Should you keep your uterus during prolapse surgery, or is hysterectomy the safer long-term choice? ? This is one of the questions I get asked most in consultation, and the honest answer is: it depends. Let me walk you through how I actually think about it.
When we talk about pelvic organ prolapse repair, there are two main paths: a hysteropexy (repairing the prolapse with the uterus left in place, often using mesh) or a hysterectomy (removing the uterus as part of the repair). Patients often ask me, "Why would you take out an organ that isn't diseased?" And that's a completely fair question — but it's not that simple.
Here's the truth: we don't actually know an organ is 100% disease-free until it's been sent to pathology. Leaving the uterus in place isn't just "not removing it" — it comes with downstream consequences: continued periods, ongoing need for Pap smears, and the possibility of future uterine issues (including cancer) down the road. It's not risk-free just because it feels less invasive in the moment.
There's also a technical reality: a hysteropexy is a more challenging surgery to perform well — and to get an equivalent outcome to a hysterectomy. And if you ever need a hysterectomy down the line after a hysteropexy, that future surgery becomes significantly more complicated. In some cases, we may even need to undo part of the original sacrocolpopexy mesh repair just to safely remove the uterus later.
That's why, in my own practice, I lean toward hysterectomy in most cases — especially if there's any current abnormality in the uterus. If everything is currently normal, the conversation gets more nuanced, including whether to remove the cervix along with the uterus (each has its own trade-offs I break down in this video).
At the end of the day, this is YOUR decision. My job is to lay out every consequence — medical, surgical, and long-term — so you can have an honest conversation with your surgeon about what feels safest for your body and your future. ?
If you're weighing this decision yourself or preparing for a consult, I hope this gives you the framework to ask the right questions. ?
✨About Your Host: Dr. Richard Farnam, MD, is a pioneer in robotic surgery and patient advocacy, dedicated to providing transparent, expert-level medical education for women everywhere.
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Disclaimer:
This content is for entertainment only, not medical advice. I'm Dr. Richard Farnam, but the character "Doctor Rich’s” comedy is often fictional, satirical, exaggerated— and may not be representative of real-life medical practices. Viewer discretion is advised for satire/humor (e.g. when it touches on sensitive subjects/pop culture) and shouldn’t be interpreted as factual commentary or endorsement. Consult a medical professional for questions.
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