What do I need to consider regarding having my cervix removed?

Keywords: Progesterone intolerance. Negative response to progestin based treatments. Pap smears. Smear test.

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Written by IAPMD
Updated over a week ago

The cervix is the lower part of the uterus, at the top of the vagina. The cervix is usually 2 to 3 cm long and is roughly cylindrical in shape. When you go for pap/smear tests, it is the cervix that is swabbed to check for abnormal cells.

You will need to speak with your doctor to determine if the pros outweigh the cons for retaining it. There are mixed opinions from both patients and medical professionals regarding whether or not there are benefits to keeping the cervix after a hysterectomy, so it is very important that you speak to your doctor about what is right for you. 

Some people are reluctant to have their cervix removed because they want to retain as much of their reproductive system as possible. If you feel this way, ask your surgeon whether there are any risks associated with keeping your cervix. 

Sometimes this decision will depend on whether a patient has an adverse negative reaction to progesterone/progestin based treatments (also often called progestogen intolerance)

Many patients are concerned that removing the cervix will lead to bowel, urinary, or sexual problems. However, a recent meta-analytic (combined) review of studies found no differences in sexual, bowel, or urinary function between those who did and did not keep their cervix

Do I still need to have pap smears after the surgery? Does keeping or not keeping my cervix change that?

  • If you keep your cervix, you'll need to continue having regular cervical/pap screening. 

  • If you have your cervix removed, and you have a history of significant cervical dysplasia (CIN-2 or 3), it is recommended that you continue to receive pap smears of the vaginal vault for 20 years after hysterectomy. 

If you have your cervix removed, and you do not have a history of significant cervical dysplasia (CIN-2 or 3), then you no longer need to receive routine pap smears following surgery.

Although some individuals have wondered whether keeping the cervix (i.e., a supracervical or subtotal hysterectomy) reduces the risk of sexual problems following hysterectomy, a recent review of studies found that there were no differences in sexual function between those who did and did not remove the cervix. So, keeping your cervix (or not keeping your cervix) probably does not make any difference for sexual function after surgery. 

Accreditation: SMAC

Additional reading:

Visit www.iapmd.org/surgery for lots of evidence based information and resources for those considering, going through or recovering from surgery for PMDD/PME.

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