A hysterectomy always removes the uterus, but depending on the type of procedure and the reason for surgery, it may also involve the cervix, fallopian tubes, ovaries, and surrounding tissue. What actually gets taken out varies significantly from one person to the next, and understanding the differences can help you make sense of what your surgeon is recommending.
The Three Main Types
There are three primary categories of hysterectomy, each defined by how much tissue is removed:
- Supracervical (partial) hysterectomy: The upper portion of the uterus is removed, but the cervix stays in place.
- Total hysterectomy: Both the uterus and cervix are removed entirely. This is the most common type.
- Radical hysterectomy: The uterus, cervix, and the connective tissue surrounding the uterus (called the parametrium) are all removed. Pelvic lymph nodes are typically taken as well. This version is reserved for cancer cases.
In all three types, the surgeon separates the uterus from the ovaries, fallopian tubes, upper vagina, blood vessels, and the connective tissue that holds it in place. The ovaries and fallopian tubes are not automatically removed in any of these procedures. Taking them out is a separate decision made based on your age, cancer risk, and overall health.
Why the Cervix Matters
One of the biggest decisions in a non-cancer hysterectomy is whether to keep or remove the cervix. In a supracervical hysterectomy, the cervix is left behind. In a total hysterectomy, it comes out with the rest of the uterus.
Keeping the cervix has potential benefits. Because the surgery disrupts fewer nerves and ligaments, some data suggest it may preserve sexual sensation and reduce the risk of pelvic organ prolapse and urinary incontinence afterward. That said, these advantages are still debated among surgeons. If the cervix stays, you’ll still need routine Pap smears to screen for cervical cancer. Removing it eliminates that need entirely.
For certain patients, particularly those with ovarian cancer, leaving the cervix in place can be a safer choice if removing it would increase the risk of bladder injury or prolapse.
What Happens to the Ovaries
Removing the ovaries is not part of a hysterectomy by definition. It’s a separate procedure (called an oophorectomy) that may or may not be done at the same time. Your surgeon might recommend removing them if you have a high genetic risk for ovarian cancer, endometriosis affecting the ovaries, or certain hormone-sensitive conditions. Otherwise, especially for premenopausal women, the ovaries are often preserved to maintain natural hormone production.
A common concern is whether removing the uterus damages the ovaries even when they’re left in place. The uterine artery supplies some blood to the ovaries, and cutting it during surgery could theoretically reduce ovarian blood flow. Research tracking ovarian function after hysterectomy found that blood flow to the ovaries and markers of ovarian reserve remained stable for at least three months after surgery. However, some longer-term studies have raised the possibility that hysterectomy could contribute to earlier menopause, though the evidence is mixed. If you’re premenopausal and keeping your ovaries, this is worth discussing with your surgeon.
What a Radical Hysterectomy Adds
A radical hysterectomy goes well beyond what the other types involve. In addition to the uterus and cervix, the surgeon removes the parametrium, which is the band of connective tissue and ligaments that anchors the uterus to the pelvic wall. The uterosacral ligaments, which help support the uterus from behind, are also taken. Pelvic lymph nodes, including those in the obturator fossa (a space deep in the pelvis), are dissected and removed so they can be checked for cancer spread.
This more extensive tissue removal is why radical hysterectomies carry higher risks of nerve damage, bladder dysfunction, and longer recovery times compared to total or supracervical procedures. They are performed almost exclusively for cervical cancer and select cases of early-stage uterine cancer.
How the Body Is Closed Afterward
When the cervix is removed in a total or radical hysterectomy, the top of the vagina is left open where the cervix used to be. The surgeon closes this opening by stitching the vaginal walls together to create what’s called a vaginal cuff. This is done with dissolvable sutures that incorporate the full thickness of the vaginal tissue. Once healed (typically over six to eight weeks), the cuff forms a sealed end to the vaginal canal. The vagina itself is not shortened in a meaningful way for most patients.
In a supracervical hysterectomy, no vaginal cuff is needed because the cervix remains and continues to serve as the natural boundary between the vaginal canal and the pelvic cavity.
The Fallopian Tubes
Even when the ovaries are preserved, many surgeons now recommend removing the fallopian tubes during a hysterectomy. Growing evidence suggests that the most common type of ovarian cancer actually originates in the fallopian tubes, not the ovaries themselves. Removing the tubes while leaving the ovaries in place eliminates a potential cancer source without affecting hormone production or triggering menopause. This has become increasingly standard practice, though it’s still a conversation between you and your surgeon rather than an automatic step.