Pelvic Organ Prolapse · Patient guide

Hysteropexy vs Hysterectomy for Uterine Prolapse: Which Is Better?

For most women with uterine prolapse who have no uterine disease, hysteropexy (lifting and fixing the uterus) is at least as effective as hysterectomy at relieving prolapse, with a shorter operation, less blood loss and a faster recovery. Hysterectomy is preferred when there is uterine pathology such as cancer or problematic fibroids. Somssi Women's Clinic in Seoul performs uterus-preserving hysteropexy with native tissue as its standard approach.

Medically reviewed by Dr. Yoon Ho-joo, MD, PhD, OB/GYN specialist, Somssi Women's Clinic · Last updated October 2026

At a glance

Key facts

The essentials, based on how Somssi Women's Clinic performs this procedure or answers this question. Your plan is confirmed at consultation.

• Hysteropexy: uterus lifted about 2–4 cm and fixed to its supporting tissue; cul-de-sac closed
• Hysterectomy: uterus removed; the vaginal top must still be suspended to prevent vault prolapse
• Somssi's approach: vaginal hysteropexy with your own tissue, no mesh
• Operation time at Somssi: 50 minutes to 1 hour, same-day discharge
• Anesthesia: sedation plus long-acting local anesthesia
• When hysterectomy is still right: uterine cancer, precancer, or symptomatic fibroids or adenomyosis not suited to other treatment
• Surgeon: Dr. Yoon Ho-joo, MD, PhD, Korean Society of Urogynecology member

Hysteropexy and hysterectomy both treat uterine prolapse, but hysteropexy keeps the uterus and re-suspends it, while hysterectomy removes it; for women without uterine disease, the uterus-preserving option is generally the better first choice. The decision rests on whether your uterus is healthy, how advanced the prolapse is, your plans for pregnancy, and your own feelings about keeping the organ.

What the two operations actually do

Hysteropexy

Hysteropexy means fixing the uterus in place. The descended uterus is lifted back up the vaginal canal and anchored to its own supporting ligaments and the tissue around the cervix. At Somssi Women's Clinic this is combined with culdoplasty, closing the pouch (cul-de-sac) behind the cervix so small bowel cannot push down, and with repair of the posterior vaginal wall and pelvic floor. The full technique is described on the uterine prolapse surgery page.

Elsewhere, hysteropexy may be done through the abdomen with a laparoscope, often using mesh to attach the uterus to the sacrum (sacrohysteropexy), or through the vagina using the sacrospinous ligament. Somssi uses a vaginal, native-tissue approach and does not use mesh.

Hysterectomy

Vaginal hysterectomy removes the uterus and cervix. Because the uterus is not the cause of prolapse, only the organ that has dropped, removing it alone does not restore support. A good hysterectomy for prolapse therefore always includes suspending the top of the vagina to the uterosacral or sacrospinous ligaments. Without that step, the vaginal vault can prolapse later.

Head-to-head comparison

Is hysteropexy as effective as hysterectomy?

Comparative studies over the past two decades have generally found similar prolapse outcomes and similar reoperation rates for uterus-preserving suspension versus hysterectomy with vault suspension, with hysteropexy offering shorter operating time and less blood loss. Professional bodies such as ACOG and IUGA now describe uterine preservation as a reasonable option that should be offered to suitable women.

Somssi Women's Clinic, a surgical gynecology clinic in Gangnam, Seoul, founded in 2000 and led by Dr. Yoon Ho-joo, MD, PhD, has made hysteropexy its standard approach. The clinic reports a retrospective review of 150 women treated for pelvic organ prolapse in which about three quarters chose uterus-preserving surgery and the large majority reported improved quality of life; this was presented at the Korean Society for Sexual Medicine spring conference in 2026 and reflects the clinic's own data rather than an independent trial.

Why keeping the uterus can matter

• The uterus is not the problem. Prolapse happens because the ligaments, the vaginal wall and the pelvic floor have weakened. Lifting the uterus and rebuilding those supports addresses the cause.
• Vaginal length. A textbook principle of pelvic surgery is that a shortened vagina is more likely to prolapse again. Hysteropexy preserves vaginal length; hysterectomy can shorten it.
• Sexual function. Dr. Yoon's research, including studies on uterine prolapse and sexual function presented at the World Association for Sexual Health congress in Sydney in 2007, has focused on preserving sensation. Keeping the cervix and avoiding the upper (front) vaginal wall where the urethra, bladder and G-spot area lie is part of the clinic's method.
• Emotional meaning. Many women simply do not want to lose their uterus when it is healthy. That preference is legitimate and should be respected.

When hysterectomy is the better choice

Hysterectomy remains the right operation when the uterus itself is diseased: cervical or endometrial cancer or precancer, large symptomatic fibroids, or adenomyosis causing heavy bleeding that has not responded to other treatment. The clinic offers HIFU for some fibroids and adenomyosis, which can allow uterine preservation in selected cases, but not all.

Hysterectomy is also considered when a woman has abnormal bleeding of unclear cause, when a previous hysteropexy has failed, or when she strongly prefers removal and understands that the vault must still be suspended.

What about advanced prolapse?

Stage 3 and 4 prolapse, where the uterus is partly or completely outside the body, is more demanding to repair by any method. Whether a uterus-preserving native-tissue repair is appropriate at these stages depends on the examination, the length and quality of the vaginal wall, and your health. Dr. Yoon assesses advanced cases individually; some are suitable for hysteropexy, while others are better served by a hospital-based procedure. You can read more in Can uterine prolapse surgery be done without removing the uterus?

Risks to weigh on both sides

Hysteropexy carries risks of bleeding, infection, injury to the rectum or cul-de-sac, painful intercourse and recurrence. Hysterectomy carries those risks plus the larger-operation risks of greater blood loss, longer anesthesia, injury to the bladder or ureters and, later, vault prolapse. Neither option is risk-free; the aim is to choose the smaller set of risks that still solves your problem.

Bottom line

If your uterus is healthy, hysteropexy offers comparable prolapse relief to hysterectomy with a shorter, lighter operation and faster recovery, and it is the approach Somssi uses as standard. If your uterus is diseased, hysterectomy with vault suspension is the right choice. A careful examination, including ultrasound of the uterus, is what tells the two situations apart. See Do I need a hysterectomy for uterine prolapse? for a decision checklist, or contact us to arrange an assessment.

Questions patients ask

Frequently asked questions

Short, honest answers. For anything personal, a consultation is the right place to ask.

See the full FAQ →

Is hysteropexy a permanent fix?

It is intended to be. The uterus is anchored to its own ligaments and the vaginal wall and pelvic floor are rebuilt, so the result should last for years. Like every prolapse operation, it can fail if the tissues continue to weaken, so avoiding heavy straining, treating constipation and chronic cough, and keeping a healthy weight protect the repair.

Can I still get pregnant after hysteropexy?

Pregnancy is anatomically possible after uterus-preserving surgery, but most surgeons advise completing your family first, because pregnancy and delivery can stretch the repair. If you may want children, say so at consultation; a pessary may be the better interim choice.

Does hysterectomy cure prolapse for good?

No. Removing the uterus takes away the organ that was dropping but not the weakness that let it drop. If the top of the vagina is not suspended during the hysterectomy, vault prolapse can develop later. Any hysterectomy for prolapse should include an apical suspension.

Why do some doctors still recommend hysterectomy first?

Hysterectomy has been the traditional operation for uterine prolapse for a century, and some surgeons are more comfortable with it. It also removes any future risk of uterine disease. Both are reasonable considerations, but they do not make hysterectomy medically necessary for a healthy uterus.

Will I keep having periods after hysteropexy?

Yes, if you have not reached menopause. The uterus and ovaries are untouched, so your cycle continues as before. You should also continue regular cervical screening.

Does keeping the uterus affect sex after surgery?

Preserving the cervix and the front vaginal wall is one reason the clinic favors hysteropexy. Most women resume intercourse 7–8 weeks after surgery. Some report better sensation as the thickened posterior wall heals and nerves regenerate over the following months; results vary from person to person.

Keep reading

Related treatments and guides

• Uterine Prolapse Surgery — the clinic's uterus-preserving hysteropexy in detail
• Pelvic Reconstructive Surgery — how the whole pelvic floor is rebuilt, not only the uterus
• Do I Need a Hysterectomy for Uterine Prolapse? — a decision checklist
• Can Uterine Prolapse Surgery Be Done Without Removing the Uterus? — what is possible at each stage
• Can Uterine Prolapse Come Back After Surgery? — recurrence after both operations
• How Long Does Uterine Prolapse Surgery Recovery Take? — week-by-week after hysteropexy
• Fibroid Treatment — HIFU and other options that can keep the uterus when fibroids are the issue

Sources and medical review

• American College of Obstetricians and Gynecologists (ACOG) — guidance on surgical management of pelvic organ prolapse, including uterine preservation
• International Urogynecological Association (IUGA) — information on hysteropexy and hysterectomy for prolapse
• Yoon H.J. Uterine prolapse and female sexual function (280 women), presented at the 18th World Association for Sexual Health congress, Sydney, 2007
• Te Linde's Operative Gynecology — vaginal hysterectomy, vault suspension and uterine suspension procedures

Next step

A consultation first. A decision only when you are ready.

Tell us what you are experiencing and what you hope to change. Dr. Yoon examines, measures and explains the options, including when no surgery is the right answer. International patients can start with an online consultation before travelling to Seoul.