Why Leave the Cervix? Why I Left My Cervix in During My Hysterectomy

Disclaimer: This article discusses surgery, sex, and controversial personal opinions. Please use your discretion when reading. I am not a medical professional and I am not giving medical advice. I am merely explaining why I chose to leave my cervix during my hysterectomy.

Four months ago, I got a laparoscopic supracervical hysterectomy after spending 15 months convincing medical professionals that I needed this procedure (and hell yeah I threw myself a party after all that work, as evidenced by the picture above).

In case you don’t know, a laparoscopic hysterectomy is when they use robotic instruments to remove the uterus through tiny cuts in your abdomen and belly button instead of doing a longer incision down your middle. It’s less recovery time, results in significantly smaller scars, and is generally less painful for the patient.

A supracervical hysterectomy is when the cervix is left intact while the uterus is taken out. This is not commonly done in a hysterectomy, although it was a more popular procedure in the 90s when it was first being performed.

Many women and people with vaginas aren’t super familiar with their cervix. I became intimately familiar with mine after doing the fertility awareness method (FAM) for five years before my procedure.

The cervix is technically connected to the uterus—it’s all one organ—and it connects the uterus to the vagina. You can usually feel your cervix by sticking your finger up your vag and feeling for something that feels firm and squishy, like the tip of your nose.

Removing the cervix is generally done because of fear of cervical cancer. The majority of medical professionals will argue that there is no good reason to leave the cervix in during a hysterectomy. I spoke with three surgeons during my 15-month process and two of them tried to talk me out of leaving my cervix in.

So why would I choose to leave the cervix in during my hysterectomy?

Research shows that leaving the cervix in is less traumatic (it cut my recovery time in half): you recover faster, can return to sex sooner, and have minimal blood loss during the surgery. But all of this is not why I chose to keep my cervix.

Here’s why I left my cervix in during my hysterectomy.

The Cervix Impacts Sexual Pleasure

So this is a controversial statement, but I believe the cervix does impact sexual pleasure.

Doctors will tell you it doesn’t.

Other people will tell you it doesn’t.

Research will tell you it doesn’t.

The thing is, you have to decide for yourself if it does.

For me, and we’re just gonna be really blunt here, it feels good when my cervix is stimulated by my partner’s penis. I can’t imagine what it would feel like if my cervix wasn’t there, but I have a feeling it wouldn’t be great. The cervix doesn’t have a ton of nerve endings in it, but it does feel like more of a pressure when stimulated, which can be pleasurable for some people.

The cervix is essentially the “end” of your vagina. When the cervix is removed during surgery, the surgeon has to reconstruct the top of your vagina. There won’t be anything there but scar tissue—and nothing for a penis (or sex toy) to bump up against.

For lack of a better way to describe it, the cervix drops down into your vagina, so removing the cervix essentially “lengthens” your vagina. And, depending on the size of your partner, it may or may not feel the same when you have sex. (The cervix can also be stimulated during masturbation too!)

Not to mention there is such a thing as cervical orgasms.

Two Words: Cervical Mucus

So this goes along with the sex thing, and it’s really important to discuss.

The cervix is responsible for producing cervical mucus. If you are familiar with your cycle, you may notice that you are much more wet during ovulation (which can happen between days 12-22 of your cycle) than you are right before or right after you get your period. This wetness is your body preparing to receive sperm for pregnancy. Your body is making it as easy as possible for sperm to get where they need to go.

In other words, this is a really bad time to have intercourse if you don’t want to have a baby.

If the cervix isn’t there, guess what? There’s no cervical mucus.

Yes, the vagina has natural moisture in it. But it’s nowhere near the wetness produced throughout the fertility cycle.

My thought process was this: what was the point of not being able to get pregnant if I couldn’t have sex with my body producing that amazing fluid? Why would I want to get rid of that?

For the past five years, my husband and I have been meticulously avoiding intercourse when I am fertile, as we’ve chosen not to have children. So I was about ready to start enjoying my natural fluid during intercourse again.

Secretion of cervical mucus, in my opinion, can enhance sex.

Research shows that the cervix is also responsible for the secretion of mucus during arousal, not just during ovulation, and at various points throughout intercourse, including when the penis (or toy) bumps against the cervix. However, despite our knowledge of this, researchers still can’t definitively conclude that the cervix plays a role in sexual satisfaction.

But I made that decision for myself, and it was the main reason I chose to leave my cervix in during my hysterectomy.

It’s Less Trauma Internally

We’ve already touched on this briefly, but leaving the cervix in during hysterectomy results in a much faster recovery time. And you can return to sex sooner, so, bonus.

Leaving my cervix in cut my hysterectomy recovery time by half, from eight weeks to four weeks. I was able to resume intercourse at six weeks (my primary surgeon suggested we wait an additional two weeks just to be safe, although my other surgeon said four weeks).

The surgery time is also shorter when leaving the cervix in during hysterectomy, and it generally lowers your risk of complications.

Your cervix also has a bunch of connective tissue attached to it, which keeps it anchored at the top of your vagina. When the cervix is removed, this tissue has to come with it. It’s not proven, but suggested that leaving the cervix—and, as a result, the attached ligaments—may result in better pelvic organ function and patient sexuality post-surgery.

However, again, contemporary research says there is no evidence to support leaving the cervix during hysterectomy over taking it out.

Eliminates Risk for Vaginal Cuff Dehiscence

Have you heard about vaginal cuff dehiscence?

Don’t worry, I hadn’t either—until the third surgeon I spoke to mentioned it.

(In case anyone is wondering why I spoke to different surgeons, there are a couple reasons. First, I didn’t trust the first surgeon I spoke to. She told me that she would not consider leaving my cervix in during my hysterectomy. Second, the next surgeon I spoke to—the one I ultimately chose to do my procedure—wanted an additional surgeon there to assist with severing my uterus from my cervix to ensure the procedure went well, so I had to meet with this person too.)

This last surgeon was the only one who told me that if I wanted to leave my cervix in, it was fine. Even my primary surgeon suggested removing the cervix, but I was adamant about keeping it. This third surgeon mentioned that leaving my cervix in during the hysterectomy would eliminate the risk of vaginal cuff dehiscence.

Huh?

I looked it up. Vaginal cuff dehiscence is similar to vaginal prolapse, but worse. Instead of all your female organs sagging or falling out of your vagina, in vaginal cuff dehiscence, all of the organs in your abdomen are at risk of falling out. Vaginal cuff dehiscence is life-threatening.

It’s true. It’s a thing. And if you have your cervix removed, you are at risk for this, even though the risk is low.

So, yeah.

Also, I talked to my primary surgeon about having a higher risk of prolapse after my hysterectomy. He said I’m not at higher risk and, turns out, research shows he’s right—there’s not a much higher risk of prolapse between getting a supracervical hysterectomy and a total hysterectomy (where the cervix is removed).

If you don’t know what prolapse is, please Google it and learn how you can prevent it, because I personally know three women who have had this happen to them and your risk increases if you’ve had kids.

A Word on the Dreaded “Cyclic Bleeding”

One of the reasons my surgeon wanted me to get my cervix removed was because of what medical professionals call cyclic bleeding.

Cyclic bleeding is bleeding that still occurs during your period even when you don’t have a uterus but still have your ovaries (your ovaries control your fertility cycle via hormone production, so if you keep your ovaries during a hysterectomy, you will still ovulate and go through the cycle, even though you won’t have a period).

So how on earth can you still bleed if you don’t have a uterus?

When you have the cervix removed during hysterectomy (also called a total hysterectomy), the surgeon will essentially detach your uterus and cervix from your body and pull them out through your vagina. With a total hysterectomy, there is no risk for cyclic bleeding.

However, when you leave your cervix in during hysterectomy, things get a bit more complicated.

Since your cervix is attached to your uterus, your surgeon has to find a point to separate the two to leave the cervix intact. Although they do their best to separate the two, some endometrial cells (the cells that line your uterus and are responsible for monthly bleeding) can be left over after the surgery. This is what can cause cyclic bleeding after hysterectomy.

This didn’t sound good to me. After all, I wanted to stop my bleeding, not have it continue.

But then I looked at the research.

The risk for cyclic bleeding after a supracervical hysterectomy is pretty low. My surgeon told me the risk was about 15%, but some others I have talked to said 10% or less. And, cyclic bleeding only occurs for up to two years after the procedure.

In addition to the risk being low, the third surgeon I spoke to told me what cyclic bleeding actually was—it’s not a period or even close. It’s when you go to pee, wipe yourself, and see a teeny bit of blood on the toilet paper. That’s cyclic bleeding.

So has it happened to me?

Yes. And it was exactly what the surgeon said—just a tiny bit of blood, so small and so light that I wouldn’t see it if I wasn’t looking for it. It’s not even enough to get on my undies, so it’s not even really “spotting”, as people who mensurate know the term.

I have had cyclic bleeding twice out of my four cycles since my surgery, not counting the on-off spotting I had immediately after the surgery for about three weeks (which is expected and very normal).

I have not had ANY cramps at all since my hysterectomy, even with the cyclic bleeding. In my personal experience, this teeny bit of blood is a very small price to pay for being able to keep my cervix and have no change to my sex life.

Why I Got My Fallopian Tubes Removed

So while I left my cervix during my hysterectomy, I got my fallopian tubes removed. I originally didn’t plan on this, but my primary surgeon suggested it.

He said there is research that suggests that uterine cancer can start in the fallopian tubes, so by removing them, I could potentially help lower my risk of uterine cancer (even though I would no longer have a uterus).

This sounded good to me. Plus, I didn’t need my fallopian tubes. I researched it and got a little worried that severing the fallopian tubes from my ovaries would result in reduced blood flow to the ovaries, which I thought could impact hormone production. However, my surgeon said there was no evidence of this and I haven’t found research to suggest this either.

I also learned, after my hysterectomy, that getting the fallopian tubes removed eliminates the risk of ectopic pregnancy (where the fetus begins to develop in the fallopian tube—ectopic pregnancies are not viable and are life-threatening).

Although ectopic pregnancy after a hysterectomy is rare, it can and does happen. People who have their uterus removed but keep their fallopian tubes still have a small risk for ectopic pregnancy.

There’s really no reason to keep your fallopian tubes if you are having a hysterectomy. If you are pursuing a hysterectomy for any reason, I would highly recommend talking to your surgeon about removing your fallopian tubes to potentially reduce your risk of uterine cancer and eliminate risk of a future ectopic pregnancy.

When Leaving the Cervix Is Not an Option

Unfortunately, leaving the cervix during hysterectomy will not be an option for everyone.

There are two main reasons why someone would need to get their cervix removed:

  • You’ve had a recent abnormal Pap smear or are at high risk for cervical cancer
  • You have endometriosis on your cervix

Your surgeon will require your most recent Pap results before even considering leaving your cervix during a hysterectomy. If you have endometrial implants on your cervix or are at high risk for cervical cancer, it’s unlikely you will find a surgeon who will consider leaving the cervix during a hysterectomy.

And, in these cases, it will likely be much more beneficial for you to have it removed anyway (because you don’t still want cramping and bleeding after a hysterectomy, and you definitely don’t want to have a second surgery to remove your cervix if you have cervical cancer).

Are There Cons to Leaving the Cervix During Hysterectomy?

Yes, of course! Just like there are pros and cons to everything.

The first is that you will still need to have regular Pap smears to screen for cervical cancer. If you have your cervix removed, you will not need to have Pap smears.

The second is that there is a risk that you will develop cervical cancer and need to have your cervix removed during a second surgery. This is not ideal and surgeons like to avoid this, which is part of the reason why they want to get rid of your cervix in the first place.

The third con is one we’ve already discussed—the cyclic bleeding.

That’s All, Folks

I will be posting articles soon about my healing process for my supracervical hysterectomy and about what my life is like without a uterus. So far, it’s been totally blissful and I am loving life. If you have any questions about my procedure or more questions about cervix stuff, please feel free to reach out to me or leave a comment below and I will get back to you ASAP!

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