Medical “lingo” is a different dialect than many of us are use to. In fact, many medical terms are derived from Latin. It is easy to become confused with the language that doctors and other health care providers use, especially if you are not in the health care field or have not had any experience with the illness your doctor is referring to. Sometimes it is hard for us to admit to our doctors that we do not understand what they are saying. At other times, it is the lack of explanation from the doctor that adds to our confusion. In either case, it is important to understand the illness that you have and the treatment options available in order to feel that you are receiving proper care.
I have received many questions regarding hysterectomy; this article will give you a better understanding of the different types of hysterectomy and the ways it can be performed. First however, it is important to understand the female anatomy.
Anatomy
The female organs consist of the uterus, fallopian tubes, ovaries, cervix and vagina. The uterus is made of two parts, the body and the cervix. The cervix is the lowermost portion of the uterus that is visible through the vagina. The fallopian tubes are attached to either side of the fundus (the superior-most portion of the body of the uterus). This is where the egg travels to get fertilized by the sperm. Right outside the fallopian tubes (but not attached to the fallopian tubes) are the ovaries. The ovaries contain eggs and produce hormones necessary for ovulation and menstruation. These hormones also help protect other organs outside of the female organs such as the heart, bones, bladder and brain. When the ovaries no longer produce these hormones in sufficient amounts, menopause occurs.
What is Hysterectomy and When Is It Necessary?
Hysterectomy is the surgical removal of the uterus. It does not necessarily mean that the ovaries or fallopian tubes will be removed. These organs can, however, be removed at the same time as a hysterectomy is being performed.
A hysterectomy may be performed as part of treatment for fibroids, endometriosis or chronic pelvic pain, for bleeding problems, for uterine prolapse (uterus is “falling” out through the vagina) and for cancer of the uterus, ovaries or cervix.
Types of Hysterectomy
There are two types of hysterectomy: Total (complete) and Subtotal (supracervical). Total or complete hysterectomy involves removing the uterus and the cervix. Subtotal or supracervical hysterectomy involves removing the uterus without the cervix. In this case, the cervix remains in place and yearly pap smears are still needed to screen for cervical cancer.
Having one type of procedure over another is a personal decision except in certain cases. If you are having your hysterectomy because of cancer, the cervix is removed to prevent the cancer from spreading to this organ.
Many people (doctors and patients) feel that leaving the cervix in adds better support to the vagina and results in less sexual dysfunction after hysterectomy. However, there has been no study to definitively show that having a supracervical hysterectomy will prevent these problems from occurring. Some women who are ambivalent about having a hysterectomy feel more comfortable knowing that their cervix is left in place.
Some doctors advocate total hysterectomy in an effort to decrease the chance of developing cervical cancer at a later time. However, with proper screening for cervical cancer (pap smear), abnormalities of the cervix can be detected prior to developing cervical cancer.
How is the Hysterectomy Done?
There are two main approaches to removing the uterus: through the abdomen or through the vagina.
The abdominal approach is used when a supracervical hysterectomy is being performed, in cases where the uterus is too large to come through the vagina, in cases where the physician suspects there will be a lot of scaring around the uterus and in many cancer cases. (Scarring occurs from prior abdominal or pelvic surgery, prior infections of the tubes or ovaries, ruptured appendix, or from endometriosis).
The advantage of having an abdominal hysterectomy is mostly for the physician. This will allow for the most exposure and access to the pelvic organs. This is especially necessary in cancer patients to evaluate how much the cancer has spread.
A vaginal hysterectomy can be performed with or without the use of a camera placed in the abdominal cavity for assistance. Because the procedure is carried out through the vagina, the recovery time is significantly shorter for the patient compared with an abdominal hysterectomy. And at some hospitals, this procedure is done on an outpatient basis (same day procedure).
However, not all patients are good candidates for this procedure. As stated earlier this procedure is limited to the reason for the hysterectomy, size of the uterus, and amount of scarring present.
Should I leave my ovaries in?
This is a difficult decision and outside of needing to have them removed in the cases of cancer or severe endometriosis, the decision is best made after a thorough discussion with your doctor.
Having your ovaries removed means you will be in menopause and will have all the manifestations of menopause if you do not take hormone replacement (hot flushes, bone loss etc.). With this in mind, if you are not close to menopause it is probably better to leave them in so you will still have all the benefits of hormone production from your ovaries. If you are in menopause or very close to it (average age is 51) then some would advocate taking your ovaries out. The rational is that they are minimally functioning at this point, but still susceptible to ovarian cancer. And, since you are having pelvic surgery you should have them removed to decrease your chance of getting ovarian cancer later and requiring another surgery. Keep in mind, the overall chance for a woman to develop ovarian cancer is 1/70.
Empowerment Points
Hysterectomy is the surgical removal of the uterus, with or without the cervix.
Some people feel leaving the cervix in place allows for better vaginal support and less sexual dysfunction.
The method of hysterectomy, vaginal vs. abdominal, is dependent on the reason for the hysterectomy, size of the uterus, and amount of abdominal/pelvic scarring thought to be present.
Whether the ovaries should be removed at the time of hysterectomy should be based on a discussion with your physician. In some cases it is necessary such as cancer, in other cases it is a personal decision.
Take it upon yourself to discuss your options with your doctor.
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