Hysterectomy is the second most common major surgical procedure performed in women worldwide and almost one in three women in the USA have undergone a hysterectomy by the age of 60 years. The vast majority of hysterectomies are performed on benign indications to improve quality of life, and the surgical procedure is generally associated with few complications. In recent years, an increasing number of studies have shown long-term adverse effects of hysterectomy on the pelvic floor and some studies have demonstrated unwanted effects on other health aspects. Long-term effects of hysterectomy on the pelvic floor that should be considered in surgical decision-making are: pelvic organ prolapse, urinary incontinence, bowel dysfunction, sexual function and pelvic organ fistula formation. These outcomes are particularly relevant as life expectancy has increased and sequela may occur a long time after the surgical procedure and severely impair quality of life.