Dr. Suzanne Trupin is a Clinical Professor of Obstetrics and Gynecology at the University Of Illinois College Of Medicine at Urbana-Champaign. She graduated from Stanford University and completed her medical training at New York Medical in Valhalla, New York. She received her residency training at the University of Southern California Women's Hospital in Los Angeles, California. She is Board-Certified by the American Board of Obstetrics and Gynecology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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). 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.
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:
endometriosis, and uterine prolapse (including
pelvic relaxation).
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.
There are many types of ovarian cancer, epithelial carcinoma is the most common. Women with a family history of ovarian cancer have an increased risk of developing the disease. Some ovarian cancer symptoms include abdominal pain, nausea, diarrhea, constipation, and abnormal vaginal bleeding, however, they usually do not present until the disease has progressed. Early diagnosis is important for successful treatment.
Endometriosis is the growth of cells similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis 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. Treatment of endometriosis can be with medication or surgery.
Though uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including: over age 50, endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, having colorectal cancer. Symptoms of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
Cervical cancer is cancer of the entrance to the womb (uterus). Regular pelvic exams and Pap testing can detect precancerous changes in the cervix. Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery. The most common symptom of cancer of the cervix is abnormal bleeding.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
Uterine fibroids are benign tumors that originate in the uterus and are usually round or semi-round in shape. The most common symptom of a uterine fibroid is abnormal vaginal bleeding. Other symptoms include pressure, pelvic pain, pressure on the bladder, or pain during a bowel movement. Treatment options vary from surgery to medication.
Cervical dysplasia is a condition in which the cells of the inner lining of the cervix have precancerous changes. There are two types of cervical dysplasia; 1) squamous intraepithelial lesion, and 2) cervical intraepithelial neoplasia. Cervical dysplasia is caused by infection of the cervix with HPV (human papillomavirus). There are various diagnostic measures for cervical dysplasia. Treatment generally depends upon the progression of the dysplasia, mild, moderate, or severe.
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include: abdominal pressure, pelvic pain, and pain during intercourse. Diagnosis and treatment of benign uterine growths depends upon the type of growth.
Sexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
People who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
Endometrial ablation is the surgical destruction of the lining tissues of the
uterus, known as the
endometrium.
Endometrial ablation is one type of treatment for
abnormal uterine bleeding.
Why is endometrial ablation done?
Endometrial ablation is a treatment for abnormal bleeding of the uterus that
is due to a benign (non-cancerous)
condition. Endometrial ablation is not sufficient for treatment of bleeding due
to cancer of the uterus, since cancer
cells may have grown into the deeper tissues of the uterus and would not be
removed by the procedure.
Endometrial ablation is only performed on a
nonpregnant woman who does not plan to become pregnant in the future. It should
not be performed if the woman has an active
infection of the genital tract.
Endometrial ablation is not a first-line therapy for heavy bleeding and should only be considered when
medical and hormonal therapi...