Common reasons for hysterectomies among include fibroids, heavy, irregular or painful periods, prolapse, endometriosis, cancer and pelvic inflammatory disease (PID), according to NSW obstetrician and gynaecologist Dr Harvey Ward in an online article on Reproductivecare.com.au.
A common question women ask about the effects of the procedure is how it will affect their sex life. This isn’t really surprising since many women fear the procedure will somehow reduce their femininity, make them sexually less attractive, or diminish their status as a “complete” woman. Others fear that it may have a physical impact, such vaginal dryness and resultant pain.
With some women finding it difficult to come
to terms with the emotional effects of a hysterectomy, Dr
Ward stresses the
importance of knowledge, support and reassurance from a partner.
Types of hysterectomies
First and foremost, it’s important to know and understand what your procedure
involves, and to discuss all matters relating to it with your gynaecologist, advises
the Royal Australian and New Zealand College of Obstetricians and
Gynaecologists (RANZCOG) on its website, Ranzcog.edu.au.
Your particular circumstances for having this procedure will determine the type of hysterectomy you’ll undergo, why it must be done, which organs will be removed, and the possible impact on your sex life.
The different kinds of procedures include:
1. Hysterectomy: the surgical removal of the uterus.
2. Total hysterectomy: removing the whole of the uterus and the cervix.
3. Sub-total hysterectomy: removing the uterus or womb but leaving the cervix intact. In addition to the hysterectomy, the ovaries and the Fallopian tubes may also be removed.
4. Radical hysterectomy: this is performed when there is cancer in the cervix or uterus. The whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina is removed. The procedure also involves taking additional tissue from the supports and tissues around the uterus.
Will the hysterectomy change your sex life?
The impact of a hysterectomy on a woman’s sex life depends on the type of procedure she has had, comments obstetrician and gynaecologist Dr Dana B. Jacoby on Healthywomen.org.
“If your ovaries and uterus are both removed, it may change your sexual desire. That’s because the ovaries produce both testosterone and oestrogen hormones that are important in intercourse and sexual desire,” he explains. Testosterone is believed to mostly contribute to sexual desire, Dr Jacoby adds, while oestrogen loss may cause vaginal dryness and thinning of vaginal tissue, which could make sex painful.
Dr Sarah Choi, gynaecologist and advanced laparoscopic surgeon at Sydney Women’s Endosurgery Centre (SWEC) notes on her website Drsarahchoi.com.au that a woman who only has her uterus removed can maintain her usual sexual activities after hysterectomy. Since the vagina is preserved, sex may even improve, because the inconvenience and concern about menstrual bleeding, troublesome symptoms as well as unplanned pregnancies and birth control all disappear.
Most gynaecologists, including organisations such as RANZCOG, recommend only having penetrative vaginal sex after six to eight weeks after surgery, when the top of the vagina has healed properly and until you’ve gone for your post-operative check-up. In the meantime, there are other ways to express your sexuality, including hand stimulation, hugs, kisses and massage. This is the time to be adventurous and try out new and exciting alternatives to penetrative vaginal sex with your partner.
If you don’t feel ready to have sex after six weeks, don’t let it concern you. Healing times differ for every woman. Remember to do the pelvic-floor exercises that will be recommended by your surgeon. These exercises aid recovery, tone the vaginal muscles and help improve sexual sensation.
After a hysterectomy, some women may have less interest in sex or experience reduced sexual sensation, such as less intense orgasms. But having a hysterectomy will not prevent you from having an orgasm. You still have your clitoris and labia, which are highly sensitive.
As your recovery progresses, your sexual desire may return, but if it doesn’t and you’re concerned, try to discuss it with your partner so both of you can have a good understanding of the challenges and work on them together.
If your hysterectomy entails having a vaginal repair (to repair a prolapsed uterus affecting the front or back of the vagina), the narrowing of the vagina may make sex uncomfortable or even painful. The good news is that you can usually alleviate this by using a water-based lubricant such as K-Y jelly, a vaginal cream or a soluble pessary (a small soluble block that’s inserted into the vagina). Also try to increase your body’s natural lubrication with appropriate foreplay.
Lastly, remember you don’t need to suffer in silence if you experience sexual problems after having a hysterectomy. Discuss any concerns with your partner and, of course, with your gynaecologist, GP or ask to be referred to a counsellor who specialises in sexual health or ask our sexologist.
Healthywomen; Thewomens ;Reproductivecare; NHS; Dr Sarah Choi; The hysterectomy association; Ranzcog ; Women's Health Queensland Wide ; NHS Information for patients ; Komisaruk BR, Frangos E, Whipple B. Hysterectomy improves sexual response? Addressing a crucial omission in the literature. J Minim Invasive Gynecol. 2011 May-Jun;18(3):288-95. ; Royal Women’s hospital Victoria (Australia) and UK National Health Service.