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EFFECT OF HYSTERECTOMY ON SEXUALITY AND SEXUAL FUNCTION (PART 1)

For most women, hysterectomy does not adversely affect sexuality. In studies of the effects of the operation on sexual interest and response, a minority of women — between 7 and 20% depending on the study — report some decrease in sexual function after hysterectomy. About the same proportion report an improvement, and more than half report no change. When partners of women who have had the operation are asked about its impact on sexuality, many have no comment, over a third say they are happy their partners had the operation for reasons such as removal of the fear of an unwanted pregnancy. A small minority express dissatisfaction saying things like the vagina is ‘too tight’ or ‘too dry’.

Although the overwhelming consensus from recent studies that have followed women through the experience of hysterectomy is of a clear reduction in the disabling symptoms that lead to surgery, many women continue to have concerns about the effects of hysterectomy on sexuality and sexual function. The picture is complex because at around the age when most women have a hysterectomy they may also be starting or passing through menopause. The changes associated with this transition may themselves have an impact on sexuality and sexual function and these may be incorrectly blamed on the hysterectomy.

Doctors have been aware of sexual difficulties in a minority of women who have had a hysterectomy and have sometimes attributed it to post-surgical depression or concerns about self-image. These conclusions have been questioned in recent years, with an increasing number of medical practitioners and sex therapists suggesting that the procedure itself contributes to post-surgical difficulties in some women. Our ignorance of the role of the uterus and cervix in sexual response may be partly responsible for the occurrence of these difficulties.

A generation ago, it was believed that a woman’s major sexual response was centred in her clitoris and vagina. Recent research suggests, however, that for some women there are sexual sensations associated with the uterus itself. In the process of performing a hysterectomy, major arteries, veins and nerves that flow to and from the uterus are inevitably cut. It is possible that this interference may play a role in the sexual dysfunction reported by some women after hysterectomy. For some men, too, sexual satisfaction and response may be influenced by the presence of the cervix, against which the penis taps during intercourse.

There are several main ways in which hysterectomy can change sexual response. These changes may be either positive or negative.

• Removal of the fear of pregnancy may allow women and their partners to engage in sex with fewer inhibitions.

• Reduction or elimination of heavy and prolonged menstrual bleeding may enhance the experience of orgasm and intercourse.

• This same positive outcome may occur as a result of removing adhesions, fibroids and other causes of chronic pelvic pain when the uterus is taken.

• Alteration of the size and shape of the vagina during the surgery may make the sensations associated with sex more or less pleasurable for one or both partners.

• Removal of the main part of the uterus may eliminate pleasurable sensations associated with its contraction and movement. These sensations may occur during sexual foreplay, for example when the clitoris, breasts, vulva and vagina are touched, as well as during intercourse.

• Removal of the cervix may reduce sexual satisfaction. This is because of the pleasure that a woman and her partner may derive from the tapping of the penis on the cervix during intercourse.

• Creation of new scar tissue in the pelvis or vagina as a result of a hysterectomy may cause intercourse to become more painful.

• Changes in hormone production, particularly marked if the ovaries are removed at the time of the hysterectomy, may lead to intercourse becoming less pleasurable. These hormone changes — which tend to be more acute than when menopause occurs without surgical intervention — may result in several ill-effects. Decreased oestrogen levels may be associated with a general drying and thinning of the vagina. This may in turn result in painful intercourse, and severe night sweats and insomnia leading to feelings of fatigue. A decreased output of androgen hormones, including testosterone, by the ovaries may also reduce sexual interest (libido) in women. ‘Psychological effects on either partner, related to feelings of loss of the uterus, may lead to decreased pleasure in intercourse. This is more likely to occur if intercourse has been valued mainly for the children that may result from it.

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This entry was posted on Friday, May 8th, 2009 at 10:04 am and is filed under Women's Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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