Intimacy After A Hysterectomy
If you are concerned about how a hysterectomy might affect your sex life, you are not alone. It is among the biggest worries of women considering the procedure. Many women worry about losing their sense of femininity and sexual appeal. Many also worry about loss of sex drive (libido) or the ability to experience sexual pleasure. Unfortunately, there is currently no definitive answer on whether a hysterectomy will negatively affect your sex life. If you search the literature, you will find contradictory information because women’s experiences vary.
In my clinical experience, a hysterectomy for many women can mean an end to years of misery. Without having to worry about bleeding, fear of becoming pregnant or being in pain a hysterectomy can invigorate their sex life.
While there are some recognized complications and negative side-effects associated with a hysterectomy, not all women will experience these and those who do will experience them to different degrees. In other words, while some women do experience sexual problems, this is not an inevitable outcome. In fact, research has found that many women also experience improvements in sexual well-being after a hysterectomy. Nevertheless, it is still better to be aware of potential problems and how to address them.
The most frequently reported sexual problems are described next. Remember, you might or might not experience any one or a combination of these outcomes.
Feeling less sexually attractive.
Some women experience a loss of sexual attractiveness after having their uterus removed. Being able to have children is part of the feminine identity, which you might feel has been lost now that you can’t have children. This can make you avoid intimacy, particularly if you fear your partner will no longer be sexually attracted to you. The emotional impact of losing your sense of femininity and attractiveness can lead to one of the most common post-hysterectomy illnesses - depression (Sehlo and Ramadani, 2010). Depression will reduce your sex drive and your enjoyment of sex, as will some of the other associated symptoms such as anxiety and insomnia.
Menopause and loss of sex drive.
No matter your age, if your ovaries are removed, this will trigger menopause and a subsequent decline in levels of the oestrogen hormone. This is the female hormone that is secreted more just before ovulation, increasing your sex drive when you are at your most fertile. This is why some women experience a reduced sex drive after a hysterectomy and it can be corrected by hormone replacement therapy.
Pain.
Pain is most likely if you attempt intercourse too soon after your surgery and you may also experience bleeding and possible infection.
Reduced sensation.
Some women experience reduced sexual sensation, including vaginal dryness and less intense orgasms. However, a hysterectomy does not remove your ability to have an orgasm – you still have your clitoris and labia, which play an important role in sexual pleasure. Problems might arise, however, for women who require uterine contractions in order to orgasm. Equally, if the cervix is removed, you might experience less powerful orgasms. Do remember though that any reduced sensation will be due to nerve damage and/or scarring from the surgery, some of which will heal with time.
Having a hysterectomy does not mean that you have to give up on your sex life. Although there is the possibility of negative effects, but there is also the potential for some positive benefits. Research has shown that women are more likely to report improvements in their sex life after a hysterectomy (Vomvolaki et al., 2006; Komisaruk, Frangos, and Whipple, 2011). One study in the Netherlands found that 75% of the women in the study reported such improvements (Fram, Saleh, and Sumrein, 2012). The reason for this is the alleviation of symptoms experienced prior to the surgery, increasing feelings of well-being and vitality, both of which will have a positive impact on your sex life.
If you do experience any of the problems described above, there are a number of steps you can take to address them:
Allow time.
Some problems require time. If you experience feelings of being less attractive, such feelings are likely to pass as you recuperate and regain energy. It might be helpful to discuss your feelings with your partner or your gynaecologist. If you find that these feelings are not going away it might be helpful to discuss them with a counsellor.
Self-help.
If you experience reduced sensation, pelvic floor exercises can tone up vaginal muscles and increase blood flow and sensation. These are simple exercises that you can do at home, although you might want to seek professional guidance or join a class.
Talk to your doctor.
You will be surprised how easily most of the problems you might experience can be resolved. Vaginal dryness or pain during intercourse can be eased with lubricants or hormone replacement therapy (HRT). Treating menopausal symptoms can improve your sex drive due to improved self-esteem and increased energy.
Listen to your doctor.
You will be advised to avoid sexual intercourse for four to six weeks after surgery in order to provide time and space for you to heal – physically and emotionally. While you might feel anxious to test for any effects the surgery will have on your sex life, you have experienced an invasive procedure and will need time to adjust and heal. Not giving your mind and body the benefit of this time could lead to your first sexual experience post-surgery being a negative one, which will increase your anxieties about future sexual encounters.
Talk to your partner.
Ultimately, this is a time to take care of yourself. However, recognising that your partner might also be experiencing some difficulties due to anticipated or actual changes in your sex life can make you feel less isolated. Talk to your partner - share your fears and experiences and also listen to theirs. The very act of talking to each other will make the situation less distressing for you both. Until your partner hears that you feel less sexually attractive after surgery, they will not know that your avoidance of intimacy is not because you no longer find them sexually attractive. Until you hear that your partner no longer initiates sex because he is fearful of hurting you, you will not know that his feelings towards you haven’t changed. If communication with your partner is problematic, you might want to consider psychosexual counselling.
Every woman will react differently to a hysterectomy and these reactions can be both physical and emotional. Be gentle with yourself. While you might feel discomfort at first, this should pass as you return to your sexual routine. You might also need to use trial and error to discover what feels good to you now. The key message is not to expect the worst – while some women do experience complications with their sex life after having a hysterectomy, many also experience a newfound sexual vigour.
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