Elizabeth Rattray had been married only a few years when she learned that she needed a hysterectomy (surgery to remove the uterus) to relieve the intense pain from uterine fibroids. “I was really bummed because I kept thinking, ‘This is going to be a nightmare,’” says Rattray, a licensed Medicare insurance broker in Cleveland.
The fibroids had enlarged her uterus to “the size of 5 months of pregnancy,” Rattray recalls. She started to worry about the health consequences of losing her uterus, not being able to bear children, and how the surgery might affect sex with her new husband. The couple were just in their early 30s.
Rattray did her research and sought multiple medical opinions. She says one doctor suggested surgery to remove her ovaries, along with her uterus. Rattray recalls that there was nothing going on that required her ovaries to come out.
Rattray and her husband ultimately traveled from Cleveland to Atlanta for a laparoscopic hysterectomy, upon the referral of a trusted friend. The surgeon she chose agreed that she could keep her ovaries, so she did. The surgery and recovery went well. Rattray says her sex life was better than ever. “Everything works and everything's fine,” she says.
How Long to Wait
Sex after a hysterectomy is a major concern for many women considering this surgery, but it doesn’t have to be, says Maureen Whelihan, MD, an OB/GYN in Palm Beach County, FL.
“You can have sex – sexual stimulation, orgasm, manual stimulation – any time you want after hysterectomy,” Whelihan says. You’ll need to give it time before you have penetrative vaginal sex. “You may want to wait for about 4 weeks to allow healing of the top of the vagina,” Whelihan says. “If it's a really intricate surgery, maybe the doctor will ask you to wait 6 weeks.”
“Just as a reminder,” she adds, “there are many other ways for sexual fulfillment and release that don't require penetration.”
After the healing period, women shouldn’t feel any pain during sex after a hysterectomy, Whelihan says, unless it’s in the area that was operated on or possibly if it puts pressure near a surgical cut across the belly during a sexual position in which your partner is on top.
Get Your Questions Answered
Like everything else in your medical care, it’s best to know your options, the pros and cons, and your preferences.
Get second and third opinions when necessary, says Francesca M. Rogers, MD, an OB/GYN at Woman’s Care at the Pavilion in Burbank, CA.
That means asking key questions, such as whether your ovaries really need to be removed. That was a common practice in the past, Whelihan notes. But it isn’t always needed. So if it’s recommended, make sure you know why.
Removing your uterus won’t affect your desire. But that could happen if you get your ovaries removed as well as your uterus.
“Sexual dysfunction is caused by the loss of the ovaries,” Whelihan says. The issue is really the loss of the hormones that the ovaries make. “It isn't the hysterectomy that was the problem,” Whelihan says.
If you do need to have your ovaries removed along with your uterus, hormone replacement therapy safely replaces a portion of the lost hormones, Whelihan says, and can also help lower the risk of cardiovascular problems related to the loss of estrogen. Most premenopausal women have no change in libido if they start on HRT at the time of surgery.
Many things affect a woman’s sex drive, including stress, relationship issues, and other health conditions.
Keep in mind that it might not be a physical issue, if sex still isn’t meeting your expectations. Whelihan screens her patients to check their mood. She estimates that about a third of her patients who have low libido have “underlying anxiety or depression that's not properly managed.” Addressing those other conditions may help with your libido.