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It is possible, however, to look at these limitations not as shortcomings of the study but as an important insight into the validity of patient choice and the benefits of patient education and autonomy in decision-making. Perhaps patients who have chosen to keep their cervix have a discernable advantage in regard to their perception of a higher QOL after hysterectomy.

An additional critique. Although the authors addressed a return to several daily activities that are outside the SF-36 questionnaire (e.g., a return to household chores, driving, work, exercise, and normal activities) they did not address sexual activity.

It has been the generally accepted practice to instruct patients not to place anything in the vagina, and to avoid vaginal intercourse, for at least 6 weeks after the cervix has been removed—regardless of the route of removal. After supracervical hysterectomy, however, patients can resume intercourse as early as 2 weeks. I think that it would be realistic for the authors to have stated that a quicker return to sexual activity after surgery might improve QOL scores for women, but they did not specifically address this domain.


When you’ve determined that hysterectomy is indicated for treatment of a patient’s benign disease and plan a laparoscopic approach, consider that education and autonomy of choice about whether to keep the cervix might improve quality of life postoperatively.


Andrew I. Brill, MD, and William H. Parker, MD, reviewed the manuscript of this article before it was submitted for publication.

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