Hysterectomy is commonly performed but there is scant evidence concerning appropriate subsequent follow-up by vaginal vault cytology testing. This book outlines the literature then the process of performing and results from an observational, retrospective cohort study. Routinely collected data sets were used to link women''s entire cervical screening histories with their operation details and subsequent vault cytology tests, to establish: Which women are having hysterectomies? What was the indication? Which were followed-up? How did they differ from those who were not? 6,141 women underwent hysterectomy; an incidence of 23/10,000 women/pa. Post-operatively 1,016 (16.5%) had some vault cytology testing. Those having CIN at total hysterectomy should have vault cytology but only 63% had any, of these less than 10% had it performed exactly according to protocol. Efforts to identify and eradicate inappropriate use of vault cytology tests could swiftly lead to savings. Although UK national guidelines are targeting the right women, this book recommends that all vaginal vault cytology should be undertaken in secondary care hereafter.