The cervix is a muscular, tunnel-like organ forming the lower, narrow end of the uterus, connecting it to the vagina. Often described as the “neck” of the uterus, it allows the passage of menstrual blood and facilitates sperm travel. During pregnancy, the cervix acts as a barrier to protect the fetus, later softening and dilating to allow delivery. The cervix can be removed; this procedure is medically possible and is typically performed as a component of a larger surgery for several reasons.
The Medical Necessity for Cervical Removal
The primary reasons for removing the cervix relate to the diagnosis and treatment of cancer or precancerous conditions. Cervical cancer, often caused by the Human Papillomavirus (HPV), is a major indication for surgical removal of the cervix and often the entire uterus. The tumor’s stage and size dictate the extent of the required procedure.
A common necessity involves high-grade cervical intraepithelial neoplasia (CIN) or adenocarcinoma in situ, which are severe precancerous lesions that carry a high risk of progressing to invasive cancer. When these abnormal cells are extensive or recur after less invasive treatments, removing the cervix ensures the complete eradication of the diseased tissue. Furthermore, non-cervical conditions can also lead to its removal; for instance, a total hysterectomy performed for severe uterine fibroids, untreatable hemorrhage, or uterine prolapse includes the cervix as part of the removed organ.
In cases of early-stage cervical cancer, the removal of the cervix along with surrounding tissue is considered standard of care to achieve clear surgical margins. This removal is often necessary because cervical cancer is likely to spread locally into the vaginal vault and surrounding ligaments. Ensuring that all affected tissue is removed is the main clinical justification for the procedure.
Surgical Methods for Cervix Removal
The cervix is most frequently removed as part of a total hysterectomy, which involves the surgical removal of both the uterus and the cervix. This contrasts with a supracervical or subtotal hysterectomy, where the uterus is removed but the cervix is left in place. A more extensive procedure, the radical hysterectomy, is often performed for invasive cervical cancer, removing the uterus, cervix, and surrounding structures like the upper vagina and supporting ligaments.
For individuals with early-stage cervical cancer who wish to maintain the ability to become pregnant, a distinct surgery called a radical trachelectomy is performed. This procedure focuses exclusively on removing the cervix, the upper portion of the vagina, and nearby lymph nodes, leaving the main body of the uterus intact. The trachelectomy can be performed through a vaginal approach, an abdominal incision, or using minimally invasive techniques like laparoscopy or robotic surgery.
Minimally invasive approaches often result in reduced blood loss and a shorter hospital stay. However, the abdominal approach is sometimes preferred for certain cancer surgeries due to concerns over recurrence rates. The choice between these methods depends on the medical condition, the stage of disease, and the individual’s reproductive plans.
Impact on Future Pregnancy and Fertility
The effect of cervical removal on the ability to carry a pregnancy depends entirely on whether the uterus was also removed. Following a total hysterectomy, where both the uterus and cervix are excised, biological pregnancy is no longer possible. This is because the uterus is the organ necessary for a fetus to develop.
For those who undergo a radical trachelectomy, where the cervix is removed but the uterus remains, fertility is preserved, but future pregnancies are high-risk. The loss of the cervix means the uterine opening lacks its natural structural support and barrier function, a condition known as cervical incompetence. To counteract this, a permanent suture, known as a cerclage, is typically placed at the remaining base of the uterus during the trachelectomy.
This cerclage acts as mechanical support to help hold the pregnancy within the uterus. Even with this measure, there is an increased risk of mid-trimester miscarriage and premature birth. All deliveries following a trachelectomy must be performed via cesarean section, as the remaining uterine segment cannot safely dilate for a vaginal birth. Live birth rates after trachelectomy can reach acceptable levels, making it a viable fertility-sparing option for selected patients.
Post-Surgical Physical Changes
The physical changes following cervical removal relate to the cessation of reproductive functions and the alteration of pelvic anatomy. If the cervix was removed as part of a total hysterectomy, menstruation ceases entirely because the uterine lining is no longer present. However, if a person only undergoes a trachelectomy, the uterus remains and regular menstrual bleeding will continue, though the flow may be altered.
A common anatomical change after a total hysterectomy is the creation of a vaginal cuff, where the top of the vagina is surgically stitched closed. Concerns about sexual function, including sensation and libido, are common, but the cervix plays a minor role in sexual pleasure. Most individuals report little to no negative change in sexual sensation, and for those who previously experienced pain due to the underlying condition, sexual health may actually improve after surgery.
The cervix contributes to pelvic floor support, but its removal generally does not significantly increase the long-term risk of pelvic organ prolapse beyond the risk associated with a standard hysterectomy. Some patients may experience temporary changes in bladder or bowel function immediately post-surgery due to the operation’s proximity. These issues often resolve as the body heals. Overall, physical recovery and long-term adjustment are generally positive, especially when the surgery resolves chronic pain or eliminates a serious health threat.