Choosing to Preserve the Cervix When the Uterus Is Surgically Removed
In a Complete Hysterectomy, both the Uterus and Cervix are removed to afford symptomatic relief to the patient. When the Cervix remains in the pelvic region after surgery, it then becomes a Partial or Supracervical hysterectomy. The kind of surgery that one opts for is wholly dependent on the health of the reproductive organs, and whether the dominant medical opinion says that Cervix should be spared.
The Reasons Generally Prompting a Hysterectomy
Hysterectomy is second only to Cesarean delivery as one of the most common surgical practices resorted to by American women. Cancer, Endometriosis (outgrowths of the uterine lining), unusually intense Vaginal bleeding, fibroid masses in the Uterus, and Uterine Prolapse (sagging) are some of the reasons why women opt for surgical elimination of the Uterus. Sometimes, the connecting organs such as the Cervix, Fallopian Tubes and Ovaries are also removed during surgery to obtain relief from symptoms.
Decision to Remove or Retain the Cervix
The decision whether to remove or retain the Cervix in Hysterectomy is an intensely personal choice that women ought to exercise only after weighing the pros and cons, and after deciding what is best suited to their medical condition. The threat of cancer is perhaps the sole exception that makes women brook no delay in removal of the Cervix. In all other instances, a reasoned decision can be taken in consultation with an experienced Gynecologist or Gynecological Oncologist.
Factors that Prompt the Removal of the Cervix in Total Hysterectomy
In a Complete Hysterectomy, the Uterus and Cervix and possibly some other associated organs like the Ovaries and Fallopian Tubes are removed. The following factors generally seal the decision to do a Complete Hysterectomy.
- Presence of abnormal cells in the Cervix determined through Pap Smear Screening. This usually happens after prolonged infection by the Human Papillomavirus (HPV). If Cervical Cancer is detected at an advanced stage, removal of the organ becomes inevitable to prevent the spread of cancer.
- Sagging downward of the Uterus in severe cases of Uterine Prolapse, weakening or causing partial damage to the Cervix. Affected women generally feel a kind of fullness in the Vagina or the sensation that something is about to fall through it. In severe instances, Uterine Prolapse causes Pelvic pain and distresses surrounding organs such as the Urinary Bladder and the Rectum which begin to dysfunction.
- Non-cancerous Polyps or outgrowths in the Cervix. These may trigger heavy bleeding through the Vagina. A complete Hysterectomy offers the only option to get relief from symptoms.
Reasons Why the Cervix Is Preserved in Partial Hysterectomy
The Cervix is the narrow thickened corridor between the Uterus and the Vaginal passage. The lining of the Cervix exudes a thick mucus that keeps the passageway moist, and the cervical opening dilates to eject Menstrual waste blood in monthly cycles. The Cervix also widens proportionately to enable the smooth exit of the baby during delivery.
In the majority of Hysterectomies, the Cervix, if healthy, is left untouched. The surgeon will be focused solely on removing the source of the patient’s distress (mostly the Uterus).
It is widely believed that preservation of the Cervix enhances sexual gratification by leaving more tissue and nerve receptors behind that are sensitized to sexual impulses.
In the absence of the Cervix, the Vaginal Canal shortens and this may impact sexual performance. The Penis may also chaff the upper Vaginal Wall causing the Cervix to weaken and collapse.
How Partial Hysterectomy Is Performed
For the Gynecologist, there are three methods for removing the troublesome Uterus without touching the Cervix.
1. Through the tummy: If the Uterus is abnormally enlarged, the surgeon performs a plus signed incision just below the Belly Button and above the Pubic Bone. Under the influence of general Anesthesia, the patient sleeps through the entire procedure, unaware of the operation and without feeling any pain.
Post-operative recovery may take a couple of hours in healthy patients that can be discharged the same day as the Hysterectomy operation. It may require a couple of days of close medical supervision in instances where the patient suffers from Diabetes, Chronic Hypertension and cardiac issues that delay or complicate healing and recovery.
2. Through the vagina: If the uterus is manageably small and ailments are non-cancerous, the surgeon opts to perform surgery through the upper Vaginal Wall. Many patients prefer this type of surgery as the procedure does not scar the body externally. The only drawback is avoidance of Vaginal sex for a period up to six weeks to enable complete healing.
3. Through keyhole surgery: Normally, three small cuts are made in the Navel, through which tiny surgical scopes and instruments are inserted to assist Hysterectomy using on-site 3D visualization techniques. The surgeon is actually in a position to view the abdominal organs closely and take corrective measures quickly and safely without fearing complications.
In situations where the surgeon visualizes an exceptionally enlarged Fibroid-filled Uterus, a Morcellator may be used to mince and cut up the Uterus into smaller bits that are then sucked out instantaneously via tubes inserted through the Navel incisions.
The Benefits of Laparoscopic Surgery
Laparoscopy is a minimally invasive revolution in surgical techniques, and a much sought after solution because of its speed and accuracy and the near total avoidance of complications. For the patient, nothing beats the comfort of being discharged on the same day of operation, and being able to rest and recuperate in the comfort of one’s home without greatly disturbing the daily routine and rhythm.
Risks Associated With Partial Hysterectomy
Possibility of damaging Pelvic organs
The biggest risk is the threat of damage to Pelvic organs, notably the Ureters, Urinary Bladder, and the Rectum. Perforation of Pelvic organs may later develop into full blown infection within the Peritoneal Cavity, the space separating the abdominal organs. The risk is considerably reduced if women opt for minimally invasive surgeries like Laparoscopy. The constraining factor is almost always the availability of surgeons that are sufficiently skilled in Laparoscopy.
Leaving the cervix may invite the risk of cervical cancer
Leaving the cervix in place does little to reduce the risk of developing cervical cancer at later stages by exposure to the following risk factors.
- Infection through the Human Papilloma Virus, the main route through which Cervical Cancer spreads.
- Sexual promiscuity leading to transmission of sexual diseases like Genital Herpes and Chlamydia.
- Likelihood of developing Squamous Cell type of Cervical Cancer for women who smoke.
- Diseases like HIV/AIDS or certain drugs that are taken after organ transplantation which trigger Cervical Cancer because of a weakened immune system.
The threat of developing cancer at later stages in a woman’s life is one of the main reasons why doctors recommend women to go for Total Hysterectomy involving removal of the Cervix along with the Uterus.
The emotional damage and aftermath of surgery
The loss of the Uterus can leave psychological scars that heal much slower than the body. The clouds of depression gather mainly because the woman rues her inability to have menses or to bear children, and many sense the loss of their femininity even though that is not true. The problem may worsen if normal post-operative anxiety gives way to chronic depression. Each individual needs to trust her innate wisdom to come up with the right solutions and find comfort within her family and social support group.
- When the Uterus removal operation is performed by leaving the Cervix intact, it becomes a partial or Supracervical Hysterectomy.
- A Partial Hysterectomy leaves the Cervix behind which does little to reduce the risk of developing Cervical Cancer at later stages.
- The loss of the Uterus can leave psychological scars that heal much slower than the body.