Pap smear
Question: Ten years ago I had a hysterectomy for fibroids, and my ovaries were removed. Do I need to have a Pap smear?
When a Pap smear is performed, the area examined is the cervix, and the test is primarily performed in order to find cancer of the cervix at an early stage. The cervix sits at the top of the vagina, and is the rubbery piece of tissue that forms the opening into the uterus (womb).
In a hysterectomy, the uterus and cervix are removed, but the vagina is left behind. After a hysterectomy, there is nothing left behind to perform a Pap smear on; you therefore do not require an annual trip to the doctor for this test. The one exception to this rule is those women who have had a hysterectomy because of cancer. There is a very slight risk that the cancer can spread to the top of the vagina, and so vaginal vault smears should be performed regularly in these women.
The Pap smear test is one that should be performed on all women who have ever been sexually active. A test every two years is ideal, but if there have been abnormal tests of some sort, this may be reduced to 6 or 12 months. Many other conditions other than cancer can be detected by a Pap smear. These include infections, abnormal discharges, erosions of the cervix and ulcers.
Question: I am due to have a hysterectomy because of fibroids. I want to keep my cervix, which is perfectly normal, but my gynecologist is reluctant to do this. If I have a regular Pap smear, why shouldn’t I have a sub-total hysterectomy and keep my cervix?
A sub-total hysterectomy in which the body of the uterus (the womb) is removed, but the neck of the uterus (the cervix) and the ovaries are retained is certainly an option, but it is not one that is commonly preferred.
The advantage is that you continue to have a cervix, which some experts claim is important for the full sexual satisfaction of the woman. The disadvantages are that the operation is technically more difficult, and more prone to complications, as the thick muscle of the neck of the womb must be cut through and secured, instead of the thin tissue at the top of the vagina. Your gynecologist will certainly be more experienced at doing a full hysterectomy than a partial one. As you mention, you also have the continued risk of cancer of the cervix, which can be detected early by a regular Pap smear.
My advice would be to have a full removal of your uterus and cervix (retaining one or both ovaries).
Tags: abnormal pap smear, hysterectomy, pap smear, vaginal hysterectomy