Hysterectomy

Hysterectomy is one of the most common surgeries performed in the United States.

A hysterectomy is the surgical removal of the uterus. There are some variations of hysterectomy, but in general, I perform a total hysterectomy with bilateral salpingectomy. This means that the uterus, cervix, and both fallopian tubes are removed entirely.

A hysterectomy can be performed in many ways: abdominally (with a big incision) or with minimally invasive techniques that minimize incisions. Learn more about each option below:

· Laparoscopic hysterectomy (1 – 4 small incisions)

· Robotic-assisted laparoscopic hysterectomy (1 – 4 small incisions)

· Vaginal hysterectomy (no incisions)

The benefit of minimally invasive surgery is that there is less pain, recovery is faster, and risk of complications like infection is lower.

Research has shown that removing the fallopian tubes at time of hysterectomy decreases the risk of future ovarian cancer by half. Scientists strongly believe that the origin of early ovarian cancer might actually be in the ends of the fallopian tubes. Thus, if fertility is no longer desired, removing the fallopian tubes at time of surgery (also called “opportunistic salpingectomy”) is a smart move. 

Short answer: in most cases, no. 

Nowadays, supracervical hysterectomy (removing just the body of the uterus and leaving the cervix behind) is somewhat uncommon. However, this type of hysterectomy remains appropriate for women undergoing prolapse surgery.

Otherwise, there are many benefits to removing the cervix. If the cervix is removed, the risk of cervical cancer is greatly decreased. In most cases, you will not need to have pap smears in the future.

There are downsides to keeping the cervix. Some women who keep their cervix will continue to have irregular bleeding, which can be annoying. 

Women who undergo hysterectomy as part of their treatment for chronic pelvic pain may continue to have some pelvic pain related to their cervix. Indeed, research shows that many of these women go on to have additional surgery to remove the cervical stump. This surgery, called a trachelectomy, is a more challenging surgery. 

Most women have very reasonable concerns about having a hysterectomy. Some of the most common concerns I am asked about are listed below.

Hysterectomy (with or without removal of the fallopian tubes) will not affect your ovaries. Your ovaries will continue to function and produce your normal hormones and you will not need any supplementation. Age of menopause is also not affected.

Hysterectomy should not change your sexual satisfaction or experience. In fact, it may improve it! If the reason for hysterectomy was heavy menstrual bleeding, adenomyosis, dysmenorrhea, or chronic pelvic pain, you might find that your sex life improves once the source of pain is gone.

Specifically, removal of the cervix should not change your sexual satisfaction or experience. No one but your gynecologist during a well woman exam will be able to tell that the cervix was surgically removed. 

Removal of the cervix, or hysterectomy itself, should not alter your future risk of pelvic organ prolapse.