Abstract Objective To evaluate the effect of total hysterectomy on levator ani muscle ( LAM ) and pelvic floor function by pelvic floor ultrasound combined with shear wave elastography ( SWE ). Methods 50 elderly women who received total hysterectomy l due to benign uterine diseases l were selected as the case group, and they were divided into postmenopausal and premenopausal subgroups according to whether they were menopausal before surgery. 70 married women with children who did not undergo hysterectomy during the same period were selected as the control group. Two-dimensional ultrasound parameters at rest, anal contraction and maximum Valsalva state were measured. The Emax , Emin and Emean of LAM elastic modulus at rest and maximum Valsalva state were obtained by SWE, and the difference of elastic modulus △ Emax, △ Emin and △ Emean between the two states was calculated. Results1.Compared with the control group, there was no significant difference in the distance between the bladder neck and the reference line in the resting state of the case group ( P > 0.05 ), but the distance between the bladder neck and the reference line and the mobility of the bladder neck in the maximum Valsalva state were higher than those in the control group. The difference was statistically significant ( P < 0.05 ). 2.The incidence of pelvic floor dysfunction in the postmenopausal subgroup of the case group was higher than that in the premenopausal subgroup ( P < 0.05 ). 3.Under the three conditions of two-dimensional ultrasound, the thickness of LAM on both sides of the case group was lower than that of the control group, and the anteroposterior diameter of the levator hiatus was higher than that of the control group. The difference was statistically significant ( P < 0.05 ) ;SWE showed that the medians of Emax, Emin and Emean of levator ani muscle in the case group were higher than those in the control group at rest and in Valsalva state. The ΔEmax, ΔEmin and ΔEmean of levator ani muscle on both sides of the case group were lower than those in the control group at the inferior pubic branch, muscle belly and tail, and the differences were statistically significant ( all P < 0.05 ). The two results echo each other. 4.The ROC curve of LAM elastic modulus at the maximum Valsalva state was drawn. The results showed that LAM elastic modulus △ Emax, △ Emin and △ Emean were superior to Emax, Emin and Emean in evaluating SUI and POP. Among them, △ Emean = 14.25 kpa and △ Emean = 13.86 kpa as cut-off values are the best for the diagnostic performance of SUI and POP, and have certain clinical value. Conclusion : Total hysterectomy for benign gynecological lesions has a significant negative impact on the pelvic floor structure and function of patients. Transperineal pelvic floor ultrasound combined with levator ani muscle SWE can evaluate pelvic floor function in multiple dimensions.