Considering sub-total hysterectory

Hi all,

This is my first post to this site (which I thank God for!), and I'm wondering if anyone has had a sub-total hysterectomy. I'm very concered about my sexual health post-surgery, and I believe my cervix plays an important part in my pleasure during sex. The research I've done says that studies regarding sub-total vs. total hysterectomy are inconclusive as it pertains to sexual wellbeing, and this leaves me conflicted: do I keep the cervix and risk possible periods and cervical cancer, or do I do a total hysterectomy and cross my fingers that my sex life isn't impacted? I don't know what to do, and the more I research the more confused I am.

Oh: My surgery is scheduled for December 22, due to large fibroid tumors. I'm 41, done w/childbearing, and very much looking forward to being free of periods. Unfortunately, since fibroids run in my family and I pretty much assumed a hysterectomy was in my future, I was somewhat cavalier about the procedure until I got my surgery date and started doing some research. Now I'm a little nervous, a little frightened, and a lot unsure of what the future holds for me. Any feedback I receive will be very much appreciated.

Agridulce:
I am going to be having a subtotal hysterectomy on Friday 12/9, also for a big, troublesome fibroid that is inoperable by itself. My concerns were the same as yours, and I do believe the cervix plays a part in my sexual pleasure. Perimeno has left me with a decreased libido, and I don't want to jeopardize that further. I discussed my surgery at length with DH and my GYN, and we came to the conclusion that this was the way to go. My doctor did say she'd take the cervix if it was abnormal looking, but I've never had an abnormal pap and there have been no other problems, so I don't forsee it.
Unless there is history of cervical cancer in your family, all you'll have to do is continue having pap smears after your surgery. To me it's a small price to pay for continuing pleasure! I hope all goes well for you!
Dodi

Agridulce:
I too am having LSH on 12/22! I have chosen this procedure because I have never had an irregular pap smear and I too feel like my cervix is important to my sexual response. I am not keen on removing parts of my body that are not diseased. I am having my uterus removed also because of fibroids and uncontrollable bleeding. I am leaving my ovaries, which are also healthy. My philosophy: If it ain't broke, don't fix it! All the best to you in your decision making!

Agridulce:

Regarding taking your cervix, you should make sure that your doctor is aware that there was just an announcement by Merck that a vaccine has been developed for two high risk strains of HPV. HPV is a virus that causes over 90% of cervical cancer. These two strains cause about 70% of cervical cancer.

Thus, you should get tested for HPV before making your decision. If you don't have HPV, your risk of getting cervical cancer is very small now, and will be very, very minimal once the vaccine becomes available (the relationship of HPV to Cervical Cancer is somewhat like the relationship of HIV to AIDS: if you don't have HPV, then you are unlikely to get cervical cancer, and a vaccine for most HPV makes it very unlikely that you will get cervical cancer).

I'm not in favor of taking healthy organs- there is evidence that keeping the cervix aids in pelvic support and sexual functioning (preventing vaginal dryness in particular). Thus, with this great news in the last few days that there is a vaccine for HPV, and thus a much reduced chance of getting cervical cancer if you don't have HPV, you should seriously consider keeping your cervix.

As to whether you will have "mini" periods: as I understand it, most women who keep their cervix do not have mini periods- I had a hysterectomy in May and have not had a drop of blood since, and that seems to be typical of most women who keep their cervix.

Please think carefully about your reasons to take your cervix. The two procedures to keep your cervix are LSH (Laparoscopic SupraCervical Hysterectomy), and SAH (Subtotal Abdominal Hysterectomy). The "S" stands for supracervical or subtotal, both of which mean that you keep your cervix.

The cervix is technically part of the uterus, but it is the tube-shaped organ at the bottom of the uterus that connects it to the vagina. Thus keeping it means that you have a closure at the top of the vagina, and thus may aid in sex feeling the same as before, and also in preventing vaginal cuff problems.

Thus, the crucial question in taking your cervix should be: do you have any of the high-risk strains of HPV? You can get tested for this, and should before making the final decision of whether to remove your cervix.

The two procedures that keep the cervix are LSH and SAH. If you don't have HPV, then your risks for getting cervical cancer are very, very small. Thus you should carefully consider why you would want to remove a healthy organ. A cervix can be cauterized at the top, which would lead to a very low probability of any bleeding at all.


-Torrie

Hi Agridulce,

I also had a LSH and kept my cervix and ovaries. I am over 18 months post-op now and I believe as you said..that the cervix helps with sex. I am ~very~ happy I was a candidate to retain my cervix.

I went for my annual exam today with my gyneo Dr. (and LSH Dr.) and before my Dr. came in the exam room, his nurse mentioned that she had a LSH also and that she was very pleased with her surgery results. We were discussing the cervix and how we both thought it played a part in helping with pelvic support and with sex. You can get pros and cons on keeping the cervix, and I say do what is ~right~ for you.

On the mini-period, ask your Dr. if he does cervix cauterization during surgery. If a Hyster Sister keeps one or both ovaries and the cervix, there is a chance of a mini-period in post-op. I had my cervix cauterized during my hyst, and I have not had a mini-period in post-op.

On cervical cancer, my Dr. shared that it ran in less than 5% of women. I have seen some Hyster Sisters post lower stats. And as Torrie said, check on the HPV information.

Best wishes,

Mary

Thank you so much, everyone, for your responses. I have always had clear paps, no family history, and I think (but I'm not certain so I'll check) my HMO now routinely tests for HPV. When I go for my pre-op appt I'll also ask my doctor about cauterization. Infrequent periods would be a small thing to deal with if I had to, but ideally after going through what feels like such major surgery I'm hoping all of that will be over and done with. If cauterization will help I'm all for it.

Again, thanks to everyone. luvlabs, best of luck to you this Friday! I wish you a successful surgery and a speedy recovery.

CallieKitten, let's keep in other in our thoughts from until our date!

These kinds of decisions can be scary. I had a TVH 3 weeks ago. I have one ovary. Although I have not had intercourse yet, I can tell you that Everything is working just fine .
Best Wishes ,

All of the info given by all of the ladies at Hystersister have helped me greatly! My surgery is 12/19 and I am becoming more and more peaceful about the whole thing (and wiser, thanks to all of you!) This sight has been such a blessing, I can't even tell you.
"wisdom is more precious than rubies" Proverbs 8:11

I was scheduled for a sub-total, but then made an appt with my doctor again to discuss the pros/cons of that vs taking the cervix, and at the end of the discussion, we both agreed that I would get TAH. So far its been the right decision for me. Good luck on your surgery!