A hysterectomy always removes the uterus, but depending on the type of procedure, it may also include the cervix, fallopian tubes, ovaries, or surrounding tissue. What exactly comes out depends on the medical reason for surgery and the specific type of hysterectomy your surgeon recommends.
The Three Main Types
There are three distinct levels of hysterectomy, each defined by how much tissue is removed:
- Partial (supracervical) hysterectomy: removes only the uterus, leaving the cervix in place.
- Total hysterectomy: removes the uterus and the cervix. This is the most common type.
- Radical hysterectomy: removes the uterus, cervix, the upper one-third to one-half of the vagina, surrounding connective tissue (called the parametrium), and nearby lymph nodes. This is typically reserved for cancer treatment.
In all three types, the ovaries and fallopian tubes are not automatically removed. Those are separate decisions made based on your age, cancer risk, and the condition being treated.
When Ovaries and Fallopian Tubes Come Out Too
Removing one or both ovaries alongside the uterus is called an oophorectomy. Removing the fallopian tubes is called a salpingectomy. These are add-on procedures, not part of the hysterectomy itself, but they’re performed during the same surgery when needed.
Ovaries are more likely to be removed when you have ovarian cancer, a high genetic risk for ovarian or breast cancer, endometriosis involving the ovaries, or ovarian cysts that need treatment. For people who haven’t yet reached menopause, surgeons generally try to preserve the ovaries because they produce hormones that protect bone density, heart health, and overall well-being. Losing both ovaries before natural menopause triggers surgical menopause immediately.
Fallopian tube removal has become increasingly common even when there’s no problem with the tubes themselves. The American College of Obstetricians and Gynecologists recognizes “opportunistic salpingectomy,” the preventive removal of fallopian tubes during a hysterectomy in average-risk women, because research suggests some ovarian cancers actually originate in the fallopian tubes. Removing the tubes doesn’t trigger menopause, since the ovaries remain.
Why the Reason for Surgery Shapes What’s Removed
The underlying condition drives the surgical plan. Common reasons for hysterectomy include fibroids, abnormal or heavy bleeding, endometriosis, adenomyosis, uterine prolapse, painful periods, and gynecologic cancers. Hysterectomy is also performed as part of gender-affirming surgery for some transgender men and nonbinary individuals.
For benign conditions like fibroids or heavy bleeding, a total or partial hysterectomy is usually sufficient, and the ovaries stay. Cancer changes the equation. Cervical or endometrial cancer may require a radical hysterectomy, which takes a wider margin of tissue including the upper vagina, the ligaments that anchor the uterus to the pelvis (the cardinal, sacrouterine, and vesicouterine ligaments), and pelvic lymph nodes. That broader removal helps ensure cancerous tissue doesn’t remain. Ovarian cancer typically means the ovaries, fallopian tubes, and uterus all come out.
Keeping vs. Removing the Cervix
When a partial hysterectomy is an option, some people prefer to keep the cervix. In the 1990s, smaller studies suggested that removing the cervix could lead to worse sexual function, pelvic organ prolapse, or urinary problems. That fueled a wave of interest in the supracervical approach.
Longer-term evidence tells a different story. A trial with nine years of follow-up found no significant differences between the two groups in prolapse symptoms, bladder pain, urinary urgency, frequency, or incontinence. Quality of life scores were essentially the same. There was no difference in feelings of attractiveness or femininity. Women who had a total hysterectomy actually showed a significant improvement in their ability to have and enjoy sex.
Keeping the cervix does come with trade-offs. An important minority of women experience persistent vaginal bleeding from the cervical stump, and in one retrospective series, up to 22% eventually needed a second surgery to remove it. If you keep your cervix, you’ll also still need routine Pap smears to screen for cervical cancer.
How the Uterus Is Physically Removed
The type of hysterectomy (what’s removed) is a separate decision from the surgical approach (how it’s removed). There are several routes:
In a vaginal hysterectomy, the surgeon works entirely through the vagina, freeing the uterus from its blood supply and surrounding structures, then pulling it out through the vaginal opening. If the uterus is too large, the surgeon may cut it into smaller pieces to extract it. This approach has the fewest complications and fastest recovery.
In a laparoscopic hysterectomy, the surgeon makes a few small incisions in the abdomen and uses a camera and long instruments to detach the uterus, which is then removed either through those small openings or through the vagina. Robotic-assisted surgery works the same way, with the surgeon controlling robotic arms for more precise movement. Some people go home the same day.
An abdominal hysterectomy uses a larger incision across the lower belly, either horizontal (near the pubic bone) or vertical (extending toward or past the belly button). This approach gives the surgeon the most direct access and is sometimes necessary for very large fibroids, extensive scar tissue, or cancer surgery that requires wide tissue removal.
Recovery by Surgical Approach
Overall recovery takes four to six weeks, but the approach matters. Vaginal and laparoscopic procedures recover fastest, typically in two to four weeks, and many people go home the same day. Abdominal hysterectomy generally requires two or three nights in the hospital and up to six weeks for full recovery.
Sexual Function After Hysterectomy
For most people having a total or partial hysterectomy for benign conditions, sexual function stays the same or improves, often because the pain or heavy bleeding that prompted surgery is gone. Radical hysterectomy is a different situation. Because it removes the upper vagina and surrounding tissue, it can cause vaginal shortening, reduced lubrication, and decreased sensation in the vaginal walls. Studies of women who had radical hysterectomy for early-stage cervical cancer found more pain during intercourse, difficulty with orgasm, and numbness around the labia, with some effects lasting well beyond two years.
The distinction matters: the more tissue removed, the greater the potential impact on sensation and comfort. If you’re facing a radical procedure, this is worth discussing in detail with your surgeon so you know what to expect and what rehabilitation options exist.