Our Sexuality! Magazine Spring 2017 - Page 32

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enough to bring it up themselves. Sex is a vital part of life and the loss of sexual function can be devastating. I would not be completely honest if I said that sex life is not affected by having a hysterectomy.

Many women report a decline in arousal, vaginal lubrication and/or lack of intensity of orgasm. During a hysterectomy, some of the nerves, blood vessels, and ligaments are severed to remove the uterus. The uterus and its ligaments are rich sources of blood supply. As a result, sensation to the vagina, clitoris, and/or labia can be diminished. This loss of sensation can interfere with sexual functioning. Additionally because the uterus contracts during an orgasm, some women may notice the lack of sensation if they have previously experienced contractions. If a woman has never experienced uterine contractions, then she will not notice the difference.

Desire and arousal may also be difficult for some women given the emotional connection some women experience as a result of hysterectomy. The psychological and physiological response to intercourse may be challenging for some women. The desire to have sex is based on a psychological response. Whenever there is a block/concern, it makes it difficult for a woman to become aroused. For example, as a result of having a hysterectomy a woman may anticipate pain during intercourse. Or, because she connects womanhood and sexuality with her uterus, the removal of her uterus may now make her feel like less of a woman and less sexual, thus creating a loss of desire. The physiological response of arousal may be challenging after a hysterectomy given the lack of blood vessels in the genital area may make it difficult for a woman to become aroused. The lack of arousal and lubrication may make intercourse painful.

The decline in desire, arousal and/or vaginal lubrication, that some women may experience after hysterectomy may also result from the removal of the ovaries. The ovaries produce the sex hormones estrogen, progesterone, and testosterone. Once the ovaries are removed, your body immediately stops producing estrogen and progesterone. Lubrication is lost and the vagina atrophies making sex painful which can contribute to loss of desire and/or arousal.

The changes to the vagina after hysterectomy can further hamper sexual function. The removal of the cervix requires that the vagina be shortened and sutured shut. This is called the vaginal cuff. The shortened vagina can present problems with deep penetration.

There is very little research and even less conversation regarding women’s pre- and post- hysterectomy sexual functioning. How hysterectomy affects sexual function is not very clear and depends upon a number of internal and external factors. However, studies indicate that one of the most important facts that determines what sex after hysterectomy is like, is what sex was like before hysterectomy.

Creating a sex life post-hysterectomy, like pre-hysterectomy, takes work, effort and coordination. It's all about choreography! (See my previous article on sexual choreography) Given that a “normal." whatever that is, sex life takes work, one can only imagine how much effort has to go into creating an amazing post-hysterectomy sex life. Here are some helpful tips to help you enjoy sex post hysterectomy: