Radical or simple hysterectomy? Gynecologic-oncology researcher says post-operative sexual health must be considered

For patients with low-risk, early-stage cervical cancer, a simple hysterectomy provides improved bladder function and sexual health compared to a radical hysterectomy, says an ob-gyn research team — and both procedures have similar cancer outcomes.

The team’s study, recently published in the Journal of Clinical Oncology, is the basis for a new international standard of care for patients with early-stage cervical cancer.

Lead author Sarah Ferguson, a professor and vice chair of research in the ob-gyn department, joined the International Journal of Gynecological Cancer (IJGC) podcast in March 2025 to discuss her team’s paper, “Sexual Health, Quality of Life after Low-Risk Early Stage Cervical Cancer: Results From GCIG/CCTG CX.5/SHAPE Trial Comparing Simple Versus Radical Hysterectomy.”

This study compared outcomes, over a three-year period, between patients undergoing a simple versus radical hysterectomy. Participants in the SHAPE randomized controlled trial were selected for their low-risk profiles, with small tumours of less than two centimetres. They tended to be “a young population with low cancer burden,” said Ferguson, and had a good quality of life overall.

For the primary outcome, the study found that simple hysterectomy was non-inferior to radical hysterectomy for oncologic outcomes; however, those in radical hysterectomy had worse bladder dysfunction (The results for this outcome were published in the New England Journal of Medicine.)

The secondary outcome was to prospectively evaluate — using validated sexual health questionnaires — the sexual health of the patient after undergoing surgery for cervical cancer. This had never been measured before.

The study found that after a radical hysterectomy, women reported worse sexual vaginal functioning, which persisted for up to two years. This included worse vaginal lubrication and more pain. There was no difference in ability to obtain orgasm. These changes resulted in less sexual activity and enjoyment.  

The results suggest that physicians should take into consideration negative sexual health outcomes that may come with a radical hysterectomy, and counsel patients of this possible side effect in those that still require a radical hysterectomy.

“I think we have to be proactive and keep the ovaries in, if it’s reasonable,” said Ferguson on the IJGC podcast. “And, even if you don’t think someone should have systemic hormone replacement, at minimum, give local estrogen.”

Ferguson, who is on staff at Princess Maragaret Cancer Centre, said she always promotes vaginal health with patients following surgery, which includes lubrication during intercourse, vaginal moisturizer and estrogen if needed.

In addition, she said 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 ten years ago, where it was hard to find them. I really encourage patients to explore that.”

Ferguson admitted she was surprised by the sexual health dissimilarities found between simple and radical surgeries.

“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. I think most of us felt that it’s transient, it gets better,” adding, “Maybe I was a bit naïve.”

Listen to the IJGC podcast.