Women who hear the term hysterectomy from a gynecologist experience certain deaths: the death of their reproductive lives and in the past, the death of their sex lives. But a new, less-invasive type of hysterectomy can prevent a total loss of sexual function and restore happier lives to women undergoing this procedure, according to a new study coming out of New York.
Supracervical Hysterectomy, a hysterectomy in which doctors leave a most or a portion of a woman’s cervix behind, has become increasingly used in the more than 600,000 of these surgeries performed in the U.S. every year. In the past, most doctors gave women the sole choice of an abdominal hysterectomy – a hysterectomy that removes both the uterus and the cervix that sometimes results in other problems such as incontinence in addition to sexual dysfunction.
“We claim advantages in that the operation is fast, least traumatic for the pelvic floor and it’s only taking out the pathology – or the medical problem,” said Dr. Liselotte Metter, a leading German researcher in supracervical hysterectomies. “The doctors think that the total is the only approach, but if a patient understands that she has less trauma and she has no higher incidence of the danger of cancer, she accepts it very well.”
A joint study published in January 2002 by the University of Indiana and New York University medical schools found that 43 percent of total abdominal hysterectomy patients (TAH) experienced a decrease in the ability to achieve orgasm compared with six percent of supracervical patients. It also revealed that further advantages of supracervical over TAH included decreased operative morbidity and reduced risk of urinary and sexual dysfunction.
Having a choice of a supracervical procedure also played a role in women’s mental health when it came to this traumatic decision, often arriving around the time of a diagnosis of cervical or uterine cancer. It alleviated patient concerns about sexual functioning, and the return to a normal life after surgery, according to the study, and thus made the option more viable.
Performed under general anesthesia, a supracervical hysterectomy employs a laparoscope (a telescope-like device which is attached to a video camera) introduced through the uterus through the vagina, which allows surgeons to move the uterus around for better visualization. Afterwards, dissection and coagulation instruments release uterine tissues from their blood supply and the uterus is separated from its cervical stump, cut up and removed through three small incisions around the belly button. Most patients leave the hospital the next day and are able to return to work and normal activity within 1-2 weeks.
By the age of 65, one in three women will have undergone a hysterectomy, the Indiana/New York University study estimated, and current practice in the United States still strongly favors TAH over the supracervical hysterectomy, even for more benign gynecologic problems such endometriosis, adhesions or a very large uterus. However, research points to a small but steady rise in the number of supracervical hysterectomies performed both regionally and nationally reflecting changing attitudes on the part of both patients and surgeons favoring less invasive operations.
One cautionary note: Women must also beware a study with the American College of Obstetricians and Gynecologists in 2000 suggested that the suggested that some doctors overused the hysterectomy procedure and went against set recommendations, performing hysterectomies even when the woman did not meet all the criteria. So far, though, if they do meet the conditions for a hysterectomy, less has become more for a woman who has taken the time to research this procedure, instead of just going along with a first opinion.
“There’s a learning curve for many physicians but it’s well worth the time because patient outcomes are excellent,” said Dr. Susan Johnson, an OBGYN in Oregon. “Continued Pap smears will be needed but no one looks at that as a problem if the woman has made the decision that her cervix is important to keep.”