Can Sex Really Be Better After Hysterectomy?

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Can Sex Really Be Better After Hysterectomy?

Can Sex Really Be Better After Hysterectomy?

Date : 04-12-2003 - 03:03 PM - Readers : 17474

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Can Sex Really Be Better after a Hysterectomy?

Patricia L. Morse

In November 1999, headlines leapt onto television and newspapers-hysterectomy improves sex! This, of course, brought hope to a lot of sisters heading for hysterectomies because earlier gloomier studies had said just the opposite. Most of the gloomier earlier studies had used interviews with a very few women years after their surgeries, asking them to remember how things used to be. Memory though is a hard thing; it often uses rose-colored glasses. So, this JAMA study tried a different approach.

The doctors interviewed 1,101 women and asked the same women the same questions before their hysterectomies and afterward at six-month intervals for two years.

So, the question is, Were the headlines right? Well, sort of.

Who were these sexually fulfilled women? They were mostly between 35 and 49 and had surgery in Maryland for a benign problem (not cancer). Most (65%) had abdominal surgery, and 44% had a BSO (both ovaries removed). Almost all of the women who had a BSO (88%) were on HRT. So it might help to be that age, have a benign problem, and be on HRT.

Painful sex

Before surgery, 41% of women had pain during sex (dyspareunia). At two years after surgery, 15% still had pain during sex. Most of the women who reported pain had had pain before the surgery, but some were new women who had felt no pain before. The doctors doing the study guessed that scar tissue forming in the vaginal cuff might be the cause of the new pain, though they thought that the shortening (because removal of the cervix shortens the vagina) and dryness of the vagina were problems too. Depression and pain went together, though it's not clear which was cause and which was effect.

Orgasm

Before hysterectomy, 63% said that they had had an orgasm in the month before the hysterectomy. A year or more after hysterectomy, about 72% said they were having orgasms. And, for quite a few, their orgasms got better. Before surgery, 45% said they had strong orgasms; afterward, about 58% were saying that. Lots of women improved, but for some, the situation got worse.

The older they were, the more likely they were to not have orgasm after surgery. Having a BSO and having presurgery depression were also problems. Only 15 women in the study kept their cervixes, which was too few to compare, so the doctors had no conclusion about the effect of the cervix on orgasm.

Vaginal dryness

For some, vaginal dryness actually improved after hysterectomy, but.a third of the women said it was the same and 10% said it was worse. Age and depression seemed to have a connection to being dry. The doctors guessed that the women who got worse were the ones who kept their ovaries and that their ovaries had never gotten over the shock. They guessed that the ones who were the same or got better were on HRT.

Desire

Most of the women who said they rarely thought about sex in the month before surgery said they had an increase in desire afterward. Once again, if you were depressed before surgery, you were still likely to have low desire after surgery.

The jungly part

Depression that lasts after surgery seems to be the biggest problem in having a good sex life, at least for these women. Of course, depression is terribly tangled up with hormone issues (and pain), so I think it's noticeable that a lot of these satisfied women in this JAMA study were on HRT. There are signs in this and other studies that women who aren't hormonally balanced are having less sexual satisfaction. In some of the earlier gloomier studies, a lot of women reported an increase in a sense of well-being soon after surgery, but that, with time, that sense of well-being wore off. I suspect that's the hormone jungle taking over. I think it's important that so many of these women in the JAMA study were on HRT.

It's too bad that the JAMA study had no way to study what sex had been like long before the health problems had started. That might have produced a different picture, and it might explain why the earlier studies had been gloomier. The women weren't remembering what things had been like just before surgery but how things were before they had health problems. So, the hysterectomy is better than conservative treatments and living with the pain and bleeding, but it's not an aphrodisiac.

Still, it's very encouraging to find out that, for most of us, there's a lot of sexual satisfaction possible in the land of hyster.

Sources: Journal of the American Medical Association, Continuing Medical Education Reviews, American Journal of Obstetrics and Gynecology, Medline Abstracts.

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