Why is the cervix left intact after a hysterectomy?

From the Guidelines

The cervix is often left intact after a hysterectomy to reduce surgical complications and preserve certain anatomical functions, such as maintaining pelvic floor support and potentially preserving sexual function and sensation for some women. This procedure, called a supracervical or subtotal hysterectomy, removes the uterus while leaving the cervix in place. Keeping the cervix can help maintain pelvic floor support, potentially preserving sexual function and sensation for some women. It also results in a less invasive surgery with shorter operating time, less blood loss, and potentially faster recovery. The cervix provides structural support to the vagina and surrounding tissues, helping to prevent vaginal prolapse. However, it's essential to note that leaving the cervix means regular Pap smears are still necessary to monitor for cervical cancer, as recommended by the American Cancer Society guidelines 1.

Some key points to consider when deciding whether to leave the cervix intact include:

• The patient's medical history and risk factors for cervical disease
• The potential benefits of preserving anatomical functions and reducing surgical complications
• The need for ongoing cervical cancer screening, as women with an intact cervix should continue screening until age 70 years, and afterward may elect to stop screening if they have had no abnormal/positive cytology tests within the 10-year period prior to age 70 years 1
• The importance of individualized decision-making, considering factors such as personal preferences and medical history, as emphasized in the guidelines 1

It's also important to note that the decision to remove or retain the cervix should be made on an individual basis, considering the patient's unique circumstances and medical history. Some conditions, like cervical cancer or certain types of endometriosis, would necessitate cervical removal. The American Cancer Society guidelines provide recommendations for cervical cancer screening in women who have undergone a subtotal hysterectomy, emphasizing the importance of ongoing screening for women with an intact cervix 1.

In terms of the benefits and risks of leaving the cervix intact, the evidence suggests that this approach can help reduce surgical complications and preserve anatomical functions, while also allowing for ongoing cervical cancer screening. However, it's essential to weigh these benefits against the potential risks and consider the individual patient's circumstances and medical history. Overall, the decision to leave the cervix intact after a hysterectomy should be made on a case-by-case basis, taking into account the patient's unique needs and circumstances, and in accordance with the latest guidelines and evidence 1.

From the Research

Reasons for Leaving the Cervix Intact After Hysterectomy

• The decision to leave the cervix intact after a hysterectomy is based on various factors, including the type of hysterectomy, the patient's overall health, and the reason for the hysterectomy 2, 3.
• Some studies suggest that leaving the cervix intact may help preserve sexual function and reduce the risk of urinary incontinence 2, 4.
• However, other studies have found that removing the cervix may reduce the risk of cervical cancer and the need for future surgeries 3.
• The patient's preferences and values should also be taken into account when making this decision, as some women may prefer to retain their cervix for personal or emotional reasons 5.

Potential Risks and Benefits

• Leaving the cervix intact may increase the risk of cervical cancer and the need for future surgeries 3.
• Removing the cervix may reduce the risk of cervical cancer, but may also increase the risk of short-term complications, such as bleeding and infection 3.
• The type of hysterectomy performed, such as total abdominal hysterectomy or supracervical hysterectomy, may also impact the decision to leave the cervix intact 2, 4.
• Patient-centered surgical counseling can help inform patients about the potential risks and benefits of leaving the cervix intact or removing it 5.

Clinical Practice Guidelines

• The French College of Gynecologists and Obstetricians recommends removing the cervix during hysterectomy for benign uterine disease, citing a reduced risk of cervical cancer and future surgeries 3.
• The Canadian Task Force on Preventive Health Care recommends that women considering hysterectomy be informed about the potential benefits and risks of leaving the cervix intact or removing it 2.
• Clinical practice guidelines should be based on the best available evidence and take into account patient preferences and values 3, 5.