I was recently sent a question from a reader who stated she had a hysterectomy last year but still thinks she has her ovaries and wondered why sex felt different and why “it is like no feelings when we have sex?”
I thought this was a question that many women may have and not have the courage to ask their doctors so I am answering it here as a benefit to everybody. As I have stated in my previous blogs to think of me as your big sister who happens to be a doctor. It is my goal to be open and honest but not always politically correct. This is not Web MD or a formal medical journal but my best attempt to explain things simply. I am an Internist who has treated thousands of women, many of whom have had hysterectomies but unlike a surgeon or gynecologist, I do not perform hysterectomies or any surgeries in general.
Let’s get some basic questions answered first :
What is a Hysterectomy?
A Hysterectomy is a surgical procedure that involves removing a woman’s uterus after which she can no longer have a menstrual cycle or get pregnant. Depending on the circumstance it may include removing one or both of her ovaries and it may include removing the cervix or opening to the uterus.
Why do women get hysterectomies?
Abnormal bleeding before or after menopause – this bleeding may be irregular or excessive. Also severe pain during cycle for example due to fibroids and lastly, due to cancer.
Why does it matter if the ovaries are removed?
The ovaries and the uterus both make a number of hormones that may be partially lost after the procedure. The ovaries produce significant proportion of sex hormones such as testosterone which affects your libido or sexual desire. So clearly if both of your ovaries are removed you may notice a difference. Fortunately the remainder of the sex hormones are still produced by the adrenal gland.
Why would my ovaries be removed during a hysterectomy?
That depends on your medical condition. For example, those with large cysts, severe pain or cancer or risk of ovarian cancer may have an oophorectomy.
Will the size of my vagina change after a hysterectomy?
The length of the vagina is often shorter and ends in a blind pouch if the cervix is removed.
Can I still have an orgasm if I have had a hysterectomy?
An orgasm usually happens after the clitoris is stimulated. Since your clitoris is near the outside of your vagina and still present it should not be affected. However your orgasm may feel different because for some women during an orgasm they can feel the contraction of their uterus and that sensation will be absent after a hysterectomy.
Is sex painful after a hysterectomy?
Let’s assume you have waited 6-8 weeks or whatever the advised time you were told to abstain from sexual intercourse.Your stitches have healed and there is no infection. Sex may be uncomfortable if you have significant vaginal dryness which may happen naturally due to menopause or if you had your ovaries removed causing lower levels of the sex hormones. You may also have less interest in sex and be bothered by hot flashes. Luckily this is the day and age when there are tons of different lubricating jellies. Different colors, flavors….all you have to do is go to your local pharmacy or adult store. Hormone Replacement which helps alleviate majority of the symptoms may or may not be a good option for you. It is not without risks and you should discuss this with your doctor.
Unfortunately, unlike men, women don’t have a simple quick fix like Viagra because female sexual dysfunction, although common, is more complicated and multifactorial. Most of the time men may have a “mechanical problem” – not being able to have a good erection due to poor circulation or nerve damage. They may still have the desire to have sex, they just can’t get a good enough erection. Viagra vasodilates drawing more blood to the penis. Most women on the other hand who have a sexual dysfunction don’t have anything wrong with their vagina; the issue is usually about how they feel and their emotions.
Now back to my readers question and statement – ”It is like no feelings when we have sex.” I would ask her to be more specific. Does she mean physically or emotionally?
Let’s clarify the potential causes:
- Is it a lack of sexual desire? For example he wants to have sex but you have no interest and would rather go to sleep or watch TV. If you are anxious, frustrated, angry or fearful it is less likely you would be interested in sex. May be you are exhausted after a long day or are distracted and worried about bills or your kids. Or you could be depressed? Do you have a medical condition that may interfere like diabetes or thyroid problems or are you on medication like certain antidepressants that may affect your libido?. Please see your doctor and discuss your options which may include psychological counseling, mental health counseling or sexual therapy. However, as I stated earlier, a hysterectomy that includes removal of the ovaries can result in a drop in the level of sex hormones being produced, which can cause a lack of sexual desire.
- Is it a lack of arousal? In other words an arousal disorder: You have the desire to have sex but can’t get aroused or “turned on”. When you are aroused more blood goes to your genitals and you may notice enlargement of the clitoris and increased lubrication in the vagina. For most women it is not just a physiological response but also an emotional response. You may have certain feelings along with the physical changes. Are those physical changes not happening or is it the emotional feelings you used to have? Is your partner predictable and you find yourself bored? Do you no longer find your partner attractive or do you yourself have problems feeling attractive or feminine now that you have had a hysterectomy? Have you considered changing the location of your next sexual encounter, like booking a room at a hotel or private getaway?
- Is it a problem having an orgasm? In other words you have the desire, you feel aroused during sex but you just can’t have an orgasm. Did you know there are a significant number of women who have had sex but never had an orgasm even in the USA ! I remember growing up in Africa and learning about women who had children but never had an orgasm. They were raised to believe the purpose of sex was purely to have children and for the enjoyment of men. They were kept ignorant of their own bodies and made to feel shame about something so natural. Let’s assume you know how to achieve an orgasm and awareness is not the problem. One option is to consider a vibrator or personal stimulator and if you are able to achieve an orgasm then you can rest assured that you are ok. You may also need better communication with your significant other. He or she may need to adjust how they are touching or penetrating you. Anorgasmia is a real disorder. Some women may have a delay or difficulty achieving an orgasm. Sex therapy may help.
I hope the questions I have raised will help you to sort out what the real problem is and bring you closer to a solution. I strongly advise you to discuss your concerns openly with your PMD and/or your gynecologist again, who may want to do a vaginal exam and possible lab tests depending on your medical history. You may also want a referral to a psychologist and or sex therapist.