Number Of Cervix-Sparing Hysterectomies Increasing Amid Debate Over Benefits, Risks

Main Category: Women's Health / Gynecology
Article Date: 26 Feb 2009 - 4:00 PDT

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An increasing number of gynecologists are performing hysterectomy procedures that do not remove the cervix if no cancer is found, the Wall Street Journal reports. About 600,000 hysterectomies are performed in the U.S. each year, often to remove cancers of the uterus or cervix or to treat endometriosis and fibroids. Before 1940, almost all hysterectomies preserved the cervix because it was easier and safer due to the lack of antibiotics and blood banks. However, by the 1960s, removing the cervix became the standard because it was seen as a cancer preventive when Pap smears were still new, the Journal reports. According to the Journal, the "tide appears to be turning," with more inpatient hysterectomies -- which account for 90% of all hysterectomies -- preserving the cervix. In 2006, 9.7% inpatient procedures did not include removal of the cervix, up from 1.7% 10 years earlier.

According to the Journal, physicians performing cervix-sparing hysterectomies argue that Pap smears will detect any possible cervical cancers and that leaving the cervix "reduces the risk of surgical damage to the bladder and nearby nerves, and may even allow women to enjoy a better sex life in the long term." However, the American College of Obstetricians and Gynecologists in a 2007 report said that there was minimal evidence to show that sparing the cervix improves a women's sex life or bladder function, adding that if a cancerous growth were to develop, the necessary removal of the cervix alone carries a higher risk than a hysterectomy -- including a risk of infection.

In addition, some studies have not found a "positive role for sparing the cervix," the Journal reports. A 2005 study of 135 women found no difference in sexual function or quality of life between women who had their cervix removed during their hysterectomy and those who did not. However, the Journal reports that a limitation to such research is that various studies compare hysterectomies done with a large abdominal incision, while many surgeons performing cervix-sparing hysterectomies do a minimally invasive incision that shortens recovery time. "When you give women the choice, and you tell them the pros and cons, many of them find the idea of keeping the cervix very appealing," Seth Kivnick of the Kaiser Foundation Hospital in West Los Angeles said. He added that three-quarters of women without cancer choose to keep their cervix when undergoing hysterectomies at the hospital (Johannes, Wall Street Journal, 2/24).

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