Objective: Participants in the multicenter, randomized Total or Supracervical Hysterectomy (TOSH) trial showed within-group improvement in pelvic floor symptoms 2 years postsurgery and no differences between supracervical (SCH) versus total hysterectomy (TAH). This study describes longer term outcomes from the largest recruiting site. Methods: Questionnaires addressing pelvic symptoms, sexual function, and health-related quality of life (HRQOL) were administered. Linear models and McNemar test were used. Results: Thirty-seven participants (69%) responded (19 TAH, 18 SCH); mean follow up was 9.1 ± 0.7 years. No between-group differences emerged in urinary incontinence, voiding dysfunction, pelvic prolapse symptoms, and overall HRQOL. Within-group analysis showed significant improvement in the ability to have and enjoy sex (P = 0.002) and SF-36 physical component summary scores (P = 0.03) among women randomized to TAH. Conclusions: Nine years after surgery, TOSH participants maintained improvements in and show no major between-group differences in lower urinary tract or pelvic floor symptoms. Copyright © 2010 by Lippincott Williams & Wilkins.