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Radical or Wertheim’s hysterectomy. A radical hysterectomy means that the surgeon removes the entire uterus including cervix and support structures, both ovaries, Fallopian tubes, nearby lymph nodes, and the upper portion of the vagina.

In some women, for example a patient with cancer that has infiltrated several reproductive organs, there may be no option but a radical hysterectomy. In other circumstances there may be more flexibility about the amount of tissue taken.

By the time Robyn turned thirty-seven her medical history included a myomectomy and an endometrial resection. Both procedures were undertaken to control heavy bleeding due to fibroids, but neither provided lasting relief. She had decided to accept the advice of her gynaecologist and have a hysterectomy, but was uncertain which sort would be most appropriate. The doctor proposed removing her ovaries and Fallopian tubes, along with her uterus, because of the possibility that ovarian cancer could develop some time in the future. This form of cancer tends to evade detection until it is advanced; treatment prospects are then poor. Robyn asked about the short- and long-term implications of ovary removal at her age and was told that her menopause would occur earlier than expected. Acute menopausal symptoms such as hot flushes and vaginal dryness were likely to accompany an early menopause, and hormone therapy would then be advisable. Long-term implications included an elevated risk of osteoporosis and heart disease. Even if the ovaries were left it was possible that she might experience a somewhat earlier than expected menopause, although this was by no means certain. As Robyn’s family had a tendency for heart disease, but not for ovarian cancer, she declined to have a total hysterectomy with bilateral salpingo-oophorectomy. Instead, a total hysterectomy was performed, and care was taken to preserve her ovaries intact.

There may also be some flexibility when it comes to the question of removal of the cervix. Women who have asked doctors about the implications of losing their cervix and the upper part of their vagina have received varied responses according to whether they were pre- or post-menopausal. Pre-menopausal women whose ovaries are to remain may be told to expect a reduced amount of lubricative cervical mucus around the time of the month that they ovulate. This might be one factor contributing to reduced sexual satisfaction for them and their sexual partners. At other times of the month when the output of cervical mucus is minimal, the impact of cervical secretions on sexual satisfaction would be negligible. Although recent studies do not show a reduction in vaginal size after the cervix has been removed, the absence of the cervix itself might be expected to alter the sensations experienced during intercourse. For postmenopausal women loss of the cervix would not affect lubrication, but its absence might alter sexual satisfaction for one or both partners if tapping it during intercourse was important for orgasm. On the other hand, removal of the cervix might be seen to have convenience value for some women as it would do away with the need for repeated Pap smears. It has become increasingly common to offer women the option of preservation of the ovaries and cervix and upper part of the vagina during hysterectomy.

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