It depend on your situation - some women have conditions that make removal of the cervix necessary, but others, the cervix is completely healthy and there is no need to remove it.
I decided to that is was important to keep my cervix, and had a supracervical (subtotal) hysterectomy. I am only 6 ˝ weeks post-op. I cannot give you a long-term perspective, but I am very satisfied with my choice at this point.
I was given almost no information by the medical community, other than being handed the same stupid pamphlet three times. I wanted to make a very informed choice, and the pamphlet was not it. I did tons of research--reading endless medical journals. What really surprised me was how little concrete research they have. The studies on the long term risks of hysterectomy, or studies comparing the long term outcomes of different types of hysterectomies, from my reading (although they talk to you otherwise), are limited. What money is there to exhaustively study the long-term sexual dysfunction or other issues of total- verses subtotal- hysterectomy?
I ended up choosing to get a supracervical hysterectomy for the following reasons:
1) It is a simpler surgery -- there is less cutting and less reconstruction. This means that there is less likelihood of damaging the complex ganglia of nerves in that area, which if damaged can lead to numbness and possible sexual dysfunction, less risk of damaging other things, like bladder/ureters, and an easier recovery.
2) Because they are not cutting and reattaching ligaments to your vagina, there is some evidence that in the long-term, there is better pelvic floor support.
3) You will find many women on this site complaining here about sex after hysterectomy, often related to the vaginal cuff created by a total. There are complaints of its too short, feeling scar tissue inside, numbness, ripping…yuk. Even the liability release that I had to read and sign said something like -- your vagina may be too short after the surgery. I would rather my anatomy stay as in-tact as possible.
4) There is medical research that shows that the cervix plays an important role vaginal lubrication.
I actually had to fight my doctor to keep my cervix -- she kept telling me the "standard of care" was to always do a total-removing the cervix. However, she could not give my any reason other than I might get cervical cancer in the future. Well, the “standard of care” used to be to chop out everyone’s healthy ovaries, too. They definitely found out THAT was a bad idea.
As long as you have no history of cervical problems, no other risk factors like HPV or a family history of cervical cancer, and you don’t mind getting regular pap tests (cervical cancer is one of the most easily detected and easily cured cancers), I am a strong advocate for keeping your cervix.
There is the possibility of continued very small amounts of cyclical bleeding. About 20% of women report that they have a bit of spotting each month. It depends on how much tissue is left and the technique/skill of the surgeon. Most women in the studies that report they have cyclical spotting report that is not bothersome, however. So, you would have to decide that this would be okay, since the likelihood is fairly high.
Here is a good article summarizing that state of the current research and giving you cites to start reading and research, if you’re interested.
http://ijcci.info/editorials/444-vol4a1
I have spent tons of time reading and researching this issue.
Best of luck!
Upcoming hysterectomy 2/10: what difference does it make if they take the cervix?
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