & A -

Ovary, cervix removal at 50 " seems on balance to be in favour of total

hysterectomy and, with women that age, oophorectomy. The woman has both fibroids

and adenomyosis and wonders if she can have her uterus removed without losing

her cervix and ovary. The doctor says this is indeed possible but that total

hyst & bhs would lessen her risk of future cancers. Dr Jelovsek also writes:

" Most gynecologic surgeons who are old enough to

have performed moderate numbers of both total and

subtotal hysterectomies will tell you that more

women in the years post follow-up regret not

having the ovary or ovaries removed (over age 45)

and not having the cervix removed, than regret

having them removed. I do not think these doctors

are perceiving these complaints erroneously. "

I'm not convinced by that one. The doctors are going to hear from the women who

keep their parts and then have further problems and require additional surgery.

The women who have total hysterectomy are hardly likely to return and say, " I

wish I could have my cervix back " .

But the doctor does present an interesting case of a woman who has been having

sexual problems related to her subtotal hysterectomy. Here is the relevant

paragraph in its entirety:

" The main negative from removing the cervix is that

orgasm with intercourse can change. It is not

noted as less pleasurable but the fine uterine

contractions that are sometimes present with

orgasm either change or go away. A recent patient

of mine was concerned about this and asked for

just a subtotal hysterectomy. Unfortunately

postoperatively she actually complained of a new

pain with intercourse after her subtotal

hysterectomy. I do not know the cause of the pain

but it is reproducible by moving the cervix on

pelvic exam. It may be because of adenomyosis of

the cervix or perhaps the stitches that are

suspending the cervix to keep it from prolapsing

may be putting a stretch on the ligaments that the

woman is not used to. I only relate this to you

as an example that we still do not have all the

answers about how surgery affects each individual

person and there can be other disadvantages to

leaving the cervix in. Truthfully, no one yet

knows whether the chance of painful intercourse is

higher after removal of the cervix with

hysterectomy or higher after a subtotal

hysterectomy. "

see the entire item in the Woman's Diagnostic Cyber Newsletter - December 16,

2001

http://www.wdxcyber.com/emsample.htm

(also see Nov 18, 2001 issue for an item on uterine fibroids)

[Guest guest]

My understanding is that supracervical was actually the original form of

hysterectomy!

As surgical techniques " improved " , surgeons started taking out the cervix as

well, as a prophylactic measure against cervical cancer. But with advances

in

cancer screening, supracervical hysterectomy is regaining popularity because

as Joy wrote in her letter, the cervix helps provide pelvic floor support.

from: Winn. " Well Woman Handbook " . London: Vermillion, 1995 - -

" Sub-total or partial hysterectomy: Removal of the body of the womb,

leaving the cervix in place. This operation is not very common now, because

the cervix is viewed as a potential site for cancer and the thinking is that

it might well be removed at the same time. However, the surgeon doesn't have

to cut into and then stitch the vagina, and it is quicker to recover from.

Also, many women find the cervix plays a role in sexual arousal.

" If you are advised to have a hysterectomy but do not want to lose your

cervix, ask for it to be left in place. Unless a surgeon has very good

reasons for wanting the cervix removed, your views should be respected.

Regular cervical smears are recommended whether or not you keep your cervix

after hysterectomy. "

How do you have a cervical smear without a cervix? Though I have read that a

small bit of the cervix may be left intact even in the so-called total

hysterectomy.

Some sources suggest only that you continue to need smears if you have a

supracervical (same as " sub-total " ) hysterectomy. Anyone in the group with

total hysterectomy - what were you advised about future smears? (Beware of

errors in the Winn book. I've noted a few. There's a serious mistake

in the fibroids section: " In very rare cases a fibroid may become a

malignant very fast-growing tumour of the smooth muscle of the uterus, known

as a leiomyoma. " That would be very frightening to any woman whose fibroids

were described as " myoma " - which all fibroids are. The malignant tumours

are sarcoma. I don't think it's known for sure whether or not the malignant

tumours derive from benign fibroids.

Original messages (two):

Date: Wed, 30 Jan 2002 10:09:52 -0800 (PST)

From: joy jones

Subject: Re: Re: When to take action

Anne,

A supracervical hyst involves taking the uterus but leaving the cervix (and

tubes and ovaries unless there is a reason to take them). My Dr. said that

leaving the cervix provides better pelvic floor support and of course there

is no

problem with a tight vaginal cuff afterward as when the cervix is removed.

Date: Wed, 30 Jan 2002 13:20:32 EST From:hummingbird10458

Subject: Re:hysterectomy

joy - thanks so much for the information on this type of surgery. a

supracervical hysterectomy is something ive never heard of.