Radical vs. simple hysterectomy? Researcher says post-operative sexual health should be considered

For people with low-risk, early-stage cervical cancer, a simple hysterectomy removing the uterus and cervix has similar cancer outcomes to a more invasive radical hysterectomy – all while providing improved bladder function and sexual health.

That's the finding of a Toronto-led international research team led by Sarah Ferguson, a gynecologic oncologist at Princess Margaret Cancer Centre, University Health Network, and a professor of obstetrics and gynaecology at the University of Toronto’s Temerty Faculty of Medicine.

In the study, published recently in the Journal of Clinical Oncology, researchers compared outcomes between patients undergoing a simple versus radical hysterectomy – which also involves the removal of part of the vagina and other ligaments and tissues – over a three-year period.

Their findings form the basis for a new international standard of care for people with early-stage cervical cancer.

“I don’t think, as a surgeon – and this is probably a bias of surgeons in general – that I thought there would be a significant difference,” Ferguson said on a recent episode of  the International Journal of Gynecological Cancer podcast. “I think most of us felt that it’s transient, it gets better.”

Participants in the randomized controlled trial were selected for their low-risk profiles, with small tumours of less than two centimetres. Ferguson described the cohort as “a young population with low cancer burden” who had a good quality of life overall.

For the primary outcome, the study found that simple hysterectomy to remove the uterus and cervix was non-inferior to radical hysterectomy for cancer outcomes. However, those who received a radical hysterectomy had worse bladder dysfunction. The results for this outcome were published in 2024 in the New England Journal of Medicine.

The secondary outcome was to use validated sexual health questionnaires to evaluate the sexual health of the person after undergoing surgery for cervical cancer, which had never been measured before. 

The study found that after a radical hysterectomy, participants reported worse sexual vaginal functioning, which persisted for up to two years. The results suggest that physicians should take into consideration negative sexual health outcomes that may result from a radical hysterectomy, and counsel patients of this possible side effect in those that still require the surgery.

Ferguson said she always promotes vaginal health with patients following surgery. In addition, she noted a possible way to minimize the impact on bladder function or pain from scarring is through pelvic floor physiotherapy sessions. 

“It’s really common and accessible as opposed to 10 years ago, when it was hard to find them. I really encourage patients to explore that.”