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Sex After a Hysterectomy
What is a hysterectomy?
Hysterectomies can involve either the removal of just the uterus, or
the removal of the uterus and the ovaries. Although the ovaries are
the main producers of hormones such as estrogen, progesterone,
and androgens, it has been shown that hysterectomies, even if
they do not involve the ovaries, still effect levels of these hormones.
Apparently, the uterus somehow helps to mediate body hormonal
levels. What does this mean for a woman who has had her uterus
removed?
What happens after a hysterectomy?
Hysterectomies have been shown to have side effects such as
sexual deficits (including a decrease in libido and sexual
pleasure), acceleration of cardiovascular and bone disease, and
more rapid aging. To alleviate some of these side effects, doctors
will at times prescribe hormone replacement therapy. Women who
have undergone a simple hysterectomy (leaving the ovaries intact)
are found to have a three times higher risk of developing
cardiovascular disease than women who had not undergone a
hysterectomy. A recent study suggests that this may be due to a
testosterone deficiency. Testosterone replacement therapy may
improve symptoms of decrease in sexual libido, sexual pleasure,
and sense of wellbeing. It may also serve to build stronger bones
and may protect cardiovascular health. However, testosterone
therapy is controversial and has not been shown conclusively to
have an effect in alleviating these side effects.
The Bottom Line
Women who have had a hysterectomy may experience a decline in
libido and sexual pleasure, usually as a result of vaginal dryness,
which can in turn cause pain and even bleeding during sex. Talk to
your doctor about the possibility of testosterone therapy. Keep in
mind that it may not be an appropriate treatment for you, and it
also may not work. Many women are advised not to undergo
hormone replacement therapy (HRT) for a variety of reasons.
Women who cannot undergo HRT have more limited options
because HRT tends to alleviate symptoms of vaginal dryness.
Women who are unable to undergo full hormone replacement
therapy should discuss with their doctor the possibility of using
some specific estrogen products. Some estrogen products, rather
than having an effect throughout the body, can be applied directly
to the vulva and inserted into the vagina to produce local changes
that will not effect the rest of the body. Promestriene is an example
of this, as it counteracts the loss of hormones to the vagina but not
to other parts of the body. However, there is a small amount of
adsorption into the blood stream, so not all women will be able to
use these.
A simpler way of dealing with decreased lubrication is an
over-the-counter lubricant. A variety of brands are currently on the
market, including Replens, Aqualube, Astroglide, or K-Y Jelly. One
study of Replens found it to be nearly as effective in combating
vulvar and vaginal dryness as a lubricant containing estrogen.
Although some form of lubricant may help your sex life, you can
also use this opportunity to explore other sexual options. After all,
there's more to sexuality than intercourse. Why not try outercourse?
Oral sex is a great stand-by when discomfort is an issue and saliva
makes a wonderful lubricant as well.
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