What are the main sexual issues that affect people after gynecological surgery?

Yvonne O’ Meara - Psychosocial Oncologist & Systemic Psychotherapist:

“There are 5 gynecological cancers (Vulva, Vaginal, Cervical, Uterine and Ovarian cancer). 90% of women in the first year of a gynecological diagnosis experience a sexual dysfunction, the most common one being vaginal dryness. Over 50% go onto develop a chronic sexual dysfunction. The most common are vaginal dryness,  lack of desire, painful sex, inability to orgasim and loss of ability to have penetrative sex. It is important to consult your treating teams about this issue as there are ways of lessening the impact of this when addressed early. Referrals to a pelvic floor specialist, receiving vaginal botox, attending an appropriate therapist, referral to an occupational therapist with a special interest in pelvic floor dysfunction. There is a wealth of information on the thisisGO.ie website. For the management of vulvavaginal wellness, specifically what moisturizes and lubricants to use and  please see the below booklet. . https://thisisgo.ie/flipbook/vulvovaginal-health-guide/”

Some  women diagnosed with a gynecological cancer will undergo a hysterectomy as part of their treatment pathway.  Reengaging in sexual intimacy post  hysterectomy can be a daunting thought for some. This article will look at how you can re engage in sexual intimacy and have a positive experience.

Hysterectomy explained

While a hysterectomy is a very common surgical procedure, not all hysterectomies are the same. A hysterectomy is the surgical removal of the uterus, it may also include removal of the cervix, ovaries. A salpingectomy is the removal of the fallopian tubes and other surrounding structures. A hysterectomy may be total, radical or partial.

• Total hysterectomy: Total hysterectomy is the most common surgical procedure in gynaecological cancer. The entire uterus and the cervix is removed. It can include the removal of the ovaries which can be called a oophorectomy and fallopian tubes (a salpingectomy)  

• Radical hysterectomy: A radical hysterectomy involves removal of the uterus, the top part of the vagina, the cervix and surrounding tissue. It may involve removal of the ovaries and fallopian tube. When both ovaries are removed before natural menopause, this is likely to cause menopausal symptoms such as hot flushes and night sweats. . Please see section under menopause for further information.  

• Partial hysterectomy: A partial, which can be referred to as a subtotal hysterectomy, involves the removal of the top part of the uterus. The cervix remains intact. This surgery is the least likely to have an adverse effect on a women’s sex life. The cervix is often associated with sexual pleasure during penetration. 

How soon after a hysterectomy can I start having sex?

Irrespective of the type of hysterectomy that you may have had, the general recommendations are that you are not to insert anything into the vagina for 6 weeks or to partake in penetrative sex for 6 weeks after your surgery.  After 6 weeks what happens next is very individualized, and it is important to go at your own pace when recovering from surgery. There should be no pressure placed upon you to re engage in sexual activity if you do not feel ready after 6 weeks. This should be done in consultation with your doctor as well as your partner.

What to expect in post hysterectomy sex?

There are many studies out there that state most women experience little to no change or improved sex after hysterectomy. This can be as a result of reduction of pain and discomfort for gynecological conditions post hysterectomy.  If you had painful sex or bleeding these can improve after hysterectomy . For some women the psychological impact of having a hysterectomy can leave its mark and may influence how you feel about sex and your physical experience of it.

Orgasm post hysterectomy

Removal of both ovaries prior to menopause can affect sex drive (libido).  As mentioned many women experience a psychological toll on their sexual identity post a hysterectomy. Some women feel less feminine, dislike their body post-surgery or have a decreased sex drive due to the state of their mental health. For some they can feel overall less desirable. . Accessing help within an Irish hospital setting for psychosexual related issues may be difficult. In the service directory of thisisGO.ie there is information on accessing therapists (psychotherapists, sex therapists) within your area but you will most likely have to pay. This service may be offered in your local cancer center for free or for a small contribution. So don’t be shy, if you are in need of help, talking about it is a great start! Please see articles on Body image, Desire and interventions for lack of desire on the thisisGO.ie platform.

Making sex more pleasurable post hysterectomy

It is natural to be apprehensive about re engaging in sexual activity post hysterectomy irrespective of your relationship status prior to the surgery. Here are a few tips that can guide you through it and ease your apprehension.

 Lube is your friend. Particularly if you have had your ovaries removed before natural menopause. Being nervous can lead to not feeling aroused which can also have the vagina in a non lubricant state. There are not downsides to extra lubricant. See our vulvovaginal health section on the platform for all the information you need in this area.

 Take it slow. Hysterectomy is major surgery so it is important to take it easy and see how you feel. Navigating this space is personal. Listen to your body, if it is telling you, you are not ready, don't ignore it.

 Talk to you partner. Most partners will be apprehensive with the thoughts of hurting you through penetration or fingering. Communication is key. Being able to explore this with someone who cares for you can lead to closer intimacy when the timing is right for you both. If you are single, it is important to share with a new partner what you are comfortable with. There is no one size that fits all.

 Try new positions. Explore what works for you now and talk your partner through it. It may be a case that you need to try some different positions.

Look at this website to get inspired: womenshealthmag.com/sex-and-love/a19943165/sex-positions-guide.”

Further resources are available at:

• uhn.ca

• talkpeach.org

• healthline.com

• macmillan.org.uk