Hysterectomy, Oophorectomy, and Sexuality

By OBOS Common Medical Conditions Contributors | October 15, 2011

Many women are concerned about the effect that hysterectomy, with or without oophorectomy, will have on sexual response. Some physicians and popular literature suggest that any sexual difficulties we may experience are “all in our head.” In fact, there is some physiological basis for these problems.

For women who experience orgasm primarily when a partner’s penis or fingers push against the cervix and uterus (causing uterine contractions and increased stimulation of the abdominal lining), that kind of sensation may be lost if the uterus and cervix are removed. This is probably an individual response and has not been proved in studies. In addition, if the ovaries are removed, hormone levels drop sharply, and that can affect sexual feelings:

I had a hysterectomy two years ago at the age of 45. I went from being fully aroused and fully orgasmic to having a complete loss of libido, sexual enjoyment, and orgasms immediately after the surgery. I went to doctors, all of whom denied ever having seen a woman with this problem before and told me it was psychological.

Before surgery, my husband and I were having intercourse approximately three to five times a week, simply because we have an open and loving relationship. Now I find that I have to work at becoming at all interested in intercourse. And I no longer have the orgasm that comes from pressure on the cervix, although I still have a feeble orgasm from clitoral stimulation.

Testosterone, a hormone that contributes to muscle strength, appetite, and sex drive, can increase sexual desire in women whose ovaries have been removed, but it may have masculinizing side effects, such as a lowered voice, acne, and facial hair. Side effects can be limited by using low-dose testosterone cream or gel. However, even in low doses, these products have not been adequately tested for long-term safety.

Local effects of surgery may occasionally cause problems. Vaginal lubrication tends to lessen after hysterectomy and oophorectomy, and intercourse may be uncomfortable if your vagina has been shortened by the operation, or if there is scar tissue in the pelvis or at the top of the vagina. In order to minimize scarring, preserve nerve function and ligament support, and avoid shortening the vagina, some physicians recommend leaving the cervix in if no cancer was involved.

However, for many women, sex is unchanged or even more enjoyable after hysterectomy, since painful symptoms are gone. In the words of a woman who had a hysterectomy because of huge fibroids:

I had terrible cramps all my life and genuine feelings of utter depression during my periods. My ovaries were not removed, and my libido was not affected. My sexual response, if anything, improved. I also had for the first time no fear of unwanted pregnancy and more general good health.

Consider the benefits of surgery against the possibility of changes in sexual desire or response that can’t be predicted in advance. Treatments less drastic than a hysterectomy can usually reduce pain and bleeding from benign uterine conditions and improve overall well-being.