Hysterectomy: Total versus supracervical surgery
Once considered a routine part of hysterectomy, removal of the cervix is being questioned in light of postoperative sexual function. Here, a look at both sides of the issue.
Subtotal hysterectomy
A “reverse cone”—removal of the proximal endocervical tissue—ensures excision of all endometrial tissue.
Total hysterectomy
Mobilize the bladder anteriorly, the colon posteriorly, and the ureters laterally prior to resecting the uterus and cervix.
Counseling the patient
As I mentioned at the beginning of this article, the physical and psychological make-up of each woman plays an important role in her sexuality. While surgery introduces additional factors, they are interrelated with this physical and psychological milieu. Depending on the indication for the hysterectomy and the type of procedure performed, specific outcomes can be anticipated but not predicted with any certainty.
It is my practice to discuss these issues with a woman before surgery. I review the difficulties involved in estimating her sexual functioning after surgery, emphasizing 2 important variables: her prior experiences and her expectations. I also reassure her that, with continued interest and activity, she has a very good chance of regaining or surpassing preoperative levels of sexual enjoyment. I make it a point to include her partner in these discussions, since providing the proper preoperative perspective is an invaluable part of their postoperative sexual recuperation.
Dr. Menzin reports that he is on the speakers’ bureaus for Wyeth, Ortho Biotech, and Cytyc.
