In a perfect world, every woman has a partner in her life who enables her to have earth-shattering orgasms, intimacy, and amazing sex on a regular basis. He also cooks, gives massages, and makes the bed. If that is the case in your home, things will most likely be exactly the same after your surgery since the most important thing that determines what sex after hysterectomy is like, is what sex before hysterectomy was like.
Virtually every woman expresses concerns, if not to her doctor, to her partner, or even herself about how hysterectomy will affect her sexual function, desire, and desirability. Unfortunately, studies have shown that only half of gynecologists initiate a discussion of sex and few patients (about 13%) are willing to bring it up themselves. That means a lot of women who worry about their postoperative sexuality do just that, worry.
Recent studies show that in the absence of oophorectomy, there are no significant adverse effects of hysterectomy on sexual function. However, many women report changes in sexual response after surgery. A lot of speculation exists concerning the loss of the cervix and its effect on the quality of orgasm, but again, there are little data to support this theory (see chapter 19).
A 1999 study published in The New England Journal of Medicine tracked over one thousand women during the two years after their surgeries and, unlike many earlier studies, evaluated sexual function both before and after hysterectomy. The results of the study were reassuring and validated what most gynecologists (but not most pre-op patients) knew all along. Seventy-seven percent of the women in the postoperative group were sexually active one year after surgery, in contrast to only seventy-one percent of the group the year before. This finding is not surprising, given that the study also demonstrated that the number of women who experienced pain during sex decreased from 19% to 4%. The quality and number of orgasms increased, as did overall libido. The bottom line is that frequency of sexual activity consistently increased and sexual dysfunction decreased.
Women who become menopausal as a result of surgery have an additional set of issues to deal with. If estrogen supplementation is not initiated, it is likely that mood disturbance, vaginal dryness, and a much higher risk of sexual dysfunction overall will ensue. There is no question that estrogen and androgen supplementation will absolutely increase libido, lubrication, and sexual response. Some women are fine without it, but for many women, the loss of hormones is a major blow to sexuality.
Is It Really No Sex for Six Weeks?
When your doctor says “no sex for six weeks,” what he or she really means is “no intercourse” for six weeks. It’s actually a misnomer since sex is not synonymous with intercourse. There are no restrictions on kissing, hugging, fondling, or stimulation of external genitalia. Never underestimate the value of foreplay. High school is not the only time that caressing and other erotic play are satisfying without being simply a prelude to intercourse as the grand finale. Couples often find that eliminating the goal of intercourse from a sexual repertoire actually results in greater intimacy and ability to explore new options.
After a few weeks, orgasms are fine. The restrictions are in how those orgasms are initiated. If nothing goes in the vagina, it’s usually not a problem. For all we know, the increased blood flow to the genital region during orgasm enhances healing. That study has never been done . . . or at least, never published.
Excerpted with permission from The Essential Guide to Hysterectomy.