Sexuality 3: Hysterectomy

Hysterectomy

What is hysterectomy?

Hysterectomy is the removal of the uterus. Removal of the ovaries (oophorectomy) is often performed at the time of uterine removal. Hysterectomy may include removal of the cervix (subtotal, supracervical, or partial hysterectomy); removal of the uterus, cervix, one ovary, and one fallopian tube (total or complete hyterectomy with unilateral salpingo-oophorectomy); or removal of the uterus, cervix, both ovaries, both fallopian tubes, and the regional lymph nodes in the pelvis. The majority of hysterectomies are done through abdominal incisions. They can also be done vaginally, with or without the use of a specialized instrument called a laparoscope, which gives the surgeon the ability to look into the abdomen.

When is hysterectomy performed?

Hysterectomy is indicated for a variety of conditions, including cancers of the uterus and benign uterine growths (called fibroids).

Physical changes:

With the removal of the uterus, menstrual periods and the ability to have children end. When the ovaries are removed, women may experience diminishment or loss of the sex drive, vaginal dryness, pain or discomfort with deep penetration during sexual intercourse, and “hot flashes.”

Emotional changes:

Hysterectomy results in the end of fertility, and this may be a problem with women for whom fertility is an important part of their identity. Some women feel that they may have lost their femininity with the loss of their uterus and ovaries. Others are relieved by the resolution of pain and heavy bleeding associated with removal of the uterus.

Effect on sexuality:

Sexual functioning can improve after hysterectomy, particularly when the symptoms of the problems (e.g., prolonged or heavy bleeding or pelvic pain) are resolved following surgery. Symptoms of hormonal loss when the ovaries are removed, which can negatively affect sex drive, can be relieved with the use of hormone replacement therapy. Some women find that sexual desire and orgasm improve after hysterectomy, while others experience their orgasms as “different.”

Adapted from: “Hysterectomy,” The Johns Hopkins Health Insider, InteliHealth; “Sexual Activity after Hysterectomy,” Coombe Women’s Hospital, http://www.coombe.ie/patient/sex.html; and Rhodes, J. C., et al., “1999, Hysterectomy and Sexual Functioning,” JAMA 282:1934–1941.