Let’s Talk Intimacy: Sexual Pleasure After Hysterectomy

Let’s get right to the point... We’re talking about sexual pleasure after a hysterectomy. It's a subject that deserves more attention, understanding, and a sprinkle of optimism. 

Let's dive into the realities and the solutions!

Here are the common considerations after a hysterectomy:

A hysterectomy is a major surgery, and, like any major medical procedure, it can impact your body in various ways, including sexually.

Removing the cervix can decrease lubrication and, for some, change the sensation of orgasm. You still create lubrication without your cervix, but you may find that it’s a different texture. For many people, removing the cervix is still worth it.

Removing one or both ovaries can create hormonal changes that change mood, libido, and lubrication. Even when you keep the ovaries, they can go into a temporary period of "shock,” where hormone production is lower and you struggle for a while.

Some people don’t experience any of these issues - every surgery and recovery is different.

Here are some common sexual challenges many individuals face post-hysterectomy:

• Decreased Libido: Some people may experience a reduction in sexual desire, which can be due to hormonal changes, psychological factors, or physical discomfort.

• Vaginal Dryness: The drop in estrogen levels after a hysterectomy can lead to vaginal dryness, causing discomfort or pain during intercourse. This drop in estrogen always happens if you have your ovaries removed. It does notalways happen if you keep your ovaries, but it can happen. It can be temporary or permanent.

• Changes in Orgasm: Hysterectomy can alter the sensation of orgasms for some individuals. This change can vary from person to person. 

• Changes in Sensation: Hysterectomy can alter sensation in the vaginal area. Sometimes for the better, sometimes for the worse. Typically, outcomes are best if the hysterectomy relieves pain and has the expected outcomes.

• Pelvic Floor Changes: Surgery may affect the pelvic floor muscles, potentially impacting sensation and control during sexual activity.

• Emotional Impact: The emotional and psychological effects of a hysterectomy can influence intimacy, body image, and self-esteem, affecting one's ability to enjoy sexual experiences fully.

• Pain with Penetration: Pelvic floor tightness can cause deep pain with penetration. Pain closer to the vaginal opening is more likely to be related to a lack of lubrication or foreplay.

The good news is that, with time and effort, you can enhance sexual pleasure post-hysterectomy.

Here are some tips to help you on this journey:

• Get to Know Your Pelvic Floor: Your pelvic floor should be able to fully relax and fully contract. You should be able to feel the contractions around the vagina, rectum, + clitoris. It’s more than just stopping the stream of urine!

• Train The Surrounding Muscles: Incorporate movements that train your glutes, abdominals, and adductors. These muscles all have connections to the pelvic floor and contribute to enhanced sexual pleasure.

• Open Your Pelvis: Many people carry a lot of tension and stiffness in the pelvis and hips. Increasing mobility can increase comfort and sexual pleasure.

• Stay Consistent and Patient: Like any workout routine, consistency is key. Don't be disheartened if progress is gradual—your efforts will pay off over time. You just had MAJOR surgery.

• Start Slow: It’s normal to be nervous. Communicate with your partner and start slowly in the most comfortable positions for you. Use props and pillows as needed so your body can relax. A tool called the “OhNut” can help you ease into penetration.

• Pelvic Wands + Dilators: I prefer pelvic wands for most issues, but it truly depends. You’ll want to make sure your cuff is healed, but using a pelvic wand can help decrease pelvic floor muscle tension.

• Learn How to Relax: This isn’t something you just do. The ability to relax the body is an actual skill that takes practice, especially if you’ve been dealing with chronic pain and health issues prior to your surgery.

• Foreplay + Lubrication: Spend time getting to know your changed body. You may need more foreplay, a new lubricant, or more than you needed to use previously.

• Seek Professional Advice: A pelvic floor physical therapist can provide personalized exercises and guidance based on your unique circumstances. A physician can help with things like hormone replacement therapy and local estrogen cream if dryness is an issue.

Remember, every journey is different. Communication with your partner, patience, and self-love are your best companions on this path.