Disclaimer: Everything I say here is my personal opinion and does not constitute medical advice. Please consult your own doctor for information and advice.
This post is the second of a three-part series on sex after a hysterectomy. In Part 1: The Basics, I provided an overview of what a hysterectomy is and how it is done. In this post, I’ll look at recovery from surgery and then move into the impact on our hormones and emotions. Next Tuesday’s post will focus on sex.
A hysterectomy is not a walk in the park. During the months following the surgery, a woman has to navigate healing, hormonal changes, and often unexpected emotions as well.
In order to remove the uterus, ligaments and blood vessels are cut, cauterized, and reattached to other structures. All of that cutting, cauterizing, and stitching creates small internal wounds that need to heal. (My doctor said I had around 40-50 internal stitches in addition to the places that were cauterized.) Nerves are stressed. On top of that, the removal of a major organ (the uterus) is a shock to the system. And with the uterus gone, all of our other internal organs will settle in where the uterus had been.
Many women have additional procedures done at the same time, such as the removal of ovaries and fallopian tubes or pelvic floor repair work.
The bottom line is this: No matter how it is done, a hysterectomy is a major surgery.
While most women do well with this surgery, full recovery still takes time. Some women do experience complications—so please, if you are considering this surgery, please be sure you are fully informed and seek a second (and maybe even third) opinion to be sure it is truly your best option.
What Is Recovery Like?
The first thing we encounter after our surgery is recovery.
When doctors talk about recovery, they usually are referring to the time during which you can cause complications if you overdo it. For a hysterectomy, this is usually somewhere from four to eight weeks.
When we hear this, we think, Okay, so I’ll be back to normal by then. That won’t be so bad!
Well, that isn’t the way it actually happens. Initial recovery (the time immediately after surgery when you can cause problems) might be a month or two, but full recovery—getting to a place where you feel 100% normal again—can take much longer.
The First Few Days and Months
The first few days after my surgery were fine. I took my pain medications on schedule (rather than taking a pill only after I started hurting and then waiting for the medication to kick in), and that was a huge help. Plus, the anesthesia can take around a week to leave the system, which helped me feel relaxed about most things. I’m a major wimp when it comes to pain, and I found the pain tolerable.
TMI warning for this paragraph! For me (and I know I’m not alone in this), the absolute worst part of the first week was the bathroom. The nerves to the bladder had been manipulated during surgery. I often felt like I had to urinate when I actually didn’t (which was way better than the reverse, if you know what I mean). As for the other type of bathroom activity? Um, let’s just say that those first few post-op bowel movements are terrifying and painful. Pain medications can cause constipation, which makes it even worse. My insides were sore and tender anyway. The pressure from even gas moving through my intestines hurt. Honestly, I wanted to post on Facebook when I survived my first post-op bowel movement. I didn’t, but it was that big of a deal to get it over with.
My husband took a week off to take care of meals and laundry, and my kids (teens at the time) were a big help as well. It is possible to recover without help, but I was very glad that I didn’t have to. The HysterSisters website has a lot of suggestions for managing recovery.
During the month or two of initial recovery time, most women will have some restrictions with lifting, vacuuming, driving, and climbing stairs. The specific instructions will vary according to the specifics of your procedure. It is important to follow your doctor’s orders about what you can and cannot do. You have only one chance to heal right. If you overdo it, you can make healing very difficult for yourself.
Recovery is sort of a two-steps-forward, one-step-back kind of thing. Some days were better than other. I found that if I measured my progress from one week to the next, I could see that I was slowly getting better.
The Return to Normal?
Many women find that they are easily bored during the time they are off work or away from their normal routine. My third week post-op was especially frustrating. Between my restrictions and my general soreness, I couldn’t do much of anything around the house—and as much as I’m an avid reader, I couldn’t seem to concentrate on even a magazine article.
I returned to work part-time at four weeks. I was as exhausted and sore as I was the first week after my surgery. It was nice to return to normal—but just because my routine was normal, that doesn’t mean that I felt like myself.
Most women find that they are surprised by two things during their recovery: fatigue and swelling. It is common to experience sudden and crashing fatigue off and on for months after surgery. I still had some moments of this at eleven months post-op.
Even worse was the swelling. Every single place where I’d been cut, cauterized, or stitched was a wound. You know how when you sprain your ankle, it swells up? Imagine that happening with multiple internal wounds. Being vertical brings the effects of gravity to bear on all those wounds, and swelling usually increases throughout the day. I had a pair of jeans that was a size too big for me. I would put them on in the morning and would need a belt. By the end of the day, I couldn’t even zip the pants up all the way. Swelling was at its worst at around three or four months post-op as I was resuming all my normal activities. For several more months, I continued to experience it occasionally, although not as severely.
Both fatigue and swelling are good reminders that your body is still healing. Use them as a sign that it’s time to lie down and get some rest.
This was a challenging time for my husband. By all appearances, I was back to normal. I got up and went to work. I was in regular clothes rather than sweats and fuzzy slippers. I began to have the appointments I’d put off until after my surgery.
But I was exhausted a lot—far more than when our kids had been small. I still needed him to pick up the slack around the house, and it was hard for me to be available to spend time with him.
The Road to Full Recovery
Like most women, I felt like I was around 75% recovered by six months. That is, I felt like I was back to normal most of the time. I still experienced fatigue, swelling, and occasional aching and discomfort at times.
Full recovery from a hysterectomy can take up to a year—because it can take that much time for all the internal wounds to heal, your systems to resume their new normal, and so on. This is going to be important when we get to the third part of this series where I talk about your new sex life.
While full recovery can take up to a year, it isn’t like you’re lying down unable to function for that full time. It just means that during that time, it is still common to experience signs that healing is not yet complete.
The removal of the uterus is a shock to the system—and that definitely affects your hormones.
The uterus produces low levels of some hormones, so when the uterus is gone that is enough of a shock. If you have ovaries removed, you have an even more sudden change to the system. If you keep your ovaries, they’ve still probably been jostled a bit from the surgery. Plus, without the mothership (uterus) around anymore, they seem to get confused. Even after menopause, the ovaries continue to produce some hormones, so even post-menopausal women can find themselves experiencing the effects of sudden hormone changes.
In other words, whether or not you keep your ovaries, and whether or not you are past menopause, you’re likely to encounter hormonal fluctuations of some kind.
Most women find themselves experiencing major mood swings during the second and third week post-op. I know I did!
I was lying on the couch crying about the fact that my family wasn’t cooking dinner. (Yes, actual crying, with actual tears.) This apparently made them feel guilty, so my husband and kids headed out to the kitchen. They began working as a team—doing food prep, emptying and refilling the dishwasher, and working together. My husband and children were laughing and having a great time!
Moving into the kitchen, I stood watching them all. Instead of being happy because they a) were doing what I’d asked, and b) I was going to get to eat soon, I started bawling again. I sat down right in the middle of the kitchen floor, crying because I felt left out of the family and they didn’t even need me. At least I had the presence of mind to start laughing at myself at some point.
This is completely normal—and knowing that it was normal helped all of us get through that brief time.
Many women will experience hormone changes that last beyond the first several weeks post-op. I kept my ovaries, but they never seemed to completely reboot after my surgery and I experienced symptoms of low estrogen levels. Women who experience surgical menopause due to the removal of ovaries are likely to experience major hormone changes as well.
Hormone changes can include fatigue, night sweats, hot flashes, moodiness, sleep difficulty, forgetfulness, libido changes, hair and skin becoming dryer, weight gain, and vaginal dryness.
All these hormonal changes can have an impact on marriage in general and on sex specifically. I was tired and moody from the lack of sleep. The changes in my hair and skin distressed me because they made me feel like I was getting old. I was physically uncomfortable from hot flashes. I was frightened by my forgetfulness. As a college professor, I couldn’t afford to lose my cognitive functioning.
I was caught up in the changes I was experiencing, trying to understand what was happening to me. I didn’t feel like myself at all. Although this happened during the difficult season of our marriage, I recognized the importance of communicating with my husband about what was going on. I told him clearly that I needed to know that he still loved me and that he cared that I was having a hard time. Big Guy did a great job with this.
The Emotional Aftermath
We never know what emotions we’ll experience after a hysterectomy. Given that I’m an emotional and sentimental person, I expected myself to have lots of feelings about my hysterectomy. Surprisingly, I didn’t.
For some women, a hysterectomy brings great joy and relief—no more pain! No more bleeding! No more trips down the feminine hygiene aisle at the drug store!
For some women, though, a hysterectomy is anything but positive. The removal of the womb is a clear sign that our childbearing days are behind us. For women who wanted children and were unable to have them, this can be incredibly difficult. Other women struggle as well. Women who never wanted children may feel sad that the option is gone. Women who’ve had all the children they desired may also find themselves grieving the loss of the place where they carried their babies.
In addition to feelings about the loss of childbearing capability, it is common for women to question their womanliness. Without my uterus, am I still a woman? Without my sex organs, how can I possibly be feminine and womanly? Some of these feelings can be exacerbated by the hormonal changes. It’s easy for everything to feel worse in the midst of hormonal upheaval.
Recovery challenges, hormonal changes, and emotions can put a strain on our marriages. Or, they can provide an opportunity for a husband to love his wife well and for a wife to lean on her husband in new ways.
A hysterectomy and its aftermath can definitely have an impact on sex. Next week, I’ll talk about your new sex life, post-hysterectomy.
Image courtesy of dream designs at FreeDigitalPhotos.net