Cervix: Take It or Leave It?

I recently wrote about whether or not I should take out my fallopian tubes when I get my hysterectomy. I am still on the fence about that (though leaving heavily toward taking them out), but I do know where I stand on my cervix: I am keeping it.

This may not be the right move for everyone considering a hysterectomy for adenomyosis, but I believe it is right for me, and I will share my reasoning.

Why I'm keeping my cervix

First, I do not suffer from cervical pain or complications. I have never had an abnormal Pap smear, and no history of HPV (which can increase odds of developing cervical cancer- which my mother developed and that eventually claimed her life). Unlike breast or ovarian cancer, family history and/or genetic predisposition plays no contributing role in developing cervical cancer, so my mother's diagnosis has no implications for me. Second, as someone with endo, my last lap did not reveal any endo in my cervix. Assuming that there is still little to no endo there, I do not see the reason to remove it. Even if there were some endo, unless it was extremely widespread in in my cervix and deeply infiltrating, I would want it to remain intact and rather my surgeon just remove the endometrial implants as best he can.

Many women with endo/adeno opt to have both their uterus and cervix removed (the cervix is basically considered part of the uterus- the mouth or bottleneck passage to it). But if I can keep parts of me, I want to.

The cervix & sexual function

There are also some studies that indicate maintaining the cervix in a hysterectomy can help preserve sexual function and removing it can cause complications for orgasm and sexual pain. There are contradicting studies on this, some which conclude keeping the cervix helps prevent sexual dysfunction post-hysterectomy, some which conclude there is no discernible difference either way whether it is taken out or left in. Anecdotally, I have spoken to women who have had it taken out, some who have told me it caused sexual problems (though usually these are older women who had their hysterectomies years or even decades ago before surgical innovations with laparoscopy), and others who had it out and say it didn't bother their sex life at all. So basically, I decided that keeping it won't harm me and may even help decrease my odds of experiencing negative sexual side effects.

Preserving the cervix may not always be enough to sustain sexual function prior to surgery. I have also read it helps to have surgeons who try to be delicate and not damage the nerves that pass near the cervix, as well as preserve the "uterine cervical ganglia" (whatever that is, I am investigating further)in order to increase the odds of maintaining sexual function.¹

Of course, some people find increased sexual function after hysterectomy even with the removal of the cervix - because there is relief in the pain and complications caused by endo/adeno -that more than compensates for the loss of those organs. Personally, though my adeno/endo have had adverse impacts on my life, my sexual function and ability to orgasm (including deeper internal orgasms) have been pretty good and so far has not been compromised much by my disease. That may change (or seems to be slowly changing), which is another reason I am looking into surgery now, but I want to be careful to take the precautions needed to minimize negative changes in my body as a result.

Did you have a hysterectomy and have you kept or maintained your cervix? Do you feel a difference when it comes to sex? Feel free to respond in the comments below.