Sex After a Hysterectomy

QUESTION: I had a hysterectomy two years ago. After I had the surgery, so many of my girlfriends told me I would never enjoy sex again that I have since sworn off intercourse. Are they right?

ANSWER: Your friends, while well-meaning, have passed along a common myth about hysterectomies and sex. The truth is, most women who have a hysterectomy do not see a significant change in their desire for or enjoyment of sex. When you have a simple hysterectomy, only the uterus is removed. The clitoris, G-spot and vagina are usually not affected by the surgery and remain sensitive. If you enjoyed sex prior to the procedure, chances are you will enjoy sex afterward. And if you had problems with pain and bleeding before the surgery, you may even find sex more pleasurable now that the tissue has been removed.

In many hysterectomies, the ovaries are taken out with the uterus, and that sends women into surgical menopause. The loss of estrogen and testosterone that are produced by the ovaries may cause hot flashes, dryness of the vagina, diminished sexual desire and weaker orgasms. The good news is that all these symptoms may be alleviated with herbs, toys and vaginal lubricants. You may also want to talk to your doctor about estrogen therapy. There are some complications associated with hormone-replacement therapy. Studies have found that women who take estrogen have a slightly increased risk of stroke. But the risks are relatively small. Get all the information you can before making a decision about it.

To get back into the sexual groove, take the time to become familiar with your body again. Start with a warm bath. Then, as you massage your skin with oil, pay close attention to those areas of your body that are most sensitive and provide you with pleasure. Buy a small phallic-shaped toy, and with plenty of water-based lubricant, use it to stimulate those hard-to-reach areas. Once you become comfortable and confident that you are still capable of achieving sensational sex, you are ready to share an intimate experience with a partner.

QUESTION: I used to enjoy sex, but after I started taking the pill I lost almost all interest in it. If I stop taking birth control pills, will my sex drive return? What else could be the cause?

ANSWER: Most women who begin the pill actually experience an increased sex drive, because, freed from the fear of unwanted pregnancy, they often feel more able to enjoy making love.

But some will see their libidos slow down. Decreased sexual desire and pleasure can be a side effect of many medications, including the pill. That's because the estrogen and progestin hormones in birth control pills may reduce the amount of testosterone -- the hormone responsible for sexual desire -- that's free and active in your system. Hormonal changes caused by the pill may also lead to vaginal dryness and painful sex. Water-based lubricants can provide needed moisture and make sex more enjoyable.

If your problems are caused solely by the pill, stopping it should put the spark back into your love life. Switching to one with lower estrogen or a different progestin component may also restore your libido. Every woman is different, so you may have to try multiple types of pills before you find one that works well with your body chemistry.

Many factors (stress, fatigue, depression) affect your sex drive. If you're feeling unappreciated by your partner, you may naturally lose the desire for sex. And if it has become boring, you may find it hard to get aroused. Discuss any concerns with your honey to get the juices flowing again.

Happy lovemaking!

Hilda Hutcherson, M.D., is the author of What Your Mother Never Told You About S-e-x (Perigee, 2003).

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