Subtotal versus total hysterectomy

Total hysterectomy is the surgical removal of the uterus and the cervix, which is the lower "neck" of the uterus that opens into the vagina. Subtotal hysterectomy is the removal of the uterus, leaving the cervix intact. Also known as supracervical or partial hysterectomy, subtotal hysterectomy typically has a quicker recovery time, lower risk of infection and damage to the urinary tract, and less blood loss than a total hysterectomy.¹

Deciding whether to have a total or subtotal hysterectomy can be difficult. This is because research that compares the two is limited, and shows only small differences. Factors that are commonly considered include:

• Recovery time. Subtotal hysterectomy typically has a quicker recovery time. This is because of lower risks of infection and damage to the urinary tract, and less blood loss than after a total hysterectomy.¹
• Cervical cancer risk. In the past, doctors recommended a total hysterectomy to eliminate the risk of cervical cancer. But cervical precancer is easily detected with a regular Pap test. (If you have your cervix removed as part of a hysterectomy, you no longer need Pap tests.) Cervical cancer is found in less than 0.1% of women after subtotal hysterectomy.¹
• Sexual well-being. A recent study reports that sexual well-being isn't affected differently by a subtotal versus a total hysterectomy.²
• Bladder and bowel function. One study reports that one year after hysterectomy, more women have urinary incontinence problems after a subtotal than after a total hysterectomy.³ Bowel function is not affected differently by a subtotal versus a total hysterectomy.¹
• Menstrual-like vaginal bleeding. After subtotal hysterectomy, up to 20% of women have bothersome cyclic bleeding if they have not reached menopause, or when taking hormone replacement therapy after menopause.³ This happens when uterus-like cells remain with the cervix after the uterus is removed.

Citations

1. Thakar RT, et al. (2002). Outcomes after total versus subtotal abdominal hysterectomy. New England Journal of Medicine, 347(17): 1318–1325.

2. Kuppermann M, et al. (2004). Effect of hysterectomy vs medical treatment on health-related quality of life and sexual functioning: The medicine or surgery (Ms) randomized trial. JAMA, 291(12): 1447–1455.

3. Gimbel H, et al. (2003). Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow-up results. International Journal of Obstetrics and Gynecology, 110: 1088–1098.