Short- and Long-Term, Questions to Ask

A hysterectomy is a surgery to remove the uterus, which may be necessary to help treat certain conditions. It can cause short- and long-term side effects, and like any major surgery, it also carries some immediate risks.

There a several types of hysterectomy, depending on what’s removed:

• A partial hysterectomy removes some or all of the uterus but leaves the cervix intact.
• A total hysterectomy removes both uterus and cervix.
• A total hysterectomy with salpingo-oophorectomy removes the uterus, cervix, and one or both ovaries and fallopian tubes.

Hysterectomies are performed through either the abdomen or the vagina. Some can be done laparoscopically or with robot-assisted technology. The approach your doctor uses can play a role in the side effects you might experience after surgery.

Read on to learn more about hysterectomy side effects.

Having a hysterectomy can cause several short-term physical side effects. Some may also experience emotional side effects during the recovery process.

Physical side effects

Following a hysterectomy, you may need to stay in the hospital for a day or two. During your stay, you’ll likely be given medication to help with any pain as your body heals. A laparoscopic hysterectomy sometimes doesn’t require a hospital stay.

As you recover, you’ll likely notice some bloody vaginal discharge in the days or weeks after the procedure. This is completely normal. You may find that wearing a pad during this part of recovery helps.

The actual amount of time you’ll need to recover depends on the type of surgery you have and how active you are. Most people can return to their usual activity level about six weeks after an abdominal hysterectomy.

If you have a vaginal hysterectomy, your recovery time is typically shorter. You should be able to return to your usual activities within three or four weeks.

In the weeks following your hysterectomy, you may notice:

• pain at the incision site
• swelling, redness, or bruising at the incision site
• burning or itching near the incision
• a numb feeling near the incision or down your leg

Keep in mind that if you have a total hysterectomy that removes your ovaries, you’ll immediately begin menopause. This can cause:

• hot flashes
• vaginal dryness
• night sweats
• insomnia

Emotional side effects

The uterus is a crucial organ for pregnancy. Removing it means that you won’t be able to get pregnant, which can be a hard adjustment for some. You’ll also stop menstruating after having a hysterectomy. For some, this is a huge relief. But even if you’re feeling relieved, you can still experience a sense of loss.

For some, pregnancy and menstruation are crucial aspects of femininity. Losing the capacity for both in a single procedure can be a lot to process for some people. Even if you’re excited by the prospect of not having to worry about pregnancy or menstruation, conflicting feelings can come up after the procedure.

Before you have a hysterectomy, consider checking out HysterSisters, an organization dedicated to providing information and support to those considering a hysterectomy.

Here’s one woman’s take on the emotional aspects of having a hysterectomy.

Following any type of hysterectomy, you’ll no longer have your period. You also can’t get pregnant. These are permanent effects of having a hysterectomy.

Problems with organ prolapse can happen after a hysterectomy. A 2014 study of more than 150,000 patient records reported that 12 percent of hysterectomy patients required pelvic organ prolapse surgery.

In some organ prolapse cases, the vagina is no longer connected to the uterus and cervix. The vagina can telescope down on itself, or even bulge outside the body.

Other organs such as the bowel or the bladder can prolapse down to where the uterus used to be and push on the vagina. If the bladder is involved, this can lead to urinary problems. Surgery can correct these issues.

Most women do not experience prolapse after hysterectomy. To prevent prolapse problems, if you know you are going to have a hysterectomy, consider doing pelvic floor exercises to strengthen the muscles supporting your internal organs. Kegel exercises can be done anytime and anywhere.

If you have your ovaries removed during the procedure, your menopause symptoms can last for several years. If you don’t have your ovaries removed and haven’t gone through menopause yet, you may begin menopause sooner than expected.

If you have your ovaries removed and go into menopause, some of your symptoms may impact your sex life. Sexual side effects of menopause can include:

• vaginal dryness
• pain during sex
• decreased sex drive

These are all due to the change in estrogen produced by your body. There are several things you can consider to counteract these effects, such as hormone replacement therapy.

However, many women who have a hysterectomy do not experience a negative impact on their sex life. In some cases, relief from chronic pain and bleeding improves sex drive.

Learn more about sex after a hysterectomy.

Hysterectomy is a major surgery. Like all surgeries, it comes with a number of immediate risks. These risks include:

• major blood loss
• damage to surrounding tissues, including the bladder, urethra, blood vessels, and nerves
• blood clots
• infection
• anesthesia side effects
• bowel blockage

These types of risks accompany most surgeries and don’t mean that having a hysterectomy isn’t safe. Your doctor should go over these risks with you before the procedure and inform you about steps they’ll take to minimize your risks of more serious side effects.

If they don’t go over this with you, don’t feel uncomfortable asking. If they can’t provide this information or answer your questions, they may not be the doctor for you.

A hysterectomy can be a life-changing procedure with major benefits and some potential risks. That’s why it’s so important to find a doctor that you trust and feel comfortable talking to before having the procedure.

A good doctor will set aside time to listen to your questions and concerns before surgery. While you should bring up any questions on your mind, here are some specific questions to consider asking:

• Are there any nonsurgical treatments that may improve my symptoms?
• Which type of hysterectomy do you recommend and why?
• What are the risks of leaving my ovaries, fallopian tubes, or cervix in place?
• Which approach to surgery will you take and why?
• Am I a good candidate for vaginal hysterectomy, laparoscopic surgery, or robotic surgery?
• Do you use the latest surgical techniques?
• Is there any new research related to my condition?
• Will I continue to need Pap smears after my hysterectomy?
• If you remove my ovaries, would you recommend hormone replacement therapy?
• Is general anesthesia always necessary?
• How long will I need to be hospitalized after my surgery?
• What is the standard at-home recovery time?
• Will I have scars, and where?

Hysterectomies can cause several short- and long-term side effects. They can also help to alleviate excruciating pain, heavy bleeding, and other frustrating symptoms. Work with your doctor to weigh the benefits and risks of the procedure and get a better idea of what to expect after surgery.

Having Sex After a Hysterectomy

Overview

A hysterectomy is surgery to remove the uterus (womb) — the hollow organ where babies grow and develop during pregnancy.

Having this procedure can relieve pain and other symptoms from conditions like fibroids or endometriosis. And if you have uterine or cervical cancer, it could save your life.

Any surgery can have both short-term and long-term side effects. A hysterectomy can cause side effects like pain and bleeding. Once you have this procedure, you won’t be able to carry a child.

A hysterectomy can also impact your sex life in the weeks following the procedure. Yet it shouldn’t prevent you from having sex — and enjoying it — once you’re healed.

Here’s a look at how a hysterectomy can affect your sexuality and what you can do to ensure you don’t lose this important part of your life.

Most of the surgery-related side effects should go away and your body should heal within two months.

The American College of Obstetricians and Gynecologists and U.S. Department of Health and Human Services recommend that you not insert anything in your vagina for the first six weeks after your surgery.

Doctors can perform different types of hysterectomy:

• Total hysterectomy. This is the most common type. It removes the whole uterus, including the bottom part, the cervix. The surgeon might also remove your ovaries and fallopian tubes.
• Partial (also called subtotal or supracervical) hysterectomy. Only the top part of the uterus is removed. The cervix is left in place.
• Radical hysterectomy. The surgeon removes the uterus, cervix, tissue on either side of the cervix, and the top part of the vagina. This type is often used to treat cancer of the cervix or uterus.

You might have some light bleeding and discharge after your surgery, and you’ll no longer get regular menstrual periods.

Pain, burning, and itching around the incision site are also normal. If your ovaries were removed, you’ll likely have menopause-like side effects like hot flashes and night sweats.

A hysterectomy will put your sex life on pause for a few weeks, but it shouldn’t end it.

According to one review of studies, most women said their sex life either stayed the same or improved after the procedure. They were finally free from the pain or heavy bleeding that caused them to have the surgery.

Having your ovaries removed during the procedure could dampen your desire for sex, though. That’s because your ovaries produce testosterone and estrogen — hormones that are integral to your libido.

Can I still have an orgasm?

Some women do report that they have less intense orgasms or no orgasms at all after surgery. This is because removing the uterus can cut nerves that enable you to climax.

Also, the cervix contains nerves that are stimulated during sex. If your cervix was removed during the procedure, the surgeon may have cut these nerves. This is rare and not the norm for most people who have the surgery, though.

Will sex still feel the same?

A hysterectomy shouldn’t affect sensation in your vagina. However, removing your ovaries will put you into menopause, which can dry out the tissues of the vagina and make sex more painful.

What’s the safest way to start having sex again?

First, make sure you wait at least six weeks — or as long as your doctor recommends — before you start having sex again. Take your time easing back into sex.

If vaginal dryness is making sex too painful, ask your doctor about using vaginal estrogen creams, rings, or tablets. Or, try a water-based or silicone-based lubricant like K-Y or Astroglide when you have sex.

If you’re having difficulty getting back to your normal sex life after a hysterectomy, try these tips to get back on track:

1. Take your time

When you have sex, don’t rush. Give yourself time to get aroused.

2. Experiment

Try different positions until you find one that’s most comfortable. Explore options other than vaginal sex, like oral or manual stimulation.

3. Be honest

Be open with your partner about what feels good and what hurts.

If these tips don’t work, consider seeing a sex therapist or counselor with your partner.

Once you pass the six-week mark after your surgery, you should be able to go back to a normal sex life. If you’re still having problems with arousal, orgasm, or comfort during sex, don’t just accept it. See your doctor.

Here are a few questions to ask your doctor:

• What’s the safest way to ease back into sex after my surgery?
• What should I do if sex is painful?
• How can I overcome a lack of desire?
• What should I do if my partner is getting frustrated or isn’t helping?

Together, you and your doctor can strategize ways to make your sex life as good as — or even better than it was — before your surgery.

procedure, recovery after surgery and consequences for the woman

10/16/2016

Contents

• Purpose of hysterectomy
• Indications for surgery
• Preparation
• Contraindications
• Procedure
• Rehabilitation
• Benefits of contacting MEDSI

Removal of the uterus (hysterectomy) is one of the most frequently performed operations in gynecology. Intervention is a real test for a woman. Not surprisingly, patients experience not only the fear of the operation itself, but also depression and vulnerability, confusion and inferiority. We will try to answer all the questions that women have. We will understand how the removal of the uterus is carried out, and how life can change after such an intervention.

Purpose of hysterectomy

Surgery is performed when other treatments have failed or are inappropriate. Emergency interventions often help save the patient’s life.

Interestingly, in a number of European countries and the United States, the operation is common among women after 40–45 years of age. This is due to the fact that it makes it possible to reduce the risks of developing fibroids and tissue growth, if any, and also avoids the appearance of malignant tumors.

Indications for surgery

Hysterectomy is performed in the following pathological conditions and diseases:

• Uterine cancer. After surgery, chemotherapy and radiation therapy are also carried out
• Multiple nodules of fibroids
• Internal bleeding with risk of anemia and other life-threatening conditions
• Acute pain syndrome
• Vaginal bleeding
• Growth of uterine lining tissue in ovaries and fallopian tubes

Preparation

Before the removal of the uterus, the woman undergoes a comprehensive examination. It allows you to assess the patient’s health status and identify possible contraindications.

The following diagnostic tests are usually performed:

• Pelvic ultrasound or MRI with contrast agent
• Vaginal swab
• Endometrial biopsy

The so-called hospital complex is obligatory.

It includes:

• general and biochemical blood test
• urinalysis
• blood test for group and Rh factor, as well as infections, clotting disorders, HIV and other diseases
• fluorography
• ECG

The patient consults with a gynecologist, internist and anesthetist.

Important! If temporary (relative) contraindications to the intervention are identified, the necessary treatment is carried out. If, for example, infectious diseases are detected, the doctor prescribes antibiotics and anti-inflammatory drugs. It is very important to achieve complete recovery or remission. Otherwise, there will be a high risk of surgical and postoperative complications. In addition, existing diseases negatively affect the rehabilitation process, lengthening it.

If a cervicalectomy or other operation is performed to remove a malignant tumor, hormonal and other drugs are prescribed. They help stop tumor growth. The therapy can make it possible to reduce the size of the formation, which will positively affect the course of the intervention, reducing tissue trauma.

Contraindications

Surgery to remove the uterus is not performed if there are the following contraindications:

• low blood clotting
• arterial hypertension
• acute infectious diseases (including small pelvis)
• angina pectoris
• anemia
• diabetes mellitus
• liver failure
• kidney failure
• allergic reactions to anesthetics

Important! There are both absolute and relative contraindications to intervention. In this case, the doctor makes the final decision on the operation. If necessary, the patient is consulted by specialists of narrow profiles.

Procedure

Hysterectomy of the uterus (including appendages) is performed under general anesthesia. The intervention usually takes 1-1.5 hours.

3 methods are used to access organs:

• Laparoscopic. The intervention is carried out through punctures in the area of ​​the abdominal wall. The technique allows to reduce tissue injuries and shorten the rehabilitation period. Usually only 4 small punctures and a specialized tool are required. It is inserted into the cervical canal. First, the ligaments of the uterus are excised, and then it is removed. After that, the walls of the vagina are coagulated and sutured
• Abdominal. This operation is traditional and the most traumatic. It requires a large incision in the abdominal wall. Mandatory for standard intervention is the fixation of intestinal loops. This avoids damage to them. The cervix is ​​cut off in the inner zone of the pharynx. After that, her stump and vaginal vaults are sutured. Then drain pipes are installed. They are removed after a few days
• Transvaginal. Access is provided through an incision in the vaginal area. After that, the surgeon peels off the bladder. Then the vessels and fallopian tubes, as well as ligaments, are separated and cut. After that, the uterus is cut off. The stumps of the pipes are sewn together

There are also 3 types of hysterectomy.

Radical

It involves the removal of the uterus, fallopian tubes, ovaries, regional lymph nodes and fatty tissue. The operation is performed for endometriosis and cancer.

Total

This hysterectomy involves the removal of the uterus with the cervix and appendages. It is prescribed for oncological diseases. The technique allows to reduce the risks of the spread of the tumor process. It is often combined with other methods of cancer therapy (chemotherapy, etc. ). Total hysterectomy can also be performed in emergency situations.

Subtotal

The cervix is ​​not removed during this operation. This intervention eliminates the risk of damage to the ureters and large vessels. It is prescribed for adhesions, pelvic endometriosis and some other pathologies.

Rehabilitation

Recovery after a hysterectomy is a lengthy process. Conventionally, rehabilitation is divided into 2 periods:

1. Early. 3-4 days after the intervention, the woman is under the control of medical personnel. The therapy is aimed at eliminating pain, preventing bleeding, restoring the body, reducing the risk of developing anemia and inflammation. The doctor also monitors the work of the intestines, the condition of the suture and the amount of discharge from the genitals. To remove fluid from the body, a urinary catheter is installed on the first day. During this time, the patient only drinks and does not eat anything. Then, low-fat broths and yogurts are gradually introduced into the diet. Eat light foods that are quickly digested. Chocolate, cabbage, legumes, corn are completely excluded, i.e. products that can cause increased gas formation and constipation. A woman should eat in small portions and at least 4-5 times a day
2. Late. With the classical method of the operation, it lasts about 1.5 months, with laparoscopic – no more than 30 days. The late rehabilitation period begins after discharge from the hospital. At this time, a woman should be attentive to her health and direct all actions towards its full recovery

There are certain recommendations that the patient should follow during rehabilitation:

• Mandatory intake of medicines prescribed by the doctor. Painkillers, anti-inflammatory, hormonal, enzymatic and general tonic agents are usually recommended
• Restriction of physical activity. It is especially important to avoid excessive pressure on the muscles of the abdomen and pelvic floor
• Do simple exercises (if recommended by a doctor)
• Refusal of sexual life. Return to it is carried out with caution. If a woman experiences discomfort, you need to contact a gynecologist. Perhaps it will prolong the period of sexual dormancy
• Healthy eating. Even after discharge from the clinic, you need to adhere to the correct diet with the restriction of alcohol, pastries, fatty foods, smoked meats, marinades
• Proper drinking regimen. A woman should drink about 1.5-2 liters of water per day. This will allow the natural detoxification of the body

Of course, the main consequence of the removal of the uterus is that the woman loses her childbearing function. Otherwise, life can remain as fulfilling as it was before.

Over time, the menstrual cycle is restored, the level of hormones returns to normal. After the removal of the uterus, even the libido can remain the same. At the same time, the ability to lead an active sex life fully returns.

Benefits of contacting MEDSI

• Experienced doctors. Our specialists are not only professionally trained to solve women’s problems, but also provide patients with an attentive and delicate approach
• Comprehensive surveys. They are carried out using modern equipment and ensure the accuracy of diagnosis and the identification of all pathologies
• Possibilities of using sparing techniques for hysterectomy of the uterus and ovaries. Operations are performed using minimally invasive methods, which increases their safety and shortens the rehabilitation period
• New high-tech equipment. It minimizes the risk of bleeding and the occurrence of complications and relapses
• Comfortable hospital stay before and after hysterectomy
• Outpatient rehabilitation and monitoring facilities

To clarify information or make an appointment, just call +7 (812) 336-33-33. Our specialist will answer all questions. Recording is also possible through the SmartMed application.

Do not delay treatment, see a doctor right now:

• Gastroenterologist appointment
• General practitioner appointment
• Gynecological appointment

Total or subtotal hysterectomy: time to dispel the myths?

At present, the development of innovative methods for the treatment of pathology of the female reproductive system has not led to a sharp decrease in the frequency of hysterectomy, which is still one of the most frequently performed operations in gynecology. The active introduction of minimally invasive methods of surgical treatment has led to the fact that the question of choosing a method of surgical access is practically no longer controversial, while the question of the advisability of preserving or removing the cervix during hysterectomy remains relevant. An in-depth analysis of the literature and the results of our own research allow us to state that the advantages of subtotal hysterectomy over total hysterectomy in terms of a low risk of subsequent prolapse and improvement in sexual function is an established myth that has no evidence-based medicine. Apparently, the only indication for performing subtotal hysterectomy remains the need to preserve the cervical stump when performing sacrocervicopexy, since the proportion of cervical erosion in patients with a preserved cervix is ​​​​less, in general, if necessary, subtotal hysterectomy can be performed only in specially selected patients without cervical pathology uterus and deep infiltrative endometriosis.

Hysterectomy is currently one of the most frequently performed operations in gynecology. Innovative methods of treating the pathology of the female reproductive system did not lead to the expected sharp decrease in the frequency of performing this type of surgical intervention. According to the literature, more than 1 million such operations are performed per year in various countries. For example, more than 550,000 hysterectomies are performed per year in the United States, about 100,000 in the UK, 60,000 in France, and 30,000 in Australia. The progressive development of minimally invasive surgical techniques has made this operation safer for patients. Currently, preference is given to laparoscopic access [1-14].

The most common indication for hysterectomy, according to many studies, is uterine fibroids. Approximately 40% of all hysterectomies are believed to be performed for uterine fibroids and its complications [6–7]. In English-speaking countries, indications for hysterectomy are formulated in a peculiar way, and about a third of all hysterectomies are performed for “dysfunctional or abnormal uterine bleeding. ” Endometriosis and ovarian neoplasms are the third most common reason for hysterectomy in the US.

If the question of choosing a surgical approach is no longer controversial [15, 16], then the question of choosing the extent of the operation is still relevant. The expediency of preserving the cervix is ​​also solved ambiguously [11, 14, 17, 18]. For a number of decades, the issue of removing or preserving the cervix has been discussed primarily from oncological positions. The desire for unreasonable preservation of the cervix during hysterectomy often leads to the fact that the pathologically altered cervix is ​​not removed during surgery. Subsequently, there is a risk of developing precancerous and cancerous diseases of the cervical stump. Irregular monitoring of women after supravaginal amputation of the uterus in the late postoperative period can lead to delayed diagnosis and treatment of the developed pathology of the cervical stump [4, 19-22].

According to J. Hannoun-Levi et al. [23], the number of patients with cervical stump carcinoma was 1.2–6.6% of the total number of patients with cervical cancer. It should be noted that the risk of cancer in the cervical stump is 5-10 times higher than in the vaginal stump, especially in women over 50 years of age. According to studies by Russian authors, the risk of developing cervical cancer after supravaginal amputation of the uterus varies within 0.5–1.5% [20] . However, oncological risks are not the main problem of the cervix preserved at the first operation. Perhaps that is why the national traditions of performing certain volumes of surgery vary greatly and depend on the surgical school. The advantages of supravaginal amputation of the uterus usually include the preservation of the supporting ligamentous apparatus of the uterus, a lower frequency and severity of urodynamic and sexual dysfunction [24–27]. In English-speaking countries, there has been a trend in recent years towards the exclusive use of total hysterectomy. So, according to H. Hasson [27], if in the USA up to 1940, 95% of performed hysterectomies were subtotal, in 1975 the proportion of subtotal hysterectomies was only 5%. The main reason for refusing to perform subtotal hysterectomy in those years was the high incidence of cancer in the cervical stump (5-7%). In the UK in 1992, out of 2000 hysterectomies, only 0.7% were subtotal. At the same time, most operations were performed for benign pathology of the uterus, not accompanied by changes in the cervix.

An analysis of data on thousands of subtotal hysterectomies conducted in the 60s showed that the incidence of carcinomas in the cervical stump ranges from 0.3 to 1.9%. In women diagnosed with cancer of the cervical stump, the indication for supravaginal amputation of the uterus in most cases was fibroids [20, 23, 27, 28].

Important in the problem of preventing cancer in the stump of the cervix is ​​the preoperative diagnosis of the state of the cervix. Back in 1993, W. van Wijngaarden [28] showed that if a patient had normal cytological smears before subtotal hysterectomy, then the probability of developing cervical cancer later is less than 0.3%. D. Vale et al. [22] showed on a large material that the frequency of atypical changes in cytological smears after total hysterectomy was 0.13%. In the Scandinavian countries in the 80s, some researchers believed that the risk of developing malignant changes in the cervical stump could be reduced by prophylactic coagulation of the cervical canal. The frequency of carcinoma after this procedure in studies by P. Kikku [29] was 0.11%, while without prophylactic coagulation this figure was 0.4-1.9%. According to a number of authors [30—35], the hysterectomy technique developed by Kurt Semm makes it possible to reduce the likelihood of developing pathological processes in the cervical stump due to circular resection of the endocervix. Interestingly, after this operation, dysplasia was detected in 11.5% of patients. It is noteworthy that in all observations before the operation, the cervix was considered healthy, all women had normal smears-imprints.

Therefore, intraoperative destruction of the mucous membrane of the cervical canal by electrocoagulation, as well as with the help of special instruments, does not guarantee complete destruction of the epithelium and does not exclude the possibility of developing cancer after surgery. In addition, the literature describes a large number of observations of the development of various benign pathologies in the stump of the cervix, requiring further surgical treatment.

H. Hasson [27] in the analysis of 216 extirpations of the stump of the cervix noted that in 74% of patients the indication for surgery was chronic cervicitis, in 9% – hyperplastic processes, 9% – leukoplakia, 3% – polyp of the cervical canal, 2% – leiomyoma, 2% of others – dysplasia, 1% – endometriosis. According to van Evert et al. [14], in the long-term period after laparoscopic supravaginal amputation of the uterus, cervical pathology was diagnosed in 12 (6. 3%) patients, of which extirpation of the cervical stump was required in 4 (2.1%) patients.

Often causes considerable difficulty in deciding the extent of hysterectomy in patients with internal endometriosis due to the inability to exclude the presence of endometrioid heterotopia in the cervix. IN AND. Kulakov et al. [19, 36] based on the experience of surgical treatment of the stump of the cervix, it is believed that in case of adenomyosis, it is advisable to perform hysterectomy. According to the same authors, all patients with endometriosis of the stump were previously operated on for suspected uterine fibroids. The presence of endometriosis was revealed only by histological examination of macropreparations.

According to M. Nisolle [13], careful selection of patients with benign uterine pathology is required for subtotal hysterectomy, which involves the exclusion of any cervical pathology and deep endometriosis.

One of the reasons for refusing to perform a total laparoscopic hysterectomy is the greater technical complexity of the operation and, accordingly, a higher risk of intra- and early postoperative complications. J. van Evert et al. [14] evaluated the experience of performing 192 subtotal and 198 total laparoscopic hysterectomies performed over 10 years from 1998 to 2007. The authors noted early postoperative complications in 3% of patients who underwent subtotal hysterectomy and in 12% of patients who underwent total laparoscopic hysterectomy, in while long-term negative results of treatment (genital prolapse, repeated operations) were more often observed after subtotal hysterectomy than after total: 15% versus 3%. The data of J. Scott and H. Sharp [21] on the number of complications such as infectious inflammation, bleeding, injuries of neighboring organs also do not confirm the advantages of subtotal laparoscopic hysterectomy over total.

Even if we omit the fact of the possible risk of developing background precancerous and cancerous diseases of the cervical stump, it is worth noting that, according to a number of authors, from 17 to 38% of patients who underwent subtotal hysterectomy present various complaints directly related to the presence of the cervical stump due to the occurrence of various inflammatory diseases of the cervix, violations of sexual and urinary function, the extirpation of the cervical stump after subtotal hysterectomy is associated with the highest risk of complications, especially if the first operation was performed by laparotomy access. These problems are associated with a massive adhesive process and a violation of the anatomical location of organs and tissues in the abdominal cavity [5–7, 37, 38].

The traditional argument in favor of performing a subtotal hysterectomy is the alleged decrease in the frequency of prolapse after this operation. Note that even V.I. Kulakov et al. [19, 36] pointed out that this fact is not confirmed by the results of studies and largely depends on the undiagnosed pathology of the pelvic floor prior to hysterectomy. The point of view about the decrease in the frequency of prolapse after subtotal hysterectomy is not confirmed by foreign authors [17]. For example, A. Lethaby (2006) [39] did not confirm the improvement of sexual function, as well as the function of the bladder and rectum compared with abdominal total hysterectomy. In a recent work by N. Pouwels et al. [40] also did not confirm the data on the improvement of sexual function as a result of the subtotal volume of the operation. D. Rahn et al. [41] in a study on cadavers demonstrated the same degree of fixation of the vaginal dome after abdominal total and subtotal hysterectomy. Moreover, N. Gimbel et al. [26] point to clear advantages of total hysterectomy over subtotal hysterectomy, both in terms of sexual function, delayed prolapse of the vaginal stump or cervix, and sexual comfort.

Given that, according to modern data, the overall level of complications of these operations is the same (17% for subtotal hysterectomy, 15% for total) and only early postoperative (bleeding, fever, infection, hematoma of the fornix) complications are more common with total hysterectomy, than with subtotal hysterectomy (3% versus 12%), it is safe to talk about myths regarding the “benefit” of subtotal hysterectomy [14]. Late postoperative complications (problems with the cervical stump, the need for extirpation of the stump, dyspareunia, pain, etc.) are significantly more likely to accompany subtotal hysterectomy (15% versus 3%). That is, the traditionally indicated advantages of the subtotal volume of surgery over total evidence-based studies are not confirmed [13, 14].

When analyzing sexual function after surgery, it turned out that the only predictor of deterioration in sexual function after surgery for both the patient and her partner was a negative sexual experience before the intervention. The scope of the operation, total or subtotal hysterectomy, did not affect sexual function [19, 40, 42].

Thus, at present, it can be stated with certainty that the advantage of subtotal hysterectomy over total hysterectomy, which consists in a low risk of subsequent prolapse and improvement in sexual function, is an established myth that is not supported by evidence-based medicine [40, 42]. The undoubted advantage of subtotal laparoscopic hysterectomy is the ease of its implementation [43]. Apparently, the only indication for subtotal hysterectomy remains the need to preserve the cervical stump when performing sacrocervicopexy, since the proportion of cervical erosion in patients with a preserved cervix is ​​less [13].