El cervical cancer It remains one of the most preventable gynecological tumors and, at the same time, one of those that generates the most questions among women and healthcare professionals. Despite the fact that today we have HPV vaccines Despite the lack of effective screening tests, misinformation and taboo surrounding sexual health continue to hinder prevention.
In Europe, and also in Spain, public health strategies focus on to detect precancerous lesions early of the cervix and to eradicate persistent human papillomavirus (HPV) infection. Questions such as what happens after a hysterectomy, when to continue with Pap smears, or how to get the most out of vaccination are very common in consultations.
Hysterectomy and cervical cancer risk: what really changes
One of the most frequent questions is whether, after a hysterectomyThe risk of cervical cancer remains. The answer depends primarily on if the cervix was also removed during the surgery or just the uterus. Not all operations are the same, and this affects the subsequent follow-up.
In a total hysterectomy The uterus and cervix are removed, while in a supracervical hysterectomy The cervix is ​​preserved and only the uterus is removed. This anatomical difference is key: if the cervix remainsCervical cancer may continue to develop, so the woman should continue with her checkups and screening tests.
Gynecologists usually recommend removal of the cervix This occurs when a hysterectomy is part of the treatment for uterine cancer or when minimally invasive surgery is performed. In these cases, removing the uterus through the vagina requires also removing the cervix to prevent it from blocking the opening.
Furthermore, when the intervention is done by abnormal uterine bleedingMany specialists advise removing the cervix, since if it remains, there is a possibility that The bleeding continues after surgery. In any case, the decision is individualized according to the history and anatomical situation of each patient.
Follow-up and screening after a hysterectomy
In women with supracervical hysterectomyThe cervix remains susceptible to HPV-related precancerous changes. Therefore, it is recommended to continue with the cytology (Papanicolaou) and with regular visits to the gynecologist, just as if the uterus had not been operated on.
Individual risk varies depending on the Pap smear test history and the history of HPV infection. If there have been abnormal cytology results or persistent high-risk HPV, monitoring should be closer and adapted to previous findings, something that in Europe is usually included in screening protocols organized by autonomous communities or regions.
In the case of the total hysterectomyWhen the cervix has been removed and there is no history of cervical dysplasia or precancerous cells, the likelihood of developing cervical cancer afterward is considered low. Even so, some medical teams raise concerns about potential complications. additional control period with vaginal smear, especially if there were alterations before the surgery.
The call vaginal smear It is a sample of cells taken from the vagina, similar to a Pap smear, which is analyzed to detect vaginal dysplasia, that is, abnormal changes in the cells of the vaginal mucosaThese changes may be related to HPV infection and, although they are not frequent, it is advisable to identify them early in order to treat them.
International scientific guidelines indicate that women with abnormal cytology prior to hysterectomy they might need controls for 20 to 25 years After surgery. In Europe, specific recommendations may vary between countries, so it is advisable to discuss the most appropriate check-up schedule with your gynecologist or family doctor.
The role of HPV in cervical cancer
Practically the total number of cervical cancer cases are related to a persistent infection by the human papilloma virus (HPV)This sexually transmitted virus is very common: most sexually active people come into contact with it at some point in their lives, although in many cases the body eliminates it without causing problems.
There are dozens of types of HPVbroadly grouped into low- and high-risk strains. The types of low risk They are mainly associated with benign lesions, such as genital warts, while those of high oncogenic risk They can cause persistent infections that can evolve over the years into precancerous lesions and, if left untreated, into cervical cancer.
The main route of infection is the unprotected sexincluding penetration, oral sex, and skin-to-skin contact in the genital area. Although it may seem like a virus isolated to the gynecological field, it has also been linked to other tumors such as anal cancer or certain forms of throat cancer, so prevention is of interest to both women and men.
HPV infection alone is not always enough to cause cancer. Additional factors, such as SmokingA weakened immune system, lack of regular checkups, or co-infection with other sexually transmitted infections can all contribute to the progression of lesions. Among the things that can be modified, give up smoking It is one of the most effective measures to reduce risk.
Another important aspect is that, in the early stages, cervical cancer or high-grade dysplasia can not to show symptomsThat's why regular screening using cytology and HPV testing is so important: it allows for the detection of silent changes before more noticeable signs appear.
Screening tests: Pap smear, HPV test and other techniques
The periodic gynaecological check-ups, They are the basis for the early detection of HPV-related lesions. In practice, several tools are combined: cervical cytology (Pap smear), specific HPV tests, and, in some cases, more advanced laboratory techniques.
La PAP test It remains one of the greatest allies in prevention. It consists of collecting cells from the cervix and analyzing them under a microscope to identify abnormal or precancerous cellsIn many European countries, it is recommended to perform it periodically between the ages of 25 and 65, with intervals that usually range between 3 and 5 years, depending on age and whether or not it is combined with the HPV test.
El HPV test It allows for the direct detection of the genetic material of high-risk types of the virus. It is increasingly common to use it in conjunction with cytology, especially after age 30, to better define risk. When both results are normal, the interval between checkups can be extended, maintaining a effective but less invasive screening.
In some clinical settings, methods such as the following are used: hybrid captureA laboratory technique that identifies the presence of high-risk HPV in the cervix. This test is performed using a smear similar to that of cytologyBut its primary purpose is to detect the virus, not cellular changes. It's important to remember that the Pap smear, by itself, does not confirm HPV infectionIt reveals alterations in cells that may be caused by the virus or other factors.
In women with a history of abnormal cytology, persistent HPV, or previous lesions, the medical team may recommend tighter controlscolposcopy or targeted biopsies. The goal is treat precancerous lesions before they evolve, thus preventing the development of invasive cancer.
Warning signs and symptoms to watch for
Although early-stage cervical cancer may not cause any discomfort, there are certain Symptoms that should not be ignoredDetecting them and discussing them early with a gynecologist can make a difference in the prognosis and treatment options.
Among the signs that usually trigger alarm bells, the following stand out: bleeding after sexual intercourseThis type of bleeding, especially when it recurs, requires evaluation because it can be related to both benign lesions and more serious changes in the cervix.
Other manifestations to consider include the persistent pelvic pain, discomfort during sexual intercourse and the abnormal vaginal dischargeWhether it's due to their quantity, color, or the presence of a foul odor, these symptoms don't automatically mean cancer is present, but they do warrant a thorough examination.
It is common for many women to normalize certain irregular bleeding or downplay the discomfort during sex, whether out of embarrassment or because they think it's "just a part of getting older." However, any noticeable change in the usual bleeding pattern or pelvic sensation warrants a professional evaluation.
When in doubt, experts recommend do not wait for the next scheduled review and make an appointment. A clinical assessment, combined with a gynecological examination, cytology and, if necessary, imaging tests, allows serious problems to be ruled out or treatment to begin when the lesions are still treatable in a less aggressive way.
HPV vaccination in Europe and early protection
La HPV vaccination It has become established as a key tool for reducing the incidence of cervical cancer. In most European countries, including Spain, it is part of the childhood or adolescent vaccination programs funded with public funds and aimed at both girls and, increasingly, boys.
Current vaccines are designed to protect against high-risk HPV types more closely linked to cervical cancer, and also against some types that cause genital warts. Ideally, they should be administered before the start of sexual relationsThis ensures the best immune response against a virus to which one has not yet been exposed.
Various international guidelines recommend vaccination of adolescents and young adultsAnd in Europe, the age ranges have been adjusted. Some agencies extend the recommendation to adults up to age 45, always after an individual assessment of the potential benefit, especially in people with increased risk of HPV exposure.
In environments where vaccination schedules have been simplified, a single-dose regimen For adolescents, this facilitates adherence and population coverage. Each country, within the European Union or in its surrounding area, adapts the number of doses, the age range, and the recruitment strategy according to available resources and its public health objectives.
Vaccination does not replace screening testsbut rather complements them. Even vaccinated women need to continue with checkups because the vaccine does not cover all existing HPV types. However, accumulated data suggests that a high vaccination coverage It could drastically reduce cases of cervical cancer in the coming decades.
Lifestyle habits and daily prevention
Beyond vaccines and medical tests, there are a number of Everyday habits that contribute to protecting cervical health. One of the most important is avoid tobaccobecause smoking makes it harder for the immune system to eliminate HPV and increases the risk of lesions progressing.
The practice of safe sex It also plays a key role. Correct condom use during sexual intercourse reduces the risk of HPV infection and other sexually transmitted infections, although it does not eliminate it completely, since the virus can be transmitted through contact with areas not covered by the condom.
Keep a balance dietRich in fruits, vegetables, and antioxidant-rich foods, it promotes a stronger immune system, which helps the body to better manage infectionsincluding HPV. It's not about miracle diets, but about consistently following healthy eating patterns.
Another pillar of prevention is to go to regular gynecological check-upsEven if there are no symptoms, regular visits allow for adjusting the frequency of Pap smears and HPV tests, resolving doubts, and addressing other aspects of sexual and reproductive health.
European health services are increasingly emphasizing the importance of sex education evidence-based, addressing topics such as HPV, consent, diversity of practices, and self-care. Breaking the silence and stigma surrounding cervical cancer encourages more women to participate in screening programs and take advantage of the prevention opportunities that already exist.
Today, cervical cancer is a largely preventable disease if the following measures are combined: HPV vaccination, regular screening, and healthy lifestyle habitsUnderstanding what a hysterectomy involves, when to continue with Pap smears, and how HPV is transmitted empowers every woman to make informed decisions about her health. With good coordination between primary care, gynecology, and public prevention programs, the goal of minimizing cases of cervical cancer in Europe is increasingly attainable.
