Ask the Doctors: Sex After Hysterectomy

I had a hysterectomy in the past year or so, and hadn’t had sex until very recently. My vagina feels really different and I experienced some discomfort when my partner entered me, started to move back into my vagina, and he hit the end of my vagina sooner than I thought. I no longer have a cervix, but didn’t think that my vagina was that much shorter than before (I’d asked my surgeon/ob/gyn about this and he said that it wouldn’t be). I’m wondering if there are some exercises I might do to help get my vagina back in shape (it was fine before the hysterectomy), and also wonder if a dildo or vibrator would help. I’ve been wanting to get one anyway, but just hadn’t done it yet. Do you have any suggestions of what might be most suitable?

thanks!
Re-Learning My Body

I am sorry to hear that your surgeon led you to believe your sensation changes post-hysterectomy would be minimal. He was incorrect when he said the vaginal barrel, with cervix removed, would not lose any of its length; many women have had the experience you describe here, and I and many other advisors suggest that women who must have hysterectomies try to get their doctors to agree to leave the cervix in place. (Of course, there are certainly situations that require the removal of the entire cervix, and it may be that yours was one of those cases. Plenty of doctors still opt to do the simpler surgery regardless, though, and remove the cervix with everything else whether it’s healthy or not.)

Hysterectomy is the second most common major surgery performed in the US, and while many people have heard of it as a treatment for cervical or uterine cancer, when it may be the only alternative, most of these surgeries are performed on women with fibroids, uterine prolapse, or other conditions that are less likely to be life-threatening. Doctors in training often do not learn the full range of women’s’ responses to hysterectomy and tend to downplay side effects, especially sexual ones, which are often called “all in the head” of the patient.

Some doctors, like Christiane Northrup, MD and Dr. Stanley West, have spoken up about this training and have helped challenge the conventional wisdom that hysterectomy is a largely problem-free surgery; some doctors and patient advocates go even farther and argue it is performed way too often, and unnecessarily.

There are two main elements to the sexual side effects that come with hysterectomy. You don’t say whether you still have your ovaries; in some cases they are retained, and it’s also possible they’ve been removed. In either case you can expect your hormone levels to change — with a radical hysterectomy they will change suddenly, putting you into immediate, surgically-induced menopause; and if your ovaries were not removed, the change may come more slowly. (It appears that even when the ovaries are saved, their hormone production slows down.) I’d encourage you to discuss hormone replacement with your ob/gyn — and if you have the opportunity to confer with a woman practitioner who specializes in this issue, so much the better.

No offense meant, but I am not happy with your current doctor’s ability to put himself in the shoes of a post-hysterectomy woman! In particular, seek out bio-identical hormone replacement if you have any HRT at all. Doctors frequently prescribe synthetic hormones, which can be hard on the body.

The other issue is the actual effect of the surgery (and radiation, if you had any) on your vaginal tissues. First, a little bit of info about the vagina’s functioning as far as length and flexibility is concerned. At a “resting” (non-aroused) state, most women’s vaginas are not especially long or deep; arousal allows the vaginal barrel to gain some length, so that most women can accommodate penises (or other fun things) of varying sizes — this can happen comfortably IF the woman is sufficiently aroused. The other thing that facilitates this is that the uterus/cervix moves up out of the way, and the very back of the vagina, called the posterior fornix, relaxes and adds length. Here’s a picture to help you visualize where that part of the vagina is and its relationship to the place your cervix was.

Post-hysterectomy, several things could affect your ability to get as aroused as you used to: the hormonal factors I addressed in the prior paragraph, but also emotional issues like worry and concern; any new discomfort or your reaction to changes in sensation will probably make a difference; and if you had radiation or problems with scarring, these actual physical effects will likely alter your ability to become fully aroused.

These latter issues may cause problems (at least temporarily) even if you do get completely aroused. You are likely to need lubricant even if you are very turned on, especially if your ovaries were removed or if you had radiation. You should try to take as much time as possible in the build-up to intercourse or any other vaginal insertion, because this can add to your physiological arousal, which is a function of blood flow to the pelvis and genitals; this blood flow is super-important, and the longer pleasurable and effective stimulation goes on, the more blood flow you’ll have. A complication in this discussion is that some hysterectomy surgeries affect both the nerves that serve your genitals, carrying sensation to the spinal cord and brain; and also the genital blood supply. This can be a separate surgical outcome that can also affect arousal and the ability of the vagina to expand in size.

However, having said all this about arousal and size change, if your surgeon removed your cervix, he did shorten the vaginal barrel — by what length I do not know — which means that the way you and your partner fit together has now changed, at least somewhat. It is likely that the posterior fornix is now gone. (The sensations of intercourse and possibly orgasm may also be altered by this change, particularly if you were one of those women who liked the sensations of intercourse on your cervix and/or experienced uterine contractions with orgasm.)

Unless you can address the arousal issues I wrote about above and deal with any impediments, you won’t know how much difference there ultimately is. So it’s very worthwhile for you to continue experimenting erotically, both solo and with him, so that you can determine how much of that last experience was “new normal” for you and how much change you are able to experience when you get more comfortable and more time has passed since the surgery. Masturbation allows you to explore and take your time, setting aside some of the surgery-related anxiety that may still be affecting you and really allowing you to focus on your own sensations.

There is a specific product designed to promote vaginal health called the FeMani. While technically a vibrator, it was designed by a medical doctor and therapist team to assist women with vaginal health after menopause and post-surgery; I would recommend it to you, particularly during this post-surgical period when you are noticing changes in function and assessing what effect this is having on your ability to become aroused and comfortable during sex. I’d also recommend PC exercises (aka Kegels).

Beyond any active physical therapy you might do, with the FeMani or even just utilizing self-pleasuring to reconnect with your sexual sensations, you might find it valuable to discuss your situation with other women who’ve also undergone hysterectomy. Depending on where you live, there may be a support group accessible through your health care network or a women’s health center. Or you might want to join an online forum like About.com’s Women’s Health discussion group or EmpowHER’s women’s groups.

There are many other places for this sort of discussion on the Web, some specific to the kind of health problems that led you to have the hysterectomy in the first place — fibroids, cancer, or other issues. Be aware, though, that not every woman’s experience on these forum sites can be generalized to your own experience. In health as in sex discussions, many of us have a bias toward our own experience and don’t have enough information to realize that other people’s responses, desires, and side effects may differ quite a lot. When I scan “people helping people” sites I see lots of fantastic information and bonding — and I also sometimes see misinformation presented as fact and non-generalizable specifics from one person’s experience presented as though it’s the last word for everyone. If you can weed out those kinds of messages, you may find a lot to value in the online forums.


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Dr. Carol Queen

Carol Queen has a PhD in sexology; she calls herself a "cultural sexologist" because her earlier academic degree is in sociology: while she addresses individual issues and couple's sexual concerns, her overarching interest is in cultural issues (gender, shame, access to education, etc.). Queen has worked at Good Vibrations, the woman-founded sexuality company based in San Francisco that turned 35 years old in 2012, since 1990. Her current position is Staff Sexologist and Good Vibrations Historian; her roles include representing the company to the press and the public; overseeing educational programming for staff and others; and scripting/hosting a line of sex education videos, the Pleasure-Ed series, for GV’s sister company Good Releasing. She also curates the company's Antique Vibrator Museum. She is also the founding director of the Center for Sex & Culture, a non-profit sex ed and arts center San Francisco, and is a frequent lecturer at colleges, universities, and community-based organizations. Her dozen books include a Lambda Literary Award winner, PoMoSexuals, and Real Live Nude Girl: Chronicles of Sex-Positive Culture, which are used as texts in some college classes. She blogs at the Good Vibes Magazine and at SFGate's City Brights bloggers page and contributes to the Boston Dig. For more about her at carolqueen.com.

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