Supracervical Hysterectomy versus Total Hysterectomy

Filed in archive General Health on November 6, 2007

It's no secret in a few years I'm going to have a hysterectomy. Every woman in my family has had one sometime in their mid-thirties. That number will approach me in six months. The difference between me and the rest of the women in my family is that I have not had any children. And if this is something I would like to do, needless to say, I need to do it as soon as possible.

Doctors can't quite figure out what the problem is with my family. Thyroids, fibroids, and heavy period bleeding have been blamed. But, one thing they do know is that, in all cases, full hysterectomies were needed. For the last few years, I'm weighted the option of supracervical hysterectomy, the same procedure as a total hysterectomy but the cervix stays. But, I may need to rethink that option.

According to a recent study by the American College of Obstetricians and Gynecologists, total hysterectomies are not superior to a total hysterectomy in women with non-cancerous diseases. Even more, women who have retained their cervix could be subject to future problems.

Techniques such as laparascopic vaginal and supracervical hysterectomy are often used as an alternative to total abdominal hysterectomy. In its new Committee Opinion, ACOG reviewed available research comparing supracervical, total abdominal, and laparascopic vaginal hysterectomies. "There has been renewed interest in supracervical hysterectomy as a way to reduce operative complications and reduce the effects of hysterectomy on urinary and sexual function. Unfortunately, these possible benefits are not supported by recent evidence," says Denise J. Jamieson, MD, chair of ACOG's Committee on Gynecologic Practice.

Research shows that the type of hysterectomy did not drastically affect urinary incontinence, urinary frequency, or bladder emptying, though one Danish study found that women with supracervical hysterectomy had higher rates of urinary incontinence than women who had total hysterectomy. Additionally, women gave similar postoperative ratings for measures of sexual function-such as frequency of sex, frequency and quality of orgasm, sexual desire, and body image whether they received supracervical or total abdominal hysterectomy. "Since laparoscopic hysterectomy techniques have not been carefully evaluated in randomized trials, it is unclear how preserving the cervix with laparoscopic techniques might compare in terms of risks and benefits," Dr. Jamieson adds.