Oct. 2, 2003 -- Sex after a hysterectomy is better, one group of researchers reports. It's been a worrisome subject for women.
And while the findings are likely true, women should still "carefully weigh the risks and the benefits of hysterectomy," says noted expert Jennifer Berman, MD, co-director of the Female Sexual Medicine Center at UCLA School of Medicine, Los Angeles. While not involved in the study, she offered her viewpoint.
For some women, sex after hysterectomy -- removal of the uterus -- can create loss of sensation -- loss of intense female orgasms, Berman explains.
"If women don't have severe pelvic pain or bleeding, or cancer, they should look at other options to hysterectomy," says Berman.
Inside the Female Orgasm
It's long been thought that, during a hysterectomy, damage to vaginal nerves and support structures may affect women's sexual well-being, writes researcher Jan-Paul W. R. Roovers, MD, an obstetrics-gynecology professor at the University Medical Center in Utrecht, the Netherlands.
"Gynecologists generally select vaginal hysterectomy because of reduced length of hospital stay, fewer complications, and reduced costs," writes Roovers, whose study appears in this month's British Medical Journal.
However, surgeons have not known whether one technique leaves better sex after hysterectomy and better female orgasms, than the other. Does an abdominal hysterectomy leave more nerves and blood vessels undamaged? Or does a vaginal hysterectomy offer more protection to those nerves and blood vessels?
In this study, Roovers and his colleagues -- in 13 teaching hospitals throughout the Netherlands -- compared effects of vaginal hysterectomy, abdominal hysterectomy, and abdominal hysterectomy with cervix intact in 352 women.
Before hysterectomy and six months after surgery, each woman completed a questionnaire asking about their sexuality: how they perceived their sexuality, frequency of sexual activity, problems with lubrication, orgasm, pain, or sensation in the genitals, and arousal.
Drum Roll, Please ...
Sex after hysterectomy was better, regardless of the surgical procedure they had, he reports. Most of the women -- 310 in all -- were sexually active both before and after hysterectomy. But of the 32 women who were not sexually active before hysterectomy, 53% became sexually active afterwards.
However, for some women, problems persisted. Some who had abdominal hysterectomy continued to have lubrication, arousal, and sensation difficulties. Ten women who had been sexually active before hysterectomy were no longer sexually active afterwards.
In fact, there was a trend in new sexual problems in some women but no obvious increase was detected. Roovers notes that more research is needed in this area to further clarify the effect that hysterectomy can have on sex.
For some women with severe problems, hysterectomy is indeed the best option, Berman tells WebMD.
"But women who aren't suffering daily with pain -- who have a satisfactory sexual life despite whatever is going on in the uterus -- those are the women we worry about, the women who should consider other options. " Berman says.
Female orgasms involving deep pelvic contractions -- "vaginal orgasms" -- may be affected by loss of sensation after hysterectomy, she tells WebMD. "Those women will still have clitoral orgasms, albeit less intense and less satisfying, they won't lose that ability altogether."
The options to hysterectomy: "If the problem is fibroids, endometriosis, or dysfunctional uterine bleeding, there is endometrial ablation -- a minimally invasive heat balloon -- which has minimal risk," Berman explains.
"For uterine fibroids, a procedure called uterine artery embolization shrinks blood flow to the uterus, which shrinks fibroids," she says. "This procedure has been perfected so that it spares the uterine and vaginal arteries and nerves from damage."
Laser procedures are also being developed for fibroids, she explains. And for endometriosis, the new Seasonale pill can help. Seasonale is a birth control pill that delivers a continuous dose of hormones for three months, followed by one week off -- giving the woman a period every three months.
"We're getting closer and closer to organ-preserving medicine in women," she tells WebMD. "We're trying to offer women the same sorts of options we give men."
This study is the first to focus on sex after hysterectomy and female sexual well-being, notes Roovers. Trends in persistent problems warrant further study, he says.