Hysterectomy

Hysterectomy Types

Hysterectomy is the surgical removal of a woman's uterus. In some cases, the ovaries and fallopian tubes are also removed during a hysterectomy procedure. This is called a salpingo-oophorectomy.

There are three major types of hysterectomy:

• Total hysterectomy is the surgical removal of the uterus and the cervix, which is the lower "neck" of the uterus that opens into the vagina.
• Subtotal hysterectomy is the removal of the uterus, leaving the cervix in place. It is also known as "supracervical" or "partial" hysterectomy.
• Radical hysterectomy is the removal of the uterus, cervix, ovaries, structures that support the uterus, and sometimes the lymph nodes. A radical hysterectomy may be done to treat endometriosis or cancer of the uterus, ovaries, or cervix.

Deciding whether to have a total or subtotal hysterectomy can be difficult. This is because research that compares the two is limited and shows only small differences. Factors that are commonly considered include:

• Recovery time. Subtotal hysterectomy typically has a quicker recovery time. This is because of lower risks of infection and damage to the urinary tract, and less blood loss than after a total hysterectomy.²
• Cervical cancer risk. In the past, doctors recommended a total hysterectomy to eliminate the risk of cervical cancer. But cervical precancer is easily detected with a regular Pap test. (If you have your cervix removed as part of a hysterectomy, you no longer need Pap tests.) Cervical cancer is found in less than 0.1% of women after subtotal hysterectomy.²
• Sexual well-being. A recent study reports that sexual well-being isn't affected differently by a subtotal versus a total hysterectomy.⁵
• Bladder and bowel function. One study reports that one year after hysterectomy, more women have urinary incontinence problems after a subtotal than after a total hysterectomy.⁵ Bowel function is not affected differently by a subtotal versus a total hysterectomy.²
• Menstrual-like vaginal bleeding. After subtotal hysterectomy, up to 20% of women have bothersome cyclic bleeding if they have not reached menopause, or when taking hormone replacement therapy after menopause.⁵ This happens when cells that bleed with every menstrual cycle remain with the cervix after the uterus is removed.

When considering a hysterectomy, ask your health professional about other treatments for your condition, what hysterectomy options are available to you, and how well hysterectomy is likely to work for you. If you have a hysterectomy, the type of procedure you have will depend on the medical reason for the hysterectomy, the size and position of your uterus, and your general state of health.

Different hysterectomy procedures (how the uterus is removed) include:

• Abdominal hysterectomy.
• Vaginal hysterectomy.
• Laparoscopically assisted vaginal hysterectomy (LAVH).
• Laparoscopic supracervical hysterectomy (LSH).
• Total laparoscopic hysterectomy (TLH).

For more information about procedures, see the section Comparison of Different Hysterectomy Procedures in this topic.

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Author:	Kathe Gallagher, MSW	Last Updated: August 25, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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