OBJECTIVE: Our purpose was to determine the effectiveness of vaginal cytology tests after hysterectomy for benign disease. STUDY DESIGN: We studied a 10-year retrospective cohort of patients after hysterectomy (n = 697 women, 9074 woman years). Patients were excluded if they had any type of invasive gynecologic malignancy. The main outcome variable was development of a vaginal cytologic abnormality, evaluated with Kaplan-Meier estimates and proportional hazards regression. RESULTS: We found 33 abnormal cytology results; most were of little clinical significance except for two biopsy-proven dysplasia cases. When we controlled for age, the risk was 4.67 for patients with a history of a cervical cytologic abnormality (95% confidence interval 2.1 to 10.6). We needed 633 tests to detect one true positive case of vaginal dysplasia. CONCLUSIONS: The low incidence of vaginal dysplasia and carcinoma, combined with the high false-positive rate, supports decreasing the number of screening tests performed for these low-risk patients.