June 9, 2000 -- Although it has been suggested that having a hysterectomy decreases a woman's sexual desire and ability to achieve orgasm, Canadian researchers who reviewed the published studies say there is no convincing evidence that most women have any sexual problems after a hysterectomy. In fact, the best studies found that women who have the procedure report a better overall quality of life afterward.
"The few studies that have been done well have not shown any adverse effect on quality of life, including sexuality, so I was reassured by that, and women considering [total hysterectomy] should be reassured as well," Scott A. Farrell, MD, tells WebMD.
Most hysterectomies are performed on women for noncancerous conditions such as fibroids and uterine bleeding. Hysterectomy may be total or partial (sometimes referred to as a subtotal hysterectomy or supracervical). A total hysterectomy involves removing the uterus and the cervix. A subtotal hysterectomy involves removing the uterus but leaving the cervix. The uterus can be removed either through an incision in the abdomen or through the vagina. Ovaries may be removed or may remain, regardless of the type of hysterectomy.
The idea that sexual problems occur after hysterectomy originated in the 1960s when pioneering sex researchers Masters and Johnson suggested that in some women, the uterus is a key factor in orgasm. This led to speculation that orgasm and other aspects of sexuality are affected by removal of the uterus. A 1983 study seemed to confirm that theory, and it has been widely accepted by doctors for years.
In the June issue of Obstetrics and Gynecology, Farrell and Katharina Kieser, MD, both of Dalhousie University in Halifax, Nova Scotia, say doctors and patients have been misled.
They reviewed 18 studies and found that those supposedly showing a hysterectomy had a negative impact on sex life were poorly designed. Many did not take into account other factors that affect sexual functioning, such as relationship with a partner before and after surgery, economic status, and the importance of sex to the woman. Farrell and Kieser say some doctors have used these studies to persuade women who might benefit most from a total hysterectomy to instead have partial hysterectomies or other alternatives that may not be as effective in helping them avoid sexual problems.
An expert who spoke to WebMD about the issue says women's sexuality is too complex and varied to be able to accurately predict whether a woman will have sexual problems after hysterectomy. And, he says, he is not convinced that the published research accurately reflects all women's experience with hysterectomy.
"You can't give percentages to people," says Robert Resnik, MD, a professor of reproductive medicine at the School of Medicine of the University of California in San Diego. Resnik says it's important to understand that a variety of nonphysical factors -- including how your brain is wired and all of your past personal, social, and psychological experiences -- contribute to sexual identity.
"In some patients, the type of surgery that they undergo may have an effect positively or negatively on their sex life, depending on the reason for the surgery and its interrelation with all those other factors," Resnik says. His recommendation is that women talk about sex-related issues openly and honestly with their doctors, and discuss any fears of sexual dysfunction before having surgery.
For more information, read about a study that found women's sexual functioning actually improved after a hysterectomy.