Sex After a Hysterectomy: What You Need to Know

A hysterectomy is the removal of the uterus and sometimes surrounding organs and tissue. It's necessary for a variety of reasons, including symptomatic fibroids, endometriosis, ovarian tumors (cancerous and non-cancerous), and certain reproductive tract cancers - like uterine and cervical cancer.

Hysterectomy is the second most common surgical procedure in women, second only to cesarean section in the United States. But some people are afraid to consider this type of surgery because they fear it will change their sex life. The good news is that most people have a fulfilling sex life after having a hysterectomy, with no negative effects.

Let's take a closer look at the impact a hysterectomy can have on sex, and what you can expect.

How does sex change after hysterectomy?

After a hysterectomy, your ability to have sex and the quality of sex really shouldn't change. There are a lot of myths surrounding sex after hysterectomy, like:

• Myth: Sex hormone levels will change after hysterectomy, affecting your sexual desire.

• Myth: Menopause will happen earlier after removing the uterus, decreasing pleasure.

• Myth: Removal of the uterus and cervix will change your orgasms.

• Myth: The vagina will be smaller after hysterectomy, limiting penetration.

Since these are myths, these ideas aren't true. And these aren't outcomes to expect from having a hysterectomy. While there are physical changes that occur in the body, they don't typically impact your ability to have sex or enjoy it.

In fact, for many women their sexual experience can improve after hysterectomy. Because many people who have a hysterectomy also have pain from the condition that led them to seek surgery, sex can actually get better. Some people, free from heavy menstrual bleeding, report much more rewarding sex lives and better orgasms. The feeling of freedom from no longer being able to conceive can also make sex better in some cases.

Physical changes after hysterectomy

Physical changes after hysterectomy are fairly minor, but vary from person to person. Let's review the changes you can expect to see after surgery.

Sex hormones

Sex hormones in people born female are released primarily by the ovaries. These hormones are responsible for many body functions, including regulating the menstrual cycle and preparing the body for pregnancy. These hormones naturally decline with aging and menopause, or if the ovaries are removed surgically.

It isn't common to have your ovaries removed (a surgery called an oophorectomy) along with a hysterectomy, unless you have abnormal growths on your ovaries or if you're at high risk of certain types of cancer. So, for many people your sex hormone levels won't change due to a hysterectomy.

Libido

Your sexual desire, or libido, is a complex interplay of your physical and mental health. And many factors can affect your libido, like:

• Stress

• Medications

• Relationships

• Past sexual experiences and enjoyment

• Hormone levels

Having a hysterectomy itself doesn't typically change these factors or impact your libido. But if you also have your ovaries removed, your changing hormone levels could affect your libido. You may want to consult with a sexual medicine specialist if you notice a change in your libido before or after a hysterectomy.

Orgasms

There are mixed reports about whether removal of the cervix can change the orgasm experience in some cases. For many women, orgasms come from stimulation of the clitoris - a small, sensitive area at the top of the vagina. This isn't affected by hysterectomy.

But some women report a cervical (or "C spot") orgasm. This is an orgasm that occurs with penetration and stimulation of the cervix. If this is important to you, you may want to discuss your options with your surgeon. You may want to consider having the cervix left in place rather than removed during your hysterectomy. If that's not possible, exploring clitoral or vaginal orgasm is an option.

Vaginal lubrication

It's normal to have varying amounts of vaginal lubrication. It changes with age and is primarily controlled by the estrogen hormone released by the ovaries. Vaginal lubrication shouldn't change after a hysterectomy as long as the ovaries weren't removed and there were no signs of menopause prior to the surgery.

Skin changes

The most common physical change is the appearance of surgical scars. The surgical approach determines the type and size of scar you can expect. Most hysterectomies are now done laparoscopically - a less invasive procedure. These will usually result in three to five very small incisional scars.

Emotional effects of a hysterectomy on your sex life

In some women, having a hysterectomy can have significant emotional effects. In fact, there's a link between hysterectomy and an increased risk of:

• Depression

• Anxiety

• Stress

• Grief

Some people may also feel that the removal of the uterus represents a loss of womanhood. If you were born female, the loss of the uterus doesn't change your female status. Your female sex hormones will remain the same if you aren't menopausal and if you keep your ovaries.

The inability to carry a child may be difficult for some people to come to terms with, particularly those who desire children and haven't had them.

If you have a history of depression or anxiety or feel like a hysterectomy might cause some emotional trauma, you should discuss your concerns openly with your surgeon. You may also want to consider counseling to help you learn ways to cope with the inability to go through the childbirth process.

It's also a good idea to explore your options for parenthood after a hysterectomy. It may be possible to use your eggs through egg freezing and finding a surrogate, or to pursue adoption.

How long after a hysterectomy do you have to wait to have sex?

Most gynecologic surgeons recommend pelvic rest after hysterectomy - waiting at least 6 weeks to have sex. Pelvic rest means that nothing should go in the vagina until your surgeon has removed the restrictions. This helps to promote healing because there are stitches at the top of the vagina that can loosen or get infected.

During pelvic rest, your surgeon may caution you to avoid:

• Sexual intercourse

• Use of tampons for bleeding

• Douches

• Tub baths

• Lifting items heavier than 10 pounds

With laparoscopic or robotic surgery, the pelvic rest may be extended to 8 weeks because the sutures used take longer to dissolve.

How to safely start having sex again after a hysterectomy

After your hysterectomy and the appropriate pelvic rest, you can safely resume having sex. Here are some tips to help you have a pleasurable sexual experience after your surgery:

• Make sure your surgeon has examined the vagina at your follow-up appointment. They will be able to tell you if you're ready for penetrative intercourse.

• Communicate with your partner. Go slowly and make sure to discuss both pleasure and pain.

• Try new positions.

• Use lubricants or other aids if vaginal dryness occurs.

• Avoid using sexual toys for several weeks after hysterectomy unless cleared by your surgeon.

• Consider trying pelvic floor physical therapy for increased muscle control and pain relief, if needed. (More on this below.)

It's important to know that bleeding shouldn't occur with sex after hysterectomy, particularly if the cervix is removed. If you notice bleeding with sex, let your surgeon know.

Frequently asked questions