Sex After Hysterectomy or Vaginismus

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Sex after Hysterectomy. Jetta Productions / Getty Images

Q. Can women ever expect sex to be the same again after a hysterectomy?

A.Absolutely. A recent, large study found that hysterectomy (removal of the uterus) did not interfere with sexual function.

However, removal of the uterus and ovaries (hysterectomy plus oophorectomy, sometimes referred to as total hysterectomy) causes large declines in sex hormones. Hormone replacement therapy--with or without testosterone replacement--may help to restore sexual function in women experiencing sexual difficulty after this surgery.

As with any major change in physical functioning, some women do find their sexual functioning negatively impacted. Some women miss the contractions of the uterus they have associated with orgasm. Removal of the cervix may result in a change in the physical sensation experienced during deep penetration during intercourse. In our clinical experience with women, there is wide variation in sexual functioning post-hysterectomy.

Q. What is vaginismus? Is there any hope for women with vaginismus ever having a healthy sexual relationship?

A.Vaginismus is persistent or recurrent spasm of the outer third of the vagina that interferes with intercourse. It can usually be treated by the use of vaginal dilators of increasing diameter plus relaxation training. The success rate increases in couples where the partner is involved in the therapy process. While treatment can help, it is important to note that some women have very intimate, loving relationships without intercourse.

Q. Will hormones help women with decreased sexual desire? Which hormones? Testosterone? Estrogen? Progesterone? What about DHEA?

A.In postmenopausal or perimenopausal women, estrogen replacement can decrease pain during intercourse and facilitate vaginal lubrication.

Studies have also shown that testosterone increases libido in women, so if someone's decreased desire is due to a drop in hormones, it can very likely be resolved with testosterone.

However, to date, these studies have used high doses of testosterone, which might lead to masculinization if taken for long periods of time.

Although DHEA is also a male hormone, there have been very few studies of its effect on women and none have shown that it improves a woman's libido.

Q. Is there anything else that's important for women to understand about female sexual dysfunction?

A.Sexual response varies between women and within each individual. Sexual concerns are very common. Some sexual problems, while distressing, may reflect normal variations in a woman's life. Shifting one's focus to enhancing intimacy rather than having all interactions result in intercourse may help. Not all sexual concerns or problems are "dysfunctions."

Women need to pay attention to changes in their daily lives that may cause sexual dysfunction. In cases where medications cause sexual problems, the solution may be as simple as changing the medication or adjusting the dosage.

Don't be afraid to talk to your doctor and your partner. It can be difficult and uncomfortable to initiate a conversation with a doctor about sex, but the majority of women can be helped if they are willing to talk openly to their healthcare provider to determine the best treatment for their specific problem.

I would like to thank Dr. Robert Taylor Segraves, and Dr. Kathleen Blindt Segraves for taking time out of their busy schedules to answer my questions about female sexual dysfunction.

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