Pro & Con: is supracervical hysterectomy a reasonable option for most women? (Opinion).

YES

The amount of scientific data supporting this opinion are relatively limited. There is an inherent bias toward doing a total hysterectomy because of historical concerns about the development of cervical cancer. If you want to answer this question using evidence-based data, it's hard to do.

For individuals who don't have a history of cervical precancers or cancers and who have access to health care, the available data and science would support leaving the cervix in for three main reasons:

The first reason is the surgery itself. When you leave the cervix in, the surgery can be done in less time, and data support that it can be done with few complications. If it's done laparoscopically, it can be an outpatient procedure. If it's done through a small incision, it can still be an outpatient procedure or possibly a simple overnight stay.

The second issue is about not disrupting anatomy that doesn't need to be disrupted. If the disease is in the corpus of the uterus, just remove the place where the disease is. If you also remove the cervix, it could have a negative effect on the pelvic anatomy. There's the issue of support and also the possible disruption of nerve pathways that go to the bladder, urethra, and G-spot. Potential bladder control problems due to removal of the cervix are well addressed (Obstet. Gynecol. 89[1]:133-39, 1997).

The third issue that has been discussed--which varies among different communities--is the emotional distinction between removing something that needs to be removed and removing something that's normal. Particularly when I practiced in Southern California, a common feeling was that if it's not involved in the disease process, why are you removing it? For some people who want to maintain a view of normalcy, leaving something that's normal is what you should do.

Cervical cancer is not as great a risk for American women as it was in the past because more people are being screened.