Deciding whether to remove your cervix during a hysterectomy is one of the most important choices you will make about the surgery. The short answer is that most hysterectomies in the United States remove the cervix, but keeping it is a safe and valid option for many women. Your decision depends on your reasons for the surgery, your risk of cervical cancer, and how you feel about the potential for continued light bleeding after the procedure.
What Are the Two Main Types of Hysterectomy?
Hysterectomy means surgical removal of the uterus. The cervix is the lower narrow part of the uterus that connects to the vagina. A surgeon can remove the uterus with the cervix or leave the cervix in place.
A total hysterectomy removes the entire uterus including the cervix. This is the most common type performed in the United States. A supracervical hysterectomy removes only the upper part of the uterus and leaves the cervix behind. Both procedures remove the uterus entirely, so pregnancy is no longer possible after either surgery.
The ovaries and fallopian tubes are separate from the uterus. Whether they are removed is a different decision and does not depend on whether the cervix is removed.
Why Do Surgeons Usually Remove the Cervix?
Removing the cervix is the traditional approach and remains the standard in most hospitals. There are several reasons for this.
Removing the cervix eliminates the risk of cervical cancer. A woman who keeps her cervix must continue having regular Pap smears to screen for cervical cancer. If the cervix is removed, routine screening is no longer needed because there is no cervix left to develop cancer.
The cervix is also the site where the uterus attaches to the vagina. Removing it allows the surgeon to close the top of the vagina securely. Some surgeons believe this lower risk of the upper vagina dropping down, a condition called vaginal vault prolapse. The evidence on this point is not strong either way, but it remains a common reason surgeons give for recommending removal.
Surgery that removes the cervix can often be performed through smaller incisions. A supracervical hysterectomy sometimes requires a larger abdominal incision, depending on the surgical approach. For some women this makes recovery different.
What Are the Benefits of Keeping Your Cervix?
Keeping the cervix preserves the natural structure of the upper vagina. Some women report better sexual sensation after a supracervical hysterectomy compared to a total hysterectomy. The research on this is mixed. Some studies suggest a small benefit, while others find no difference in sexual function between the two procedures.
The strongest reason to keep the cervix is the avoidance of a small but real risk of surgical injury. When the cervix is removed, the surgeon works closer to the bladder and the ureters, the tubes that carry urine from the kidneys to the bladder. Keeping the cervix means these structures are less likely to be injured during surgery.
Recovery may be slightly easier after a supracervical hysterectomy. Because the surgery is less extensive, some women experience less postoperative pain and a shorter hospital stay. This difference is modest and not guaranteed.
What Are the Downsides of Keeping Your Cervix?
The most important downside is the possibility of continued light bleeding. If you keep your cervix, a small amount of endometrial tissue may remain in the cervix. This tissue can shed monthly, causing light spotting or bleeding. This happens in a minority of women but can be bothersome enough that some later choose to have the cervix removed in a second surgery.
You will also need to continue Pap smears. The American College of Obstetricians and Gynecologists recommends that women who have a supracervical hysterectomy continue routine cervical cancer screening. This means a visit to your gynecologist every few years for the rest of your life.
There is no evidence that keeping the cervix affects pelvic organ support in any meaningful way. The ligaments that hold the pelvic organs attach to the cervix, and some surgeons believe removing it weakens support. However, studies have not shown a clear difference in prolapse rates between the two procedures.
Does Removing the Cervix Affect Sexual Function?
This is the question women ask most often. The honest answer is that the evidence is mixed and the difference, if any, is small.
Some women report that keeping the cervix preserves deeper sensation during intercourse. The cervix and the surrounding tissue contain nerve endings that some women find sensitive. Removing the cervix shortens the vagina by a small amount, though the vagina is elastic and typically accommodates this change without noticeable difference.
Research comparing sexual function after the two procedures has produced conflicting results. Some studies report better outcomes with cervical preservation, while others find no difference. A large review of studies concluded that the quality of evidence is low and that any benefit is likely small. What matters most for sexual function after hysterectomy is not the cervix but the reason for the surgery. Women who had painful conditions like endometriosis or fibroids often report improved sexual function after hysterectomy regardless of whether the cervix is removed.
How Does Your Reason for Surgery Affect the Decision?
Your underlying condition matters more than any other factor in this decision.
If you are having a hysterectomy for heavy bleeding or fibroids, keeping the cervix is a reasonable option. These conditions are located in the uterus itself and do not involve the cervix. Removing the uterus solves the problem regardless of whether the cervix stays.
If you are having a hysterectomy for endometriosis or adenomyosis, the decision is more complex. Endometriosis can involve the cervix, and adenomyosis sometimes extends into it. Leaving the cervix may leave behind disease tissue that could cause continued pain. Some surgeons recommend removing the cervix in these cases to reduce the chance of symptom recurrence.
If you have cervical dysplasia, abnormal cells on the cervix, or a history of abnormal Pap smears, removing the cervix is the safer choice. Keeping a cervix with known abnormal cells leaves you at risk for progression to cancer.
If you have gynecologic cancer, the cervix is almost always removed as part of the cancer surgery. This is not optional in most cases.
What Does the Evidence Say About Long-Term Outcomes?
Long-term studies comparing total and supracervical hysterectomy have not found major differences in most outcomes. A well-known randomized trial published in the British Medical Journal followed women for several years after surgery and found no significant differences in pelvic floor function, urinary symptoms, or quality of life between the two groups.
The same trial found that women who kept their cervix had a slightly higher rate of continued bleeding. About 7 percent of women in the cervical preservation group reported monthly bleeding after surgery. Some of these women later chose to have the cervix removed.
The risk of cervical cancer after supracervical hysterectomy is extremely low if you continue regular screening. Cervical cancer screening has dramatically reduced the incidence of this disease. With consistent screening, the risk of developing cervical cancer after cervical preservation is very small.
How Should You Decide?
Talk to your surgeon about the specific reasons for your hysterectomy. Ask whether your condition involves the cervix. Ask about the surgical approach they plan to use and whether cervical preservation is technically feasible with that approach.
Consider your own medical history. If you have had abnormal Pap smears or tested positive for high-risk HPV, cervical removal is generally the safer recommendation. If you have never had an abnormal Pap smear and are at low risk for cervical cancer, keeping the cervix is a defensible choice.
Think about whether continued screening bothers you. Some women are happy to continue Pap smears to preserve the cervix. Others find the idea of stopping cervical cancer screening entirely appealing and prefer removal.
Your comfort with the small risk of continued bleeding matters too. If even light monthly spotting would distress you, removal may be the better choice. If you are comfortable with that possibility, preservation is reasonable.
The decision is ultimately yours. No guideline mandates one approach over the other for benign conditions. Both are considered safe and acceptable by major medical organizations. The right choice depends on your anatomy, your health history, and your personal preferences.
Frequently Asked Questions
Can I still get cervical cancer if I keep my cervix?
Yes, you can still develop cervical cancer if the cervix is left in place. The risk is very low if you continue regular Pap smears, which is why screening must continue after a supracervical hysterectomy.
Will I still have periods after a hysterectomy that keeps my cervix?
You will not have regular periods because the uterus is removed. However, a small percentage of women experience light monthly spotting from remaining endometrial tissue in the cervix.
Is keeping my cervix during hysterectomy safer than removing it?
Keeping the cervix reduces the risk of injury to the bladder and ureters during surgery. The overall safety difference is small, and both procedures are considered safe for most women.
Do I need a Pap smear after a total hysterectomy?
No, routine cervical cancer screening is not needed after a total hysterectomy that removes the cervix. You should confirm with your surgeon that your cervix was completely removed at the time of surgery.
