Making The Decision as to What Type of Hysterectomy to Have

Every year new gynecologic therapies come about that reduce the numbers of hysterectomies done in the United States. At Women's Health Practice we are committed to alternatives, often have trials enrolling for heavy menstrual bleeding, and urge you to come and discuss!
But, some hysterectomies are necessary, and then you do have choices regarding the type of hysterectomy you will undergo.
All decisions with hysterectomy have risks and benefits, and shared decision making with your gyno is the most important first step..
Hysterectomy means removal of the uterus, so if you have had a removal of the uterus, but your cervix was conserved, this is called a subtotal hysterectomy. For some women there are over-riding reasons to have a subtotal hysterectomy. For others the decision to keep your cervix may be based on personal preference rather than scientific fact.
Also discuss the health of your pelvic floor.
If you are planning a hysterectomy, think about having sex afterwards and medical consequences of that. Some women who have hysterectomies also have to have repair surgery for what we call pelvic floor disorders including uterine prolapse. The medical term for painful sex is dysparunia. And it can be a chronic or an acute condition, it can occur in young women as well as old, and some women with these pelvic floor problems will have pain prior to having their hysterectomy. There are also treatments, FDA Cleared but not FDA approved,  like MonaLisa Touch and ThermiVa that can treat early pelvic floor conditions and be helpful pre and post hysterectomy.
Vaginal discharge, painful sex due to the walls of the vagina and incontinence may affect your hysterectomy decisions
Fortunately, many cases are due to newly acquired infections or conditions that can be cured. Some women have non-physical causes, but in general it's more often seen in older women than in younger women. As women age into the menopause the vaginal lining thins and sex can become more uncomfortable. But there are many factors that cause painful sex in menopause, and estrogen in some studies only cures about 75% of cases. Why there are persistent problems in some cases can be complex: pelvic floor problems, weakened muscles, too little intercourse, not enough estrogen can be tolerated, secondary effects of the treatment itself.
Be clear on what structures are being removed, terminology can be confusion, not all hysterectomies are the same
The term partial hysterectomy is not a clinical term used by gynos although women may refer to hysterectomy without taking the ovaries as a partial hysterectomy and it really doesn't refer to the taking of the uterus. In a study published in the June issue of the American Journal of Obstetrics and Gynecology showed that in fact there was no improvement in incontinence rates if the cervix was left, and preliminary studies show that the rates of incontinence could actually increase if a subtotal hysterectomy rather than a complete hysterectomy were to be performed.
Keeping sex and libido normal or even significantly improved is our goal!

Other considerations for your health if you have had cervical conservation are to be discussed with your gyno. She will likely tell you this will not impact your sexual pleasure as orgasms are from the clitoral area, and not the cervix. If you keep a cervix at the time of the hysterectomy you still need pap smears according to the plan established by your gyno. But a woman with no cervix after a hysterectomy is not routinely (excluding those with cancers and precancers) recommended to have a pap smear in any of the current guidelines. This includes the organizations: ACS, ACOG, USPSTF, ASC, ASCCP just to name a few. Don't confuse pelvic examinations with pap smears. Pelvic examinations can determine the health of your vagina, the health of your vulva, the health of your urethra, feel your inner organs, and determine your pelvic floor muscle health, just to name a few of the benefits.