Total vs subtotal hysterectomy in Vasco: is the cervix kept?
Medically reviewed by our consultant obstetrician & gynaecologist (MBBS, MS OBG). Last reviewed: 6 November 2026.
In a total hysterectomy, the womb and the cervix, or neck of the womb, are both removed. In a subtotal, or supracervical, hysterectomy, the womb is removed and the cervix is left in place. Neither suits every woman. The choice depends on your cervix, your screening history and the reason for surgery, and is agreed before the operation in Vasco.
When a hysterectomy is planned, most women expect one simple question: will the womb come out? There is often a second question that is easy to miss on the admission papers: will the cervix stay? This guide by the Pai Hospital Team explains the two types in plain words, what each means for screening, bleeding and recovery, and how the choice is made with you. For the wider picture of why and how a womb is removed, start with our hysterectomy overview. If you are still deciding whether an operation is needed at all, that page also explains options that keep the womb, such as removing fibroids alone.
What is the cervix, and why does it matter in a hysterectomy?
The cervix is the narrow, lower part of the womb. It sits at the top of the vagina, like a short neck joining the two. It is the part checked during a Pap smear, and the part a baby passes through at a normal birth. In a hysterectomy the surgeon either removes the cervix with the rest of the womb, or divides the womb just above it and leaves it in place.
What is a total hysterectomy?
In a total hysterectomy, the body of the womb and the cervix are removed together. The top of the vagina is then closed with stitches, forming what is called the vaginal vault. This is the more common type, and it is what "TLH", or total laparoscopic hysterectomy, refers to when it is done through keyhole cuts. Once the cervix is gone, there is no tissue left there that can later form cervical precancer, which is one reason it is chosen.
What is a subtotal or supracervical hysterectomy?
In a subtotal hysterectomy, also called a supracervical or partial hysterectomy, the body of the womb is removed and the cervix is left behind. The top of the vagina is not opened. Through keyhole surgery, the womb body is usually cut into smaller pieces inside a closed bag so it can come out through the small cuts. Some women ask for this type because they wish to keep the cervix; for others it is suggested because it may shorten the operation when the surgery is difficult.
Is it the same decision as removing the ovaries?
No, and this often causes confusion. "Total" describes the cervix, not the ovaries. A woman can have a total hysterectomy and keep both ovaries, or a subtotal hysterectomy and have them removed. The ovaries and tubes are a separate choice, explained in our guide on whether the ovaries are removed in a hysterectomy.
When is a total hysterectomy usually advised?
Removing the cervix is generally recommended when:
- you have had abnormal Pap smear results, CIN or other precancer changes of the cervix, or a positive HPV test that needs follow-up;
- there is concern about precancer or cancer of the womb lining or the cervix;
- you have endometriosis or adenomyosis that involves the lower womb or the area behind the cervix, where leaving tissue may leave pain behind;
- you would rather not continue cervical screening for the rest of your screening years, and there is no medical reason to keep the cervix.
If your smear tests have not been up to date, a smear is usually taken before surgery. Our page on the Pap smear test in Vasco explains what the test involves.
When may a subtotal hysterectomy be offered?
Keeping the cervix may be discussed when your smears have always been normal, there is no suspicion of cancer, and the reason for surgery is in the body of the womb, such as fibroids. It may also be chosen during the operation itself if dense scar tissue around the bladder or bowel makes removing the cervix riskier than usual. In that case, the possibility is talked through with you beforehand so that it is not a surprise afterwards.
What does keeping the cervix mean for screening afterwards?
This is the most important practical difference. If your cervix is kept, it can still develop the same cell changes as before, so cervical screening carries on at the usual intervals for the rest of your screening years. If your cervix is removed for a reason that is not cancer or precancer, routine smears are often no longer needed. After a total hysterectomy for CIN or cancer, a follow-up check of the vaginal vault is usually advised for a time. Ask for your own plan to be written in your discharge papers.
Can there be spotting after a subtotal hysterectomy?
Regular periods stop after either type. A small number of women who keep the cervix notice light spotting each month, at about the time a period would have been due, because a small amount of lining sits at the top of the cervix. It is usually light, but any bleeding after a hysterectomy should be reported, so it can be checked rather than assumed. Rarely, ongoing bleeding or discomfort from the cervix that was kept leads to a later, smaller operation to remove it.
Does keeping the cervix affect prolapse or intimacy?
It was once thought that leaving the cervix would better support the vagina and protect sexual feeling. Studies comparing the two types have not shown a clear difference in later prolapse, bladder control or sexual satisfaction for most women. The pelvic floor muscles and ligaments do most of the supporting work either way. What matters more is your own health, the reason for surgery and good healing.
Is recovery different between the two types?
Recovery is broadly similar. With a subtotal hysterectomy the vagina is not opened, so there is no vault stitch line to heal, and some women have a little less discharge in the first weeks. With a total hysterectomy, intercourse is usually avoided for about six weeks while the vault heals. After a subtotal hysterectomy, your doctor will advise when intercourse can resume. The route of surgery, keyhole, vaginal or open, has a bigger effect on recovery than whether the cervix is kept. Our article on keyhole and open gynae surgery explains those routes.
How is the choice made at the Vaddem hospital in Vasco?
At the consultation before surgery, your doctor goes over your scan and smear results, the reason for the operation and your own wishes. Together you decide whether the cervix is kept or removed, and whether the ovaries and tubes are kept, and these choices are written on the consent form. The operation is done at Pai Hospital, Vaddem, Vasco-da-Gama. What happens from arrival to discharge is described in our guide to the day of a laparoscopic hysterectomy.
Your questions
What is the difference between a total and a subtotal hysterectomy?
A total hysterectomy removes the womb together with the cervix, which is the neck of the womb at the top of the vagina. A subtotal, or supracervical, hysterectomy removes the body of the womb and leaves the cervix where it is. The ovaries are a separate decision in both.
Do I still need Pap smears after a subtotal hysterectomy?
Yes. Because the cervix stays, it can still develop the cell changes that screening looks for, so regular cervical screening continues just as before. After a total hysterectomy done for a non-cancer reason, with no history of abnormal smears, routine smears are often no longer needed. Your doctor will tell you which applies to you.
Can I have periods after a subtotal hysterectomy?
Proper periods stop, because the lining of the womb body is removed. A small number of women notice light spotting around the time a period would have come, from a little lining left at the top of the cervix. It is usually slight, but tell your doctor about any bleeding after surgery so it can be checked.
When is removing the cervix advised?
A total hysterectomy is usually advised when the cervix itself has had problems, such as abnormal smear results, CIN or other precancer changes, or when there is concern about cancer of the womb or cervix. It may also be suggested for some women with endometriosis or adenomyosis, or with ongoing pain linked to the cervix.
Does keeping the cervix prevent prolapse?
This is a common belief, but research has not shown that keeping the cervix clearly protects against later prolapse. Support for the vagina comes mainly from the pelvic floor muscles and ligaments. Your doctor will explain the evidence as it stands and help you weigh it with your own history.
Where is the surgery done and who decides which type?
The operation is done at Pai Hospital, Vaddem, Vasco-da-Gama. You and your doctor decide together, at the consultation before surgery, whether the cervix is kept or removed, and the choice is written on your consent form so everyone in theatre follows the same plan.
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This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.