By Dana B. Jacoby, MD, FACOG
Obstetrician and Gynecologist Tinton Falls, NJ
It depends on the type of hysterectomy you undergo. If the doctor removes your ovaries along with your uterus, which occurs in about half of all hysterectomies in this country, then yes, your sexual desire may change. That’s because both testosterone and estrogen, hormones that are important in sexual desire and intercourse, are produced in the ovaries. These glands produce about half of testosterone and nearly all of estrogen. While testosterone is thought to contribute mainly to desire, estrogen is important for healthy vaginal tissue, keeping it thick, moist and flexible. Without estrogen, vaginal tissue becomes drier and thinner, more likely to tear and lead to painful intercourse. While supplemental estrogen can prevent or minimize this, without it you may find the fear of pain prevents you from having sex.
Many studies, however, show an improvement in sexual function after a hysterectomy. This is likely because the surgery eliminates the pain, bleeding or other symptoms that may have caused problems with sex. Also, the surgery eliminates the possibility of pregnancy, thus making sex more gratifying for some women.
Ask your doctor if he or she plans to remove your cervix and the upper part of your vagina as part of the hysterectomy. Many do, although it’s usually not necessary (unless you are at risk for cervical cancer). Some doctors believe that their patients do better if the cervix remains and suggest that retaining the cervix enables the vagina to open up more fully for sexual intercourse, improving the depth of the vagina for intercourse. Although doctors may have concerns about removing the cervix, recent research has not supported those concerns.
One recent study shows similarly improved sexual functioning and quality of life after hysterectomy, regardless of whether the cervix was removed. Discuss your surgical options and your concerns about sexuality with your health care provider. And remember, you will still require a Pap test if your cervix is not removed to help avoid cervical cancer.