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 third 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 Part 2: The Aftermath, I talked about recovery, hormones, and emotions. In this post I’ll talk about your new sex life, post-hysterectomy.
Most women do well with a hysterectomy—which is no consolation for women who experience a complication. Complications can range from temporary infections and fever on the mild end to permanent problems such as adhesions, pelvic floor prolapse, and nerve damage.
My biggest fear about having a hysterectomy was the effect on my sex life. This was during the years when I was actively avoiding and resisting sex, so it’s more than a little ironic that I was concerned about sex.
I’d read that for most women, if they have a good sex life before the hysterectomy, they’ll have a good one after a hysterectomy.
I was a little terrified, though. My specific fear was that I would never again experience an orgasm. I made the decision to have the hysterectomy only when I realized that I would rather live without the possibility of an orgasm than live with the pain that had become debilitating.
In many respects, sex after a hysterectomy feels like a whole new sex life—at least for a while. Everything feels different—and it takes quite a while before you really know how your sex life is going to be moving forward.
I’d like to first spend some time talking about sex during the recovery period. Then I’d like to look at the sex life you have after you’re all healed.
In the hours and days after surgery, sex was the last thing on my mind. My body was a jumble of swelling and aching, both in the pelvic region where my uterus had been and in the vagina itself. I felt completely unsexual.
I cannot stress enough how important it is to understand and follow your doctor’s instructions for your hysterectomy recovery. Most women are simply told not to insert anything into the vagina—no fingers, no vibrators, and definitely not a penis or a tongue. However, they may be allowed to try “outercourse” when they feel up to it—external stimulation (with clean hands or vibrator). As embarrassing as it is, it is important to ask your doctor if it is okay.
Some women are required to be on total pelvic rest, meaning that they should avoid not only orgasm, but also arousal. Most women are told to avoid intercourse for a period of time (often four to six weeks) but are not told anything about other sexual activity unless they ask. Many doctors will say to avoid intercourse until you’ve had a post-op check-up that includes an internal examination to confirm that you are healing well.
In one of the really unfair after-effects of a hysterectomy, most women experience a surge of hormones during the second or third week post-op. For some, it is the first time in their live they have felt constantly horny—and they can’t do a thing about it. I remember thinking, Oh, so THIS is what it’s like to be a teenage boy! It is common during this time to experience sexy dreams and orgasms in your sleep.
Do What Your Doctor Says—or Else
What can happen if you don’t follow your doctor’s orders about sexual activity? I don’t want to scare you, but, well, actually, I DO want to scare you. Here’s what can happen:
- Sexual arousal involves an increase in blood flow to the genital region. Tissue swells. The top end of the vagina expands. This extra blood flow adds pressure to tissue that is already swollen. If the cervix was removed, the top end of the vagina likely has stitches in it. Changes in vaginal shape pull on stitches. This may not be damaging, but it can be painful or uncomfortable for some women.
- Both arousal and orgasm bring blood rushing through blood vessels that have been manipulated and may be healing from stitching or just being jostled around. This can interfere with healing, especially if pelvic floor repair work was done.
- Even outercourse can increase the chance of infection. If your hands or your husband’s hands are not very clean, they can introduce bacteria that may lead to an infection that makes you quite ill and compromises your recovery.
- The back-and-forth jostling of intercourse puts a great deal of strain on stitches.
- Intercourse can rupture the stitches at the top end of your vagina. I have read some women’s stories of how the thrusting of the penis burst through the stitches, causing intense pain and spreading bacteria past the vagina and into the abdominal cavity. This is likely to require another hospital stay and an even longer time without intercourse (like three or four months).
Please, please, please follow your doctor’s orders. You have only one chance to heal right from this surgery. Don’t risk permanent damage.
What does this mean for sex during the post-op period?
Off-limit activities include vaginal penetration of any kind (including fingers, toy, or penis), anal penetration (too much risk of bacteria and internal pressure against tissue that is still healing), and oral sex for you.
There’s still a lot of sexual activity you CAN enjoy, as long as you have the green light on outercourse. Your husband can manually stimulate you with very clean hands. He can use a vibrator externally (but you may find that even a low vibration speed is too intense). You can provide him with manual or oral stimulation. You can masturbate with each other (again, as long as your hands or vibrator are completely clean).
If you are prescribed total pelvic rest, then you should avoid arousal. What does that mean for your husband? Most men will need occasional ejaculations to relieve physiological pain and discomfort. Because your husband loves you, it will be best for him emotionally if you are part of that ejaculation. If you are able to manually or orally stimulate him without becoming aroused yourself, that would be a loving and intimate thing to do.
However, if you can’t see him experiencing sexual pleasure without experiencing your own arousal, being on total pelvic rest poses a bit of a challenge. In When It Hurts: Maintaining Sexual Intimacy While Dealing with Pain, I made this suggestion:
Give him something to work with. If you are prescribed total pelvic rest and should not experience arousal, then even being in the room while your husband masturbates can be a problem. Despite the fact that sexual intimacy is not about the orgasm alone, your husband does have a physical need for release aside from his emotional need for intimacy with you. If he needs to masturbate away from you for a short season in life, let him have pictures or videos of you to help him focus on you and your love for him. Apps like Couple offer a password-protected way to share images with each other.
Finally! Sex Again
At some point, your doctor will clear you to resume intercourse. Like many women, I was afraid something would rupture. In some ways, I felt kind of like a virgin, unsure how all the parts would work and wondering if everything would still fit.
The first several times you have intercourse after a hysterectomy, use lots of artificial lubrication. Lots. Your vaginal lubrication may not be back to normal depending on your hormones, and you will be more comfortable if you know that dryness won’t add to any discomfort.
Be slow and gentle, and use positions that allow you to control angle and thrust. If you get uncomfortable or nervous about proceeding, finish up with manual or oral stimulation. Whether or not you experience orgasm, it is normal to experience an achy and crampy feeling for several days after intercourse.
In Part 2 of this series, I explained that full healing and recovery can take up to year. This applies to every aspect of your body that has been affected—including your sexual response system. Your body will continue to experience swelling and occasional aches and pains for months. How your body feels and responds during that first year is not necessarily an indication of a problem.
That said, if you experience pain—or if your discomfort increases over time—see your doctor right away. It means that something is not healing right. The sooner you address it, the better chance you will have of a full recovery.
Orgasm After a Hysterectomy
Most women are able to experience an orgasm after a hysterectomy. As I was preparing for my surgery, I kept reading what women had to say about this, and I even asked a few women in my real life. When asked what an orgasm is like after a hysterectomy, just about every single woman responded by saying it was good, but different?
Different does not necessarily mean worse, although for some women it might seem like this at first.
A Different O
- For women whose cervix plays a role in sexual response, the removal of the cervix is quite a loss.
- Orgasm includes contractions in the uterus, vagina, anus, and pelvic floor. With the uterus gone, those contraction will no longer be present. However, it may make the other contractions feel more prominent.
- Blood vessels are usually affected during a hysterectomy. As ligaments that attach internal structures are cut or reattached elsewhere, the blood vessels that supply those ligaments are felt differently. As the orgasm contractions suddenly release the pelvic congestion (all the blood that engorged your sexual tissue), the blood flies through your blood vessels all at once. These blood vessels may not be exactly where they had been, so it just feels different internally. The sensation is the same as before, but it feels like things have shifted—because they have!
- If any nerves were affected by the surgery, this may affect how you experience the feelings of an orgasm as well.
- If you’d found that orgasm was easier for you around the time of ovulation and now you no longer have ovaries, orgasm may be a bit of a challenge.
Sexual Function and Your New Sex Life
As your body recovers during that first year, you should find that your sex life settles into a new version of itself. If you had a good sex life before, you’re likely to have a good sex life afterward.
The post-hysterectomy bed may not be made of roses, however. Hormonal changes can lead to vaginal dryness and atrophy, and they can have a negative impact on your libido. If you are struggling with your emotions or your feelings of femininity, that may affect your sexual desire as well. (Talk to your doctor if you experience any of these things.)
Unfortunately, some women find that their sex life never recovers. Sometimes the surgery itself damages ligaments or nerves in a way that makes sex not pleasurable or even painful. Some women experience drastic hormonal changes that affect their sexual response in significant ways. Talk with your doctor, and see specialists if you need to. Be sure to include your husband in these appointments, as he needs to understand what you are experiencing and learn how he can support you.
For some women, sex after a hysterectomy is far better than before. If you had your hysterectomy for painful fibroids, you main find yourself experiencing pain-free sex for the first time. If you’d been experiencing heavy or irregular bleeding before, now you don’t ever have to think about what time of the month it is in planning a weekend away with your husband. If you’d been using a form of birth control before your hysterectomy, now you no longer have to think about taking time to insert a diaphragm, or you get to experience condom-free sex.
It is impossible to know what kind of outcome you will have with a hysterectomy. You probably will be fine, and your sex life will probably be fine—but there is a chance that you and your sex life will not recover.
A difficult outcome can still strengthen your marriage. As you and your husband consult doctors and work on connecting in other ways, you may still find that your intimacy grows deeper.
Sexual intimacy can be so much more than just the ability to have intercourse. If sex is painful, try some of the suggestions in this post. Spend time fostering emotional and spiritual intimacy with your husband. Do what you can to sexually connect with him, and don’t beat yourself up about what you can’t do.
If you are facing a hysterectomy, do your research. Get a second and even third opinion. Visit HysterSisters. Know all your options, and examine the pros and cons of each option in light of your own medical situation. Make an informed decision. If your recovery doesn’t go well, talk with your doctor about how to address your challenges.
Be well, and know that your marriage–and your sex life–can thrive after a hysterectomy.
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