Many women are worried that hysterectomy (removal of the uterus, or womb) will affect their ability to enjoy sexual intercourse, or reduce their sexual attractiveness. Some scientists in the Netherlands have looked into this . . .
Hysterectomy (removal of the uterus) is the most common gynecological operation performed today. As many as 25% of women will undergo one of several forms of hysterectomy:
- vaginal hysterectomy - where the uterus is removed through the vaginal opening, without an abdominal incision
- subtotal abdominal hysterectomy - the uterus is removed through a low abdominal incision, but the cervix is left in place
- total hysterectomy - the uterus, including the cervix, is removed through an abdominal incision
Many women are worried that hysterectomy will affect their ability to enjoy sexual intercourse, or their sexual attractiveness. To see whether sexual well-being is influenced by one type of hysterectomy more than another, researchers in the Netherlands conducted a study. Here's a summary of the results they reported in the British Medical Journal .
What they did
Over an 18-month period all women who had been offered hysterectomies in 13 Dutch hospitals completed a questionnaire before, and 6 months after, their surgery. There were 36 questions - 16 on the patient's own perception of her sexuality and frequency of intercourse, 18 on problems arising during sex, and two 'summary' questions as to their general satisfaction with sexuality.
The main analysis concentrated on those women who were sexually active before and after hysterectomy, comparing their outcome with different surgical techniques.
What they found out
Out of 477 women questioned, 413 gave permission for their answers to be analyzed. However, only 352 women who had a male partner replied to the 6-month questionnaire. Of these, 310 were sexually active both before and after surgery; 29% had a vaginal hysterectomy, 25% had a subtotal hysterectomy, and 47% had a total hysterectomy. There were no significant differences among actual surgical techniques for those who remained, or became, sexually active after surgery.
Sexual pleasure improved, on average, after all three types of surgery. There was a reduction in all sexual problems reported before surgery, again with all three types of operation.
Six months after hysterectomy, 43% of vaginal, 41% of subtotal, and 39% of total hysterectomy patients still reported one or more bothersome problems. The differences between these groups were not significant (i.e. they could have emerged by chance alone). New sexual problems developed in 23%, 24%, and 19% of the patient groups, respectively; again, there was no significant difference between the types of operation.
What does this mean?
Once again, an 'old wives tale' has been laid to rest. Women faced with having a hysterectomy needn't worry that one type of operation rather than another will adversely affect their sex life. Rather the reverse. As in many other cases, precise knowledge can usually help dispel anxieties.
Hysterectomy and sexual wellbeing: prospective observational study of vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy. J-PWR. Roovers, JG. van der Bom, CH. van der Vaart, et al., BMJ, 2003, vol. 327, pp. 774--777
After hysterectomy, some women will notice that, during orgasm, they no longer experience uterine contractions because they no longer have a uterus. But, as evidenced by the study above, many women feel that their sex life is improved after hysterectomy, especially if the surgery was performed to alleviate pain, pressure, or discomfort. For women who have undergone abdominal hysterectomy with no shortening of the vagina, sex after hysterectomy should not feel much different. However, if the hysterectomy procedure requires that the vagina be made shorter, women may experience pain with sex. Deep penetration sex after a vaginal hysterectomy may cause discomfort in the first few months after surgery, but this can be overcome by altering positions or the angle of penetration. Sexual intercourse also gradually stretches vaginal tissues, so with a little patience, painful sex after hysterectomy may resolve. Progesterone pills or creams help to restore libido or hormone balance, both of which can contribute to an improved sex life. Talk to your doctor about your concerns for ways to maintain a healthy sex life after hysterectomy.