Hysterectomy
Medical Author: Suzanne R Trupin, MD
Medical Editor: Melissa Conrad Stöppler, MD
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Hysterectomy and Pap Smears
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
Viewer Question: Is it necessary to have a Pap smear if you have had a hysterectomy?
Dr. Stöppler's Answer: In some types of hysterectomy, the entire uterus is removed, including the cervix (the opening to the uterus). The
Pap smear is primarily used to screen for cervical dysplasia (precancerous changes) and
cancer of the cervix, so if you have had your cervix removed, you usually won't need to have regular Pap smears. In other types of hysterectomies, the cervix is left intact, and the portion of the uterus above the cervix is removed. In this case, the cervix is still present and
Pap smears are still required.
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What is a hysterectomy?
A hysterectomy is a surgical procedure whereby the
uterus (womb) is removed. Hysterectomy is the most common non-obstetrical surgical procedure of women in the United States.
How common is hysterectomy?
Approximately 300 out of every 100,000 women will undergo a hysterectomy.
Why is a hysterectomy performed?
The most common reason
hysterectomy is performed is for uterine fibroids The next most common reasons
are:
Only 10% of hysterectomy is performed for
cancer. This article will primarily focus on
the use of hysterectomy for non-cancerous, non-emergency reasons, which can involve
even more challenging decisions for women and their doctors.
Uterine fibroids (also known as uterine leiomyomata) are by far the most common reason a hysterectomy is performed. Uterine fibroids are benign growths of the uterus, the cause of which is unknown. Although the vast majority are benign, meaning they do not cause or turn into cancer, uterine fibroids can cause medical problems. Indications for hysterectomy in cases of uterine fibroids are excessive size (usually greater than the size of an eight month
pregnancy), pressure or pain, and/or bleeding severe enough to produce anemia. Pelvic relaxation is another condition that can require treatment with a hysterectomy. In this condition, a woman experiences a loosening of the support muscles and tissues in the pelvic area. Mild relaxation can cause first degree prolapse, in which the cervix (the uterine opening) is about halfway down into the vagina. In second degree prolapse, the cervix or leading edge of the uterus has moved to the vaginal opening, and in third degree prolapse the cervix and uterus protrude past the vaginal opening. Second and third degree uterine prolapse must be treated with hysterectomy. A loosening, vaginal wall weakness such as a cystocele, rectocele, or urethrocele, can lead to symptoms such as urinary incontinence (unintentional loss of urine), pelvic heaviness, and impaired sexual performance. The urine loss tends to be aggravated by sneezing, coughing, or laughing. Childbearing is probably involved in increasing the risk for pelvic relaxation, though the exact reasons for this remain unclear. Avoidance of vaginal birth and having a caesarean section doesn't eliminate the risk of developing pelvic relaxation.
A hysterectomy is also performed to treat
uterine cancer or very severe pre-cancers (called dysplasia, carcinoma in situ, or CIN III, or microinvasive carcinoma of the cervix). A hysterectomy for endometrial cancer (uterine lining cancer) has an obvious purpose, that of removal of the cancer from the body. This procedure is the foundation of treatment for cancer of the uterus.
Next: What tests or treatments are performed prior to a hysterectomy? »
- Pap Smear - Read about Pap smear, a test to screen for cervical cancer, and precancerous changes in the cervix. Risk factors for abnormal Pap include HPV, smoking medicaitons, and a weakened immune system.
- Ovarian Cancer - Get information on ovarian cancer symptoms, diagnosis, tests, staging, research, surgery and risk factors. Treatment options include surgery, chemotherapy and radiation.
- Endometrial Ablation - Read about endometrial ablation, a procedure performed to treat abnormal bleeding of the uterus. During the procedure the lining tissues of the uterus are destroyed.
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Hysterectomy
Endometriosis »
What is endometriosis?
Endometriosis is the growth of cells similar to those that form the inside of
the uterus (endometrial
cells), but in a location outside of the uterus. Endometrial cells are the same
cells that are shed each month during menstruation. The cells of endometriosis
attach themselves to tissue outside the uterus and are called endometriosis
implants. These implants are most commonly found on the ovaries, the Fallopian
tubes, outer surfaces of the uterus or intestines, and on the surface lining of
the pelvic cavity. They can also be
found in the vagina, cervix, and bladder, although less commonly than other
locations in the pelvis. Rarely,
endometriosis implants can occur outside the pelvis, on the liver, in old
surgery scars, and even in or around the lung or brain. Endometrial implants,
while they can cause problems, are
benign (not cancerous).
Who is affected by endometriosis?
Endometriosis affec...
Read the Endometriosis article »
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