DOI: 10.1111/1471-0528.

12914 Gynaecological surgery

www.bjog.org

Five-year follow up of a randomised controlled

trial comparing subtotal with total abdominal
hysterectomy
LL Andersen,a V Zobbe,b B Ottesen,c C Gluud,d A Tabor,b H Gimbel,a the Danish Hysterectomy Trial
Group*
a
Department of Obstetrics and Gynaecology, Nykøbing Falster Hospital, Nykøbing Falster, Denmark b Department of Obstetrics and
Gynaecology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark c Juliane Marie Centre, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark d Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen
University Hospital, Copenhagen, Denmark
Correspondence: LL Andersen, Department of Women and Children’s Health 7821, Juliane Marie Centre, Rigshospitalet, Blegdamsvej 9,
2100 Copenhagen, Denmark. Email lland@regionsjaelland.dk

Accepted 6 April 2014. Published Online 11 June 2014.

Objectives To compare the rates of urinary incontinence (UI) and
other complications of subtotal abdominal hysterectomy (SAH)
with total abdominal hysterectomy (TAH) at 5 years after surgery.
Design Randomised clinical trial with central, computer-generated
randomisation.
Setting Danish multi-centre trial performed in 11 departments of
gynaecology.
Population Women referred with benign uterine diseases
scheduled for abdominal hysterectomy.
Methods Women were randomised to either SAH (n = 161) or TAH
(n = 158). Follow-up data were collected from participants using
postal questionnaires sent out 5 years after surgery. Complications of
hysterectomy were further examined by scrutinising registered
discharge summaries following hospitalisation. Intention-to-treat
and per-protocol analyses were conducted. Potential bias caused by
missing data was handled using multiple imputation.
Main outcome measures The primary outcome was UI. Secondary
outcomes included constipation, prolapse of the vaginal vault or
cervical stump, satisfaction with sexual life, pelvic pain,
postoperative complications and vaginal bleeding.
Results The response rate was 234/319 (73.4%). A significantly
higher proportion of respondents had urinary incontinence
5 years after SAH 34/113 (30.1%) than TAH 21/119 (17.6%)
(RR 1.71, 95% confidence interval 1.06–2.75, P = 0.026). This
difference reduced after multiple imputation to account for
missing data (RR 1.37, 95% confidence interval 0.99–1.89,
P = 0.052). Eleven of the 101 women (11%) in the SAH
group still experienced vaginal bleeding. No other
differences were found between the two types of abdominal
hysterectomy.
Authors’ conclusions A smaller proportion of women suffered
from UI after TAH than after SAH 5 years postoperatively.
Around one in ten women continued to experience vaginal
bleeding 5 years after SAH.
Keywords Complications, hysterectomy, long-term follow-up,
pelvic organ prolapse, randomised, urinary incontinence.

Please cite this paper as: Andersen LL, Zobbe V, Ottesen B, Gluud C, Tabor A, Gimbel H. Five-year follow up of a randomised controlled trial comparing
subtotal with total abdominal hysterectomy. BJOG 2015;122:851–857.

*A list of the investigators in the Danish Hysterectomy Trial Group not
included as authors is given at the end of the text.
Trial register: The trial is registered on clinicaltrials.gov under Nykoebing
Falster County Hospital Record sj-268: Total versus Subtotal Hysterectomy:
&rank=27">http://clinicaltrials.gov/ct2/show/NCT01880710?term=hysterec
tomy&rank=27
Introduction
In 2011, 4457 elective hysterectomies were performed for
benign indications in Denmark.1 Of these, 1919 (43.0%)
were undertaken abdominally: 1719 women had a total
abdominal hysterectomy (TAH) and 200 had a subtotal
abdominal hysterectomy (SAH). This means that

ª 2014 Royal College of Obstetricians and Gynaecologists 851

 Andersen et al.
approximately 10% of the abdominal hysterectomies in
Denmark were subtotal.1 A total of 1005 laparoscopic hys-
terectomies was performed and 19% of these were subtotal.
Altogether, 393 women (13.4%) had a subtotal hysterec-
tomy. The remaining 1533 (34.4%) benign hysterectomies
performed in Denmark in 2011 were vaginal.1 In the past 5
years we have seen a shift towards more vaginal and lapa-
roscopic hysterectomies; however, abdominal hysterectomy
remains the most common type in Denmark. The regional
differences are large in terms of which type of hysterectomy
is preferred, both in Denmark and internationally.
A recent Cochrane review2 stated that an increase in
subtotal hysterectomies is seen along with the increase in
laparoscopic hysterectomy, as the subtotal procedure
seems easier to perform when doing a laparoscopy. The
same Cochrane review, including eight randomised clini-
cal trials of abdominal and one of laparoscopic hysterec-
tomy, concludes that there are no proven benefits of
subtotal compared with total hysterectomy regarding uri-
nary, sexual or bowel function, and that the increase in
subtotal hysterectomies seems unwarranted. Only one of
the trials reported long-term outcomes with an average
follow up of 9 years.3 The review recommended that fur-
ther trials comparing total and subtotal hysterectomy
should be conducted with long-term follow up in order
to shed light on the consequences of whether these sur-
gical procedures are performed as open or laparoscopic
operations.
Since this review,2 two other long-term randomised clin-
ical trials4,5 have been published. One followed 37 women
for 9 years4 and the other followed 151 women for
11.3 years.5 Neither of these trials showed significant differ-
ences between the surgical groups.
We conducted a 5-year follow up of a randomised clini-
cal trial of subtotal versus total abdominal hysterectomy.6
As described in the protocol before the trial started, the
aim was to compare the surgical methods with regard to
urinary incontinence (UI), postoperative complications,
constipation, prolapse of the vaginal vault or cervical
stump, sexual function, and pelvic pain 5 years after sur-
gery and to evaluate vaginal bleeding after SAH.
Methods
During 1996–2000, a cohort of 319 women, scheduled for
hysterectomy on benign indications, was randomised to
subtotal (SAH, n = 161) versus total (TAH, n = 158)
abdominal hysterectomy (Figure S1).6 Details about inclu-
sion, randomisation, intervention, collection of data,
interim analysis, and follow up 1 year after the operation
have been described previously.6 The sample size was based
on a prevalence of UI after TAH of approximately 23%.7,8
With a power of 0.80, a type I error of 5%, and a 15%
852
absolute difference in UI between the two operations, 160
participants were needed in each intervention group.6
Participants were followed using a validated postal ques-
tionnaire (Appendices S1 and S2)9 up to exactly 5 years post-
operatively. A reminder was sent out twice to those who did
not respond. Those who did not respond to the letters were
contacted by telephone. Any hospitalisations that might be
related to the hysterectomy were recorded from registered
discharge summaries to detect long-term complications of
hysterectomy. The search of discharge summaries focused on
gynaecological, urological (including urinary incontinence),
gastrointestinal, and dermatological/plastic-surgical hospital
contacts. Complications up to 1 year postoperatively have
been reported earlier6 so the data in the current paper are
restricted to those arising 1 year after surgery.
Urinary incontinence, as reported in the questionnaire
(Appendices S1 and S2), was pre-specified as the primary
outcome.6 Urinary incontinence was defined as a subjective
complaint of involuntary urinary leakage experienced
‘always’ or ‘often’ (question 35 in Appendices S1 and S2).
Subjective complaints of urinary leakage being present
‘rarely’ or ‘never’ were defined as continent. The analyses
were done on the dichotomised data urinary incontinent ver-
sus urinary continent as explained above. Patients stating
they were continent but who had a discharge summary stat-
ing surgery for incontinence since the hysterectomy were
considered incontinent. In addition to the primary overall UI
outcome, the type of UI was analysed from question 34: ‘In
which situations do you usually experience urinary inconti-
nence?’ (Appendices S1 and S2) and also grouped into stress
UI only, urge UI only, and mixed UI. All answers to question
34 were included in this analysis regardless of the answer
given in question 35. This means that women stating that
they ‘rarely’ experience UI in question 35 (primary outcome)
are included in the analysis of question 34 as incontinent and
those who answered ‘never’ are defined as continent.
The secondary outcomes included constipation (defined
as hard stools), pelvic organ prolapse (POP), i.e. prolapse
of the vault or cervical stump, sexual function, pelvic pain
and vaginal bleeding after SAH. All secondary outcomes,
except for postoperative complications, were based on the
validated questionnaire.9 For POP, those who had a dis-
charge summary of prolapse surgery since the hysterectomy
but stated in the questionnaire that they did not have pro-
lapse were considered to have POP. The postoperative
complications from 1 to 5 years were based on discharge
summaries up to 5 years postoperatively extracted from a
central registry of discharge summaries covering all public
hospitals in Denmark. The analyses of sexual satisfaction
were performed for all respondents as well as separately for
those stating they had a partner and those who did not.
The significance levels of the outcomes were pre-specified.
The level of significance for the primary outcome, UI, was
ª 2014 Royal College of Obstetricians and Gynaecologists
 SAH versus TAH: RCT with 5-year follow up

set at P < 0.05. For the secondary outcomes, the significance
level was set at P < 0.01 to take the problem of multiple sta-
tistical tests into consideration. All outcomes were analysed
by intention-to-treat (ITT) as well as per-protocol (PP)
approaches. The PP analyses excluded women for whom the
surgical method had been changed pre- or peri-operatively
and women who did not meet the inclusion criteria (Figure
S1). The conclusions were based on the regular ITT analysis.
Some women did not answer all questions in the question-
naire and therefore the total number for each analysis differs
slightly. The total for each analysis is given in the tables. For
all outcomes, the two types of surgery were compared using
a Chi-squared test. Data was processed and analysed using
SASJMP version 10 (SAS institute, Cary, NC, USA).
To analyse possible bias caused by missing data, multiple
imputation was carried out according to the FCS method
in SAS version 9.3 (SAS Institute) using the PROC MI
and MIANALYZE functions. The 5-year outcomes that
were imputed were UI, pelvic pain, POP, satisfaction with
sexual life and constipation. The following variables were
included in the imputation model because they showed
some correlation with one or more of the outcomes in
multivariate logistic regression: baseline variables encom-
passing type of surgery, age, weight, height, number of
deliveries, smoking, alcohol consumption, UI, satisfaction
with sexual life, pain, and constipation and follow-up vari-
ables: UI at 6 months and 1 year, and pelvic pain, POP,
constipation, and satisfaction with sexual life at 1 year. In
all, 100 imputed data sets were created using a maximum
of 100 iterations. These numbers were chosen to obtain
sufficient precision in the analyses. Multiple imputation
was carried out under the MAR (missing at random)
assumption that missing data is related to other observed
variables, but not to any unobserved variables or to the
missing item itself.10 The imputed data sets were analysed
by a Chi-squared test and the pooled analyses were carried
out using the MIANALYZE function. Relative risks were
logarithmically transformed prior to pooling to comply
with Rubin’s rules for pooling imputed results.11
The local ethics committees of the participating centres
and the Danish Data Protection Agency accepted the design
of the randomised trial prior to recruitment as well as the
follow-up schedule.6
Results
Of the 319 women randomised, 240 responded (75.2%);
five women in the SAH and one in the TAH group
returned the questionnaire unanswered. Thus, 115 women
from the SAH group and 119 women from the TAH group
answered the questionnaire (234/319, 73.4%). None of the
women participating in the trial had died. Baseline charac-
teristics of the two intervention groups with 5-year follow
up were still comparable and there was no apparent differ-
ence between responders and non-responders (Table 1).
The average age at follow up was 51 years. There was a
tendency towards a higher proportion of women with a
body mass index (BMI) over 25 in the SAH group (58.8%)
than in the TAH group (46.9%) at 5-year follow up (RR
1.26, 95% confidence interval 0.98–1.62, P = 0.063). Some
participants did not answer all questions on the question-
naire, and therefore the total number of observations in
each analysis of the observed data differs slightly. The total
numbers for each analysis are given in the Tables 1 and 2.

Table 1. Characteristics of responders and non-responders at 5 years

SAH (%) TAH (%) Lost to follow Lost to follow up

(n = 115) (n = 119) up SAH (%) (n = 46) TAH (%) (n = 39)

Age (years, SD) 51.6 (6.4) 50.3 (5.5) 49.8 (6.3) 49.8 (6.2)
No. of deliveries (range) 1.8 (0–5) 1.7 (0–4) 1.7 (0–5) 1.9 (0–4)
Indication for hysterectomy
Fibroids 67 (58.3) 72 (60) 27 (58.6) 19 (48.7)
Dysfunctional uterine bleeding 37 (32) 39 (32.7) 15 (33.3) 14 (35.9)
Dysmenorrhoea 3 (2.5) 4 (3.4) 3 (6.5) 2 (5.1)
Pelvic pain 7 (6.1) 2 (1.7) 1 (2.2) 3 (7.7)
Endometriosis 0 0 0 1 (2.6)
Other 1 (0,9) 0 0 0
Smoking >5 cigarettes per day 29 (25.2) 40 (33.6) 15 (32.6) 13 (33.3)
Alcohol >14 units per week 12 (10.4) 11 (9.2) 3 (6.5) 2 (5.1)
BMI >25 kg/m2 67 (58.8) (n = 114) 53 (46.9) (n = 114) 15 (35.7) (n = 42) 17 (47.2) (n = 36)
Chronic illness 54 (46.9) 48 (40.3)

The information derives primarily from the preoperative baseline questionnaire (except BMI and chronic illnesses registered in the 5-year
questionnaire for responders).

ª 2014 Royal College of Obstetricians and Gynaecologists 853

 Andersen et al.

Urinary incontinence was reported in 30.1% of the SAH
group and 17.6% of the TAH group (RR 1.71, 95% confi-
dence interval 1.06–2.75, P = 0.026). No differences were
found in any of the secondary outcomes (Table 2). There was
no difference between surgical groups in any of the analyses
regarding satisfaction with sexual life (Table S1). Those with-
out a partner were less likely to be satisfied with their sexual
life regardless of type of surgery (P < 0.0001). Eleven of the
101 responders in the SAH group (11%) reported vaginal
bleeding 5 years after initial surgery (Table 2).
A higher proportion of UI in the SAH group was also
seen in the PP analysis: SAH: 29 (29.9%) versus TAH: 18
(16.9%), RR 1.76, 95% confidence interval 1.04–2.96,
P = 0.029. Analyses of multiple imputed data showed the
same tendency as the analyses of the observed data for all
outcomes; however, in the final model the analysis of UI
resulted in P = 0.052, i.e. this was no longer a statistically
significant finding (Table 2). We found no significant dif-
ferences between surgical groups on subtypes of UI (Fig-
ure 1). However, significantly more women in the TAH
group stated that they never experienced UI. The total
number of complications found from 1 to 5 years postop-
eratively was 13 after TAH and nine after SAH. No signifi-
cant difference was found between surgical groups. Urinary
incontinence accounted for six of these, five in the TAH
group and one in the SAH group. Three in the SAH group
had bleeding from the cervical stump and two of them had
it removed. Other complications were abdominal or pelvic
pain (n = 6), lower urinary tract symptoms (n = 3) (other
than UI), POP (n = 3) and one hernia.
Discussion
Main findings
We found a significantly higher frequency of UI after SAH
compared with TAH 5 years after initial surgery. However,
this finding became of borderline significance after
accounting for missing data through multiple imputation.
The analysis of UI subtype also showed no difference
between the surgical groups. However, significantly more
women after TAH than after SAH reported never having
experienced UI. Furthermore, in the SAH group 11% of
women still experienced vaginal bleeding. No other signifi-
cant differences were seen. The difference in UI is consis-
tent with prior follow ups of this trial.6
Strengths and limitations
The main strengths of this trial are the randomised design,
number of participants and long follow-up period. Our
response was only 73.4%, but this was comparable with three
smaller long-term trials published with 27.4% (n = 37),4
65% (n = 181),3 and 82% (n = 151)5 responses, respectively.
Although non-response can introduce bias, we found that
there was no differential loss to follow up and that the demo-
graphic characteristics of responders were comparable to
that of non-responders. Furthermore, we carried out multi-
ple imputation to account for missing data and this reanaly-
sis showed the same tendency on the primary outcome
although the difference in UI no longer reached statistical
significance. None of the previously published trials with
long-term follow-up included multiple imputation or other
methods to account for possible bias caused by missing
data.3–5 For complications, we had data for all randomised
patients, although only for hospital contacts, not treatment
in the primary care sector or private clinics.
Our trial was not blinded, but we believe that this limita-
tion was unlikely to cause the higher observed rate of UI fol-
lowing SAH because bias from lack of blinding usually
favours the experimental intervention.12 We and others13
found it difficult to blind participants in this type of trial
because some women in the SAH group had vaginal bleeding,
whereas none in the TAH group did. Furthermore, partici-
pants could easily un-blind themselves by self examination
and it would be unethical to blind women for 5 years because

Table 2. Primary and secondary outcome measures at 5 year follow up intention-to-treat analyses (%) and multiple imputations

Observed data Multiple imputed data

(pooled result)

Outcome SAH (%) TAH (%) Relative risk 95% CI P Relative risk 95% CI P

Urinary incontinence (n = 113/119) 34 (30.1) 21 (17.6) 1.71 1.06–2.75 0.026* 1.37 0.99–1.89 0.052
Constipation (n = 112/119) 9 (8.0) 15 (12.6) 0.63 0.29–1.40 0.25 0.87 0.60–1.26 0.46
Pelvic organ prolapse (n = 113/116) 9 (7.9) 11 (9.5) 0.84 0.36–1.95 0.68 0.86 0.59–1.25 0.42
Satisfied with sexual life (n = 111/113) 67 (60.4) 77 (68.1) 0.89 0.73–1.08 0.22 0.84 0.64–1.11 0.22
Pelvic pain (n = 114/119) 15 (13.2) 19 (15.9) 0.82 0.44–1.54 0.54 0.86 0.63–1.17 0.34
Vaginal bleeding (n = 101) 11 (10.9) 0

*Statistically significant difference.

854 ª 2014 Royal College of Obstetricians and Gynaecologists


Figure 1. Subtypes of urinary incontinence according to type of hysterectomy.
the SAH group should continue cervical cancer screening.
Another potential limitation is that our trial relies on subjec-
tive information from participants and few objective mea-
surements. An evaluator-blinded clinical examination might
lead to a different conclusion and should be included in
future trials along with the subjective symptoms. The postop-
erative complications are more objective as they rely on dis-
charge summaries from public hospitals in Denmark.
Interpretation
Comparable randomised clinical trials reported no signifi-
cant differences in UI between the two intervention
groups.3–5,14–16 Three other randomised clinical trials have
follow-up longer than 2 years3–5 and none showed any dif-
ferences in long-term outcomes between intervention
groups. One explanation could be that we reported UI as a
subjective outcome, whereas others assessed UI objec-
tively.3,14 Another explanation could be differences in pop-
ulations. One of the other published trials included a large
proportion of women of African descent,3,14 who are
thought to suffer less than Caucasian women from UI.17
Another of the previously published trials5 showed a non-
significant tendency towards more incontinence in the SAH
group (45 vs 39%) as well as a trend towards better out-
comes after TAH. They concluded that this might indicate
an adverse effect of SAH on the pelvic floor that might
have been evident had the study had sufficient power.5 The
difference in UI we found could be explained by the sur-
geons performing a better suspension during TAH than
ª 2014 Royal College of Obstetricians and Gynaecologists
SAH versus TAH: RCT with 5-year follow up
during SAH, resulting in a better angle of the bladder and
urethra, facilitating the physiological closure of the urethra
during high intra-abdominal pressure. The suspension done
during TAH could yield more support than the woman’s
own connective tissue spared in SAH. However, this is
speculative as no instructions were given to the surgeons
on how to suspend the vagina.
We found no difference in satisfaction with sexual life. This
is consistent with most other studies regarding sexual-
ity.14,16,18–20 No difference was seen regarding POP; only nine
in the SAH versus 11 in the TAH group reported POP.
Thakar et al.3 and Persson et al.5 included the Pelvic Organ
Prolapse Quantification system (POP-Q)21 measurement,
which gives an objective assessment of POP, in their long-
term follow ups. They found more women with POP than we
did, but most prolapses were small (stage 2)3,5 and they did
not specify whether the women had symptoms. Dietz et al.22
suggested a definition of clinically relevant cut-off points of
POP and found that the small stage 2 prolapses (lowest point
at 1 cm above the hymen) were often not clinically relevant.
According to a Swedish study,23 one of five women did not
recognise their symptoms as being related to prolapse before
gynaecological examination. Therefore, our low occurrence
of POP might be an underestimate, whereas POP-Q measure-
ments without a symptoms questionnaire would overestimate
POP. This would influence both types of surgery and not
cause bias. The average age of women in this follow up was
51 years. It is likely that longer follow-up would show a rise
in POP due to higher age and change in menopausal status.
855
 Andersen et al.
In all, 11% of women experienced vaginal bleeding 5 years
after SAH. Seven percent of women undergoing SAH had
regular vaginal bleeding after 1 year in another trial14 but
longer term data assessing this outcome were not reported.3,5
However, one trial found that 7% of women after SAH had
the cervix removed during the follow-up period.5 Other
studies showed vaginal bleeding in between 5 and 20% of
women after SAH.13–15,24 The large variation in post-SAH
bleeding could be a result of varying surgical techniques and
surgeons’ experience.25 In our trial and that of Thakar et al.,
the surgeons were instructed to electrocoagulate the endocer-
vical canal.6,14 Other studies have left this decision up to the
surgeon, or not described it.16,24,26,27 Some use reverse
conisation of the endocervical canal25 to minimise vaginal
bleeding. Women considering SAH should be informed of the
risk of on-going vaginal bleeding even 5 years after surgery.
Conclusions
We observed that more women were urine incontinent
5 years after SAH than after TAH and that 11% of the
women in the SAH group still experienced vaginal bleed-
ing. As proposed in a Cochrane review,2 longer follow-up
studies are needed to investigate possible differences
regarding POP, as this may occur years after surgery, espe-
cially after the menopause. Further research should evaluate
laparoscopic approaches to subtotal and total hysterectomy,
as well as methods for vaginal suspension on long-term
complications such as persistent bleeding, UI and POP.
Women considering total and subtotal hysterectomy should
be provided with evidence-based information, especially
regarding the long-term consequences.
*The Danish Hysterectomy Trial Group consists of the
authors of this article and the following members: Kristian
Jakobsen, MD, Helle Christina Sørensen, MD, Kim Toftag-
er-Larsen, MD, Dr Med Sci, Nini Møller, MD, Department
of Obstetrics and Gynaecology, Nordsjællands Hospital,
Hillerød, Denmark, Ellen Merete Madsen, MD, Department
of Obstetrics and Gynaecology, Gentofte County Hospital,
Gentofte, Denmark, Mogens Vejtorp, MD, Dr Med Sci,
Helle Clausen, MD, PhD, Department of Obstetrics and
Gynaecology, Herlev University Hospital, Herlev, Denmark.
Disclosure of interest
None of the authors or the study group reports any con-
flicts of interest regarding this article.
Contribution to authorship
HG is the principal investigator and is responsible for the
design and conduct of the trial including creating the ques-
tionnaire, recruiting and randomising patients and con-
ducting prior follow-ups. HG sent out the questionnaires.
856
LA is responsible for handling data, statistical analysis, and
drafting and revising the article. LA is also the correspond-
ing author. BO, VZ, CG and AT participated in the design
and conduct of the trial. All authors critically revised the
article and approved the final version. The Danish Hyster-
ectomy Trial Group all participated in recruitment and
randomising of patients.
Details of ethics approval
The local ethics committees of the participating centres,
Bornholm, Frederiksborg, Roskilde, Storstrøms and Ves-
tsjællands Counties, journal number 1995-1-65, and the
Danish Data Protection Agency accepted the design of the
randomised clinical trial before recruitment of patients.
Funding
This study has been supported by grants from the Research
Foundation in Region Sjaelland, The Health Insurance
Fond, The Copenhagen Hospital Corporation’s Medical
Research Council, The Danish Medical Research Council,
The Foundation Supporting Medical Research in Roskilde,
Vestsjællands, Storstrøms, Frederiksborg, and Bornholms
Counties, The Højmoseg
ard Foundation, Organon’s Foun-
dation supporting Gynaecological Research, The Roskilde
County Hospital, The Copenhagen Trial Unit, and The
Research Foundation at the Department of Obstetrics and
Gynaecology, H:S Hvidovre Hospital.
Acknowledgements
We wish to thank Jakob Hjort for his skilled generation of
the allocation sequence and excellent management of the
randomisation procedure and program, Kasper Munck,
SAS Institute, for statistical advice and help with the multi-
ple imputation, and Per Winkel, Copenhagen Trial Unit,
for advice about multiple imputation.
Supporting Information
Additional Supporting Information may be found in the
online version of this article:
Figure S1 Flow of the patients through each stage of the
trial at 5-year follow up.
Table S1 Satisfaction with sexual life according to part-
ner status.
Appendix S1 Questionnaire for women who have had a
subtotal hysterectomy 5 years after the operation.
Appendix S2 Questionnaire for women who have had a
total hysterectomy 5 years after the operation. &
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