What implication does hysterectomy have on sex life? Without knowing the facts about hysterectomy it is difficult for women to make a decision.

 

Controversial opinions have always been expressed in regard to the effect of hysterectomy on women’s sex life. In the past hysterectomy has been accused of reducing libido, ruining orgasm and causing negative side effects such as dryness, lack of interest, fear of the act, and depression.

 

A political dimension was a feminist point of view, which also accused hysterectomy of being“ a patriarchal control of sexuality” by reducing the ability of orgasm with the removal of the uterus.

 

Negative points of view alone only serve to induce fear in women about hyster-ectomy and do not inform them. It is important that women who go in for the operation are armed with facts and feel secure about what they intend to achieve by having this procedure.

 

Those who choose surgery should have explored conservative management first. If women are in the position that conservative treatment has not worked as a long-term solution and symptoms re-occur or if conservative management is not an option for them it is then that the different surgical options should be compared.

 

 Each surgical option should be analysed weighing up the risks and benefits of these options and where possible the least invasive procedure should always be the first choice.

 

So what is the impact hysterectomy has on sex life

 

Scientific facts

1. Conventional hysterectomy leads to scarring and shortening of the vagina, which can affect the sexual experience for some women. If the cervix is maintained research shows that the outcome with regards to sexual experience is either better or the same as with conventional surgery. 

# LaSH as a more minimal management therefore is more physiological and carries less risk of effecting sex life in a negative way.

2. Removing the ovaries during a hysterectomy is associated with reduced sexual satisfaction.

# The removing of the ovaries is not part of a LaSH. However if an oophorectomy (the removal of the ovaries) is specifically indicated/requested this can be carried out with LaSH after detailed counselling.

3. After LaSH sexual intercourse can be resumed about 4 weeks earlier than after other forms of hysterectomy where the cervix is removed.

4.  “Among women with menorrhagia, hysterectomy improves sexual functioning, whereas the Mirena® Intrauterine system  (Mirena®) does not have such a positive effect.” Halmesmäki K 

5. “Women who have undergone abdominal hysterectomy are dissatisfied with their body image because of the abdominal scar, experienced more pain” Gütl P, Greimel ER, Roth R, Winter R.

 

6. “Hysterectomy appears to result in decreased pain with sexual relations.”Dragisic KG, Milad MP.

 

7.  The female orgasm comprises two elements.

Blood vessel engorgement during arousal phase and uterine, vaginal and perhaps clitoral contractions.  Some women perceive all of these while others perceive only some. After hysterectomy there are no more uterine contractions. It could be that women who are particularly sensitive to uterine contraction may perceive a lesser orgasm. However an all-too-local/genital approach deflects us from our under-standing of the orgasm, as the latter is a central experience in which extra-genital and, above all, psychological factors also play an important part.

 

 

SUMMARY

 

For most women there is no change in the way they feel. For some their sex life is enhanced because they do not have their original problem to contend with and they do not have to be concerned about unwanted pregnancy.

 

Psychological changes can affect the way a woman feels about herself which can impact sexual desire or sexual satisfaction. They may feel that their partners see them differently. A visit to a sex therapist or counsellor before or after hysterectomy may be advisable for those women who are concerned about problems with their sex life after hysterectomy.

 

If choosing a procedure the least invasive should be the procedure of choice.

 

Non-Invasive treatment first.

 

If hysterectomy is the procedure for you then LaSH is recommended as the least invasive form of surgical hysterectomy.