By E. Scott Sills, MD,
OBGYN.net Editorial
Advisor
Atlanta Reproductive Health
Center
NEW YORK - U.S. investigators have published two reports that shed more light on how hysterectomy practice is changing in this country. Two papers recently appearing in peer-reviewed medical journals focused on the frequency of the two principal kinds of abdominal hysterectomy, total and supracervical. A third report, presented at a major gynecology conference, investigated how these two hysterectomy types might impact postoperative sexual function.
Demographically, the number of hysterectomies performed each year in the U.S. has declined for several years. But as the overall number of abdominal hysterectomies has fallen, a specific type of abdominal hysterectomy has steadily gained popularity in the meantime. Dr. E. Scott Sills and colleagues at Cornell Medical Center in Manhattan found that supracervical (or "sub-total") hysterectomies done in the U.S. increased by an impressive 250% from 1991 to 1994.
A related publication on hysterectomy activity in New York State by Sills et al showed a five-fold jump in supracervical abdominal hysterectomies from 1990 to 1996.
During the study period, the traditional or "total" abdominal hysterectomy actually decreased by about 20% across the country. The number of total abdominal hysterectomies also fell significantly in New York. The two operations are different only in that the supracervical hysterectomy preserves the cervix, a feature some have argued results in fewer sexual and/or bladder problems after surgery. Most studies on sex after hysterectomy have been done outside the U.S., but those works may have gained more attention here in recent years.
The costs of the two abdominal operations were also found to be different, with supracervical hysterectomy usually being more expensive. This could be due to numerous factors including surgical complications, researchers say.
While these seem like dramatic trends in an important operation (more than 500,000 hysterectomies were done in 1990 alone), Sills cautions that his findings should not be viewed as too alarming. "Total abdominal hysterectomy still makes up the lion's share of all hysterectomy activity in the U.S., and it would take many years of the current practice patterns before supracervical hysterectomy overtakes it-if ever."
Perhaps a more intriguing question is "what's causing the shift in U.S.hysterectomy practice?" NYU pelvic surgery expert Dr. Joy Saini and associates studied the effects of hysterectomy type on sexual function.
Using a specially-developed anonymous questionnaire, she found worse sexual function in the total abdominal hysterectomy group than in the supracervical hysterectomy group. Her conclusions agreed with European researchers, but Dr. Saini feels that "future prospective studies are needed to confirm our findings."
In Dr. Saini's scientific abstract, frequency of intercourse, orgasm frequency and overall sexual satisfaction were significantly better when the cervix was not surgically removed. Her report was discussed at the Society of Gynecologic Surgeons' 24th Annual Meeting, and a full paper elaborating on these results is expected. "This is a vital area of research for women's health that is not well studied and sadly underfunded", noted Dr. Saini.
References:
Sills ES, Saini J, Applegate MS, McGee M, Gretz HF (1998). Supracervical and total abdominal hysterectomy trends in New York State: 1990-1996. Bull N Y Acad Med 75:903-910.
Saini J, Sills ES, Kuczynski E, Gretz HF (1998). Supracervical hysterectomy vs. total abdominal hysterectomy: perceived effects on sexual function [abstract]. 24th Annual Meeting, Society of Gynecologic Surgeons.
Sills ES, Saini J, Steiner CA, McGee M,Gretz HF (1998). Abdominal hysterectomy practice patterns in the United States. Int J Gynecol Obstet 63:277-283.