A hysterectomy is a surgical procedure involving the removal of the uterus. The cervix is the lower, narrow part of the uterus that connects to the vagina, and its removal depends entirely on the specific type of procedure performed. The decision to retain or remove the cervix impacts subsequent anatomical changes and future health screening requirements.
The Defining Difference in Hysterectomy Types
The presence or absence of the cervix is determined by the distinction between a total and a supracervical procedure. A total hysterectomy involves the removal of the entire uterus, including the cervix. This approach is often the standard choice, especially if there is a history of abnormal cervical cells, existing cervical disease, or for cancer prevention.
Conversely, a supracervical hysterectomy, sometimes called a partial or subtotal hysterectomy, removes only the upper portion of the uterus, leaving the cervix in place. Surgeons may opt for this type to reduce operative time, potentially resulting in a shorter recovery period. If the cervix remains, the patient may still experience light, cyclic bleeding or spotting because some endometrial tissue within the cervical canal may persist. Leaving the cervix intact means that the risk of developing cervical cancer remains.
The choice between these two types is a joint decision made by the patient and surgeon, weighing factors like medical history, the reason for the surgery, and personal preferences. For instance, a history of abnormal Pap smears usually makes the removal of the cervix medically advisable. Studies have shown that retaining the cervix does not offer a clear benefit regarding sexual satisfaction or improved pelvic floor support compared to removing it.
Understanding the Vaginal Cuff
When a total hysterectomy is performed and the cervix is removed, a structure called the vaginal cuff is created. The cuff is the surgical closure point at the top of the vagina, where the cervix was previously attached. The surgeon closes this opening by stitching the edges of the vaginal canal, sealing off the top of the vagina from the abdominal cavity. This strong area of scar tissue provides structural support to pelvic organs, such as the bladder and rectum. Sexual activity is generally resumed once healing is complete, typically around 10 to 12 weeks post-operation.
Health Screening Needs After Surgery
The need for continued cancer screening post-hysterectomy is directly linked to whether the cervix was removed and the patient’s medical history. If a supracervical hysterectomy was performed and the cervix remains, the patient must continue to undergo regular cervical cancer screening, traditionally known as a Pap smear. For patients who have undergone a total hysterectomy, routine Pap smears are generally no longer required if the surgery was performed for benign conditions and they have a history of normal test results. However, a specific screening called a vaginal vault smear, or vaginal cytology, is sometimes recommended if the patient had a history of high-grade pre-cancerous cells or cancer in the cervix or vagina. This vault smear collects cells from the vaginal cuff to monitor for the development of vaginal intraepithelial neoplasia (VAIN).