Sex after a hysterectomy: never better

by Laura Chisholm, MPH

A hysterectomy doesn't signal the end of your sex life. In fact, it may create wonderful new opportunities!

Despite the fact that more than half a million American women have their uteruses surgically removed each year, most women don't blithely sign up for the procedure. Besides having the usual worries about undergoing major abdominal surgery, they are concerned about how hysterectomy will affect their lives, especially their sex lives. In fact, studies have shown that concerns about sexual functioning are foremost in women's minds before surgery.

"While not all women contemplating hysterectomy ask about the effect of the procedure upon sexual functioning, they most certainly think about it," writes gynecologist Sarah Berga, MD, in a recent issue of OB/GYN Clinical Alert. But there's good news about sex after hysterectomy. A recent study revealed that hysterectomy can have very positive effects on a woman's sex life, especially if she was experiencing significant medically related sexual problems before surgery.

Published in the November issue of the Journal of the American Medical Association, the Maryland Women's Health Study followed the experiences of 1101 women during the first two years after a hysterectomy. The results were surprisingly positive. Overall, the study group's frequency of sexual relations increased after surgery, and the number of women experiencing pain during sex dropped from 41% to 15%. Although improvements in vaginal dryness were not as marked, women in the study group did report strong orgasms almost 15% more frequently one year after surgery. Even more impressively, almost three-quarters of the women initially experiencing low libido reported an improvement after surgery, and two thirds of the women who reported not having orgasms before hysterectomy were having them a year later.

"This study shows that women are incredibly adaptable sexually," says Jillian Romm, RN, LICSW, a medical social worker who specializes in counseling women on reproductive issues. "Even after a major pelvic surgery, women can actually improve on their past in many cases," she says.

Although hysterectomies are very common?second only to Cesarean section among major surgeries performed in the United States?the procedure hasn't enjoyed a sterling reputation among the general public. Common knowledge held that removal of the uterus was the cause of many problems, including increased vaginal dryness, painful intercourse, lack of interest in sex, and lower number and quality of orgasms.

However, according to Leon Speroff, MD, professor of obstetrics and gynecology at Oregon Health Sciences University in Portland, Oregon, the results of the Maryland study didn't surprise experts. "It's not new news, and the results make good sense," he says. "Because women usually undergo hysterectomy as a result of major medical problems, it's not surprising that quality of life generally improves after surgery."

One cause of the confusion about hysterectomy's affect upon sexual functioning may have been the public's assumption that all hysterectomies are the same. They're not. Sometimes the ovaries are removed along with the uterus, and in other cases they're left intact. Although the uterus is thought to play a role in women's hormonal functioning, the ovaries are the master producers of estrogen and the regulators of the menstrual cycle.

"Oophorectomy [surgical removal of the ovaries] often has a far more devastating impact than removal of the uterus, particularly among premenopausal women," says Amanda Clark, MD, a gynecological surgeon at the Oregon Health Sciences University Center for Women's Health. "When a woman hasn't reached menopause and her ovaries are surgically removed, we get a situation of 'instant menopause' that can cause just the sort of sexual problems that people commonly blame on hysterectomy," she says.

Another possible cause for hysterectomy's bad reputation may be recent arguments that the procedure is performed too frequently. "The uterus has hardly been studied separate from its role in childbearing," writes Christiane Northrup, MD, in Women's Bodies, Women's Wisdom. "After the uterus's childbearing function has been completed or when a woman chooses not to have a child, modern medicine considers the uterus to have no inherent value."

The high number of hysterectomies performed in the United States has also caused an outcry from feminists who refer to the procedure as "the ultimate rape" and argue that it represents a form of cultural and sexual discrimination. Although opposing views may confuse the issue, the continuing controversy over hysterectomy does remind women to keep themselves well informed.

Romm believes that one of the best ways to increase the chances of having a positive sexual recovery from hysterectomy is to contemplate the decision as thoroughly as possible ahead of time.

Not only should women explore all of the available medical options, but they can also benefit from delving into related psychological issues, she says. "I help each patient explore the nature of her attachment to her uterus. If having a womb is a big part of what makes a woman feel feminine, then having a hysterectomy will be a much bigger deal for her than, say, having her appendix out."

According to Romm, each woman's process of pre-surgery decision making, as well as her subsequent experiences during recovery, are entirely individual and must be treated as such. "What makes our sexual self really alive is extremely individual. I urge women to talk about their feelings with loved ones, and think through every possible outcome. This takes a lot of the fear and unpredictability out of the process of adjusting."

Along with the practical and emotional preparation, it's important for women and their partners to have realistic expectations about recovery. "It's really common to go through a post-operative honeymoon period," says Romm. "It's kind of exciting, like having a whole new vagina. But then things usually settle down into the pre-surgery pattern." Knowing what to expect, she says, makes changes easier to accept in a positive light. Because hysterectomy also releases many women from previous medical problems and fear of pregnancy, the odds seem to be stacking up in favor of great sex after hysterectomy.