Related Media: Hysterectomy

Despite the fact that many American women have their uteruses surgically removed each year, most women do not sign up for the procedure unless there is a good reason. In addition to the usual worries about major abdominal surgery, they are concerned about how a hysterectomy will affect their health and lives, especially their sex lives. Sexual functioning actually may be foremost in women's minds before surgery.

But there's good news about sex after hysterectomy. A 1999 study revealed that hysterectomy can have very positive effects on a woman's sex life, especially if she was experiencing significant medically related sexual problems before surgery.

The Good News

Published in November 1999 in the Journal of the American Medical Association , the Maryland Women's Health Study followed the experiences of 1,101 women during the first two years after a hysterectomy. The results were surprisingly positive. Overall, the study group's frequency of sexual relations increased after surgery, and the number of women experiencing pain during sex dropped from 41% to 15%. Although improvements in vaginal dryness were not as marked, women in the study group did report strong orgasms almost 15% more frequently one year after surgery. Even more impressively, almost three-quarters of the women initially experiencing low libido reported an improvement after surgery, and two-thirds of the women who reported not having orgasms before hysterectomy were having them a year later.

"Even after a major pelvic surgery, women can actually improve on their past in many cases," says Jillian Romm, RN, LICSW, a medical social worker who specializes in counseling women on reproductive issues.

A Change In Thinking?

Although hysterectomies are very common among major surgeries performed in the United States, the procedure hasn't had the best reputation among the general public. Common knowledge held that removal of the uterus was the cause of many problems, including increased vaginal dryness, painful intercourse, lack of interest in sex, and lower number and quality of orgasms.

However, according to Leon Speroff, MD, professor of obstetrics and gynecology at Oregon Health Sciences University in Portland, Oregon, the results of the Maryland study didn't surprise experts. "Because women usually undergo hysterectomy as a result of major medical problems, it's not surprising that quality of life generally improves after surgery."

All Hysterectomies Are Not the Same

One cause of the confusion about hysterectomy's affect upon sexual functioning may have been the public's assumption that all hysterectomies are the same. They're not. Sometimes the ovaries are removed along with the uterus, and in other cases they're left intact. Although the uterus is thought to play a role in women's hormonal functioning, the ovaries are the master producers of estrogen and the regulators of the menstrual cycle.

" Oophorectomy [surgical removal of the ovaries] often has a far more devastating impact than removal of the uterus, particularly among premenopausal women," says Amanda Clark, MD, a gynecological surgeon at the Oregon Health Sciences University Center for Women's Health. "When a woman hasn't reached menopause and her ovaries are surgically removed, we get a situation of 'instant menopause' that can cause just the sort of sexual problems that people commonly blame on hysterectomy," she says.

Too Many Hysterectomies?

Another possible cause for hysterectomy's bad reputation may be arguments that the procedure is performed too frequently. Although opposing views may confuse the issue, the continuing controversy over hysterectomy does remind women to keep themselves well-educated and informed.

An Informed Recovery

Romm believes that one of the best ways to increase the chances of having a positive sexual recovery after hysterectomy is to contemplate the decision to undergo the surgery as thoroughly as possible ahead of time.

Not only should women explore all available medical options, but they may also benefit from delving into related psychological issues, she says.

"I help each patient explore the nature of her attachment to her uterus. If having a womb is a big part of what makes a woman feel feminine, then having a hysterectomy will be a much bigger deal for her than, say, having her appendix out."

According to Romm, each woman's process of pre-surgery decision making, as well as her subsequent experiences during recovery, are entirely individual and must be treated as such.

"What makes our sexual self really alive is extremely individual. I urge women to talk about their feelings with loved ones, and think through every possible outcome. This takes a lot of the fear and unpredictability out of the process of adjusting."

Preparation: Key to a Positive Outcome

Along with the practical and emotional preparation, it's important for women and their partners to have realistic expectations about recovery.

Knowing what to expect, she says, makes changes easier to accept in a positive light. Because hysterectomy also releases many women from previous medical problems and fear of pregnancy, the odds seem to be stacking up in favor of great sex after hysterectomy.