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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Hysterectomy: Everything You Should Know

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