Purpose of investigation: To investigate the incidence and risk factors of venous thromboembolism (VTE) after gynecological surgery without systemic thromboprophylaxis. Materials and Methods: Consecutive adult Chinese medical patients not receiving pharmacological or systemic mechanical prophylaxis for VTE before elective gynecological surgery. An observational cohort study of 620 patients in a gynecological department in a Chinese tertiary hospital. Results: Lower extremity deep venous thrombosis was detected by ultrasound examination in 57 (9.19%) of the patients, 39 had computed tomography pulmonary angiography (CTPA) evaluation after being diagnosed with lower extremity deep venous thrombosis (LEDVT), and the diagnosis was confirmed in 18 subjects, resulting in a pulmonary embolism (PE) incidence of 46.2% among the 39 patients, and 13 (72.2%) were asymptomatic and without significant clinical features. Conclusions: In the absence of pharmacological or systemic mechanical prophylaxis, gynecological surgeries carried a significant risk for VTE in the Chinese study population. As clinical features are not able to reliably exclude the presence of PE, early routine prophylaxis is warranted based on risk factors in postoperative gynecological patients and should strongly be considered.