March 2002 · Vol. 14, No. 3Hysterectomy: 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.
ANDREW
W.
MENZIN,
MDDr. Menzin is the associate chief of the division of gynecologic oncology at North Shore University Hospital in Manhasset,
NY.
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Key points
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An “internal orgasm” may be linked to sensory input from the cervix. Therefore, removal of the cervix may inhibit sexual satisfaction.
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In a study evaluating the sexual functioning of women prior to and following supracervical, or “subtotal,” hysterectomy, about half the women reported improved sexual function, one-third reported little change, and one-fifth noted deterioration.
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The more interested and sexually active a woman is preoperatively, the more likely she is to report satisfactory sexual function postoperatively.
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Concerns about postoperative sexuality often top the list of questions when a woman contemplates hysterectomy.1 Unfortunately, data regarding the impact of hysterectomy on sexual function are conflicting. Further, as Grimes points out, the literature fails to elucidate the role of the cervix in sexual response.2 Thus, it is difficult to advise women which procedure is better: a total or supracervical (“subtotal”) hysterectomy. The decision must be individualized following a thorough discussion with the patient.
One factor hampering scientific evaluation of the subject is the complex and ambiguous nature of the physiologic and psychologic aspects of sexuality. Preoperative medical conditions, emotional well-being, and/or the pathologic process necessitating the hysterectomy itself may contribute to both pre- and postoperative sexual functioning, as may the nature of a woman’s personal relationships and her support system. Therefore, it is no surprise that various studies have shown improvement, stability, and deterioration in sexuality following hysterectomy.1
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