Doctors Debate What To Remove During Hysterectomies

Several new studies are challenging previously held beliefs about hysterectomies; specifically, some experts claim that removing the cervix and the ovaries could be detrimental to both a woman’s health and her sex life.

Hysterectomies are the second most common surgical procedure for women of reproductive age (the first being cesarean sections). By the age of 60, nearly a third of all American woman will have had the surgery. It is estimated that 600,000 hysterectomies are performed in the U.S. each year, giving America one of the highest hysterectomy rates. Some argue that American doctors are way too likely to chose a hysterectomy over alternative procedures, and that up to two thirds of the women who received hysterectomies did not actually need them.

There is also some debate among doctors over what exactly needs to be removed during a hysterectomy. While most doctors remove the cervix along with the uterus, experts assert that doing so may increase the risk of damage to the bladder and nearby nerves. Just as important is the possibility that preserving the cervix may allow many women to enjoy better post-procedure sex lives:

Some researchers believe that for at least some women, the cervix may contribute to sexual pleasure; doctors also say leaving it in place makes it easier to avoid unwittingly shortening the vaginal canal. A 212-patient Finnish study from 1983 found pain upon intercourse pre-hysterectomy was better relieved by a cervix-sparing procedure. A parallel study, involving the same women, found the frequency of orgasms decreased in women who had their cervix removed but not in those who didn’t.

However, these claims are not without controversy. Some doctors still believe that there is no solid reason to spare the cervix, and that removing the cervix can help patients avoid cancer, frequent pap smears, and spotting.

A similar question has been raised about the preservation of the ovaries, reports Newsweek. Two new studies suggest that, among women with stage one endometrial cancer, there are similar survival rates for those who have their ovaries removed along with the uterus, and those who choose to keep their ovaries. There may also be health benefits to keeping the ovaries intact: estrogen produced by the ovaries can help protect against heart disease and thinning bones. Furthermore, women who had their ovaries removed before menopause have a greater chance of developing dementia or other memory problems.

Dr. Seth Kivnick from the Kaiser Foundation Hospital in West Los Angeles stresses the importance of letting a woman decide for herself whether or not she would like to keep her cervix: “When you give women the choice, and you tell them the pros and cons, many of them find the idea of keeping the cervix very appealing.”

The Debate Over Sparing the Cervix In Hysterectomies [WSJ]
Female Trouble [Newsweek]
Experts: Two-thirds Of Hysterectomies Unnecessary [CNN]