Feb. 21, 2000 (San Francisco) -- Janet Harris knew she should have a hysterectomy. Her doctors told her. Her mother told her. Her friends told her. But she just couldn't do it.
''I heard the stories about how your sex life is ruined and you go right into menopause," says Harris, 39, of Baltimore. She put off the surgery for years until the symptoms from her uterine fibroids got so bad -- aching legs, constant cramps, menstrual periods lasting 15 or 20 days a month -- that she had the operation.
The big surprise? Her sex life hasn't been this good in years.
New Study Refutes Older Studies
The reluctance of women to undergo hysterectomy because of worries about a decrease in their sexual satisfaction isn't unfounded. Studies published in the British Medical Journal and Obstetrics and Gynecology have reported that between 13 and 37% of women report deterioration of their sex lives after hysterectomy.
However a recent study has found that sexual functioning improved overall after hysterectomy. For two years, researchers from the University of Maryland tracked sexual function in women at regular intervals after hysterectomy. "We saw a dramatic reduction in pain during sex," says Julia Rhodes, M.S., co-author of the study, which was published in the Journal of the American Medical Association (JAMA) on November 24, 1999.
Two years after the surgery, 76.7% of women were having sexual relations, compared to 70.5% of women before surgery. The number who reported pain during sex plunged from 18.6 to 3.6%. Inability to attain orgasm fell from 7.6 to 4.9%. And low libido dropped from 10.4 to 6.2%. In all, 1,101 women between the ages of 35 to 49 completed the study; 90% had not yet entered menopause.
According to the latest hysterectomy data from the federal Centers for Disease Control and Prevention (CDC), covering the years 1980 to 1993, women most likely to have a hysterectomy are between the ages 40 and 44, while 36% are between the ages of 25 and 39.
A hysterectomy may be done vaginally or abdominally and may include removal not only of the uterus but also of the cervix and one or both ovaries. Ovary removal is performed in 51% of hysterectomies and is more likely to be done in older women and in those whose diagnosis is cancer, according to the CDC. In the JAMA study, the women had undergone a variety of approaches. Only 15 of the 1,299 women who entered the study had their cervix after the operation, although the trend now, says Rhodes, is to try to retain the cervix.
It's not known for sure, she says, whether losing the cervix affects sensation during sex. In their study, the researchers say that external orgasms, caused by clitoral stimulation, ''are not likely to be affected by hysterectomy,'' but point to a study published in the Journal of Reproductive Medicine in 1993, in which the author speculated that removal of the cervix may hamper internal (vaginal) orgasms.
Hysterectomy as Sex Therapy?
All this is not to suggest that women should embrace major surgery as a means to improve their sex lives, the Maryland researchers say. Typically, improvements in a woman's sex life occur only if they have had sexual problems before the surgery.
But not all of the 600,000 American women who have hysterectomies each year are experiencing pain, says Michael Broder, M.D., Assistant Professor of Obstetrics and Gynecology at UCLA Medical School. And in his most recent study, published February 2000 in Obstetrics and Gynecology, he suggests that many women should first try other, less invasive treatments. ''I'd say that 10 to 15% of hysterectomies shouldn't be done,'' he says. Sometimes, the most common problems that lead to a hysterectomy (uterine fibroids, endometriosis, and abnormal bleeding) can be treated with hormone therapy or laparoscopic surgery that saves the uterus.
But for some, a hysterectomy can mean a return to a more satisfying sex life. "Now I can have sex whenever I want without discomfort," Harris says.