Let’s talk about sex baby!!
Ok, let’s be honest… sex probably didn’t come up much in the conversations you had with your consultant or nurses and if it did, it was probably a little awkward as we find it embarrassing to talk about, despite the fact that every animal on planet earth has it and it’s important not just for procreation, but for many other emotional and sociological reasons… let’s be honest, a good orgasm is great!! :-) So for those of you with questions, here is the abridged version of the 40 minute in depth discussion we have on the Sex after Hysterectomy Video Discussion.
WHEN CAN I HAVE SEX SAFELY?
In the recovery video section of this website we have a whole talk on healing times of tissue after surgery, including the new vaginal vault or cuff. For those with an interest you can geek out on facts! But the gist is that for around 40% of women the cuff is fully healed at 6 weeks. For 80% of women it’s fully healed at 8 weeks. the last 20% of women can take another couple of weeks to completely heal. If you are having any pink discharge at all then it’s likely you are not fully healed so hang fire until you are discharge free. The injury risk of having sex too early is something called dehiscence, which is basically where the surgical sutures creating the join of the cuff can be pulled apart creating a tear. Now this is super rare… only abut 2% of women actually get this but early sexual activity is pretty much always the cause. Now personally having sex again was not high on my priority list whilst healing so there was no way I felt like it before around the 8 weeks mark anyway, but if you are feeling especially ready to get going quickly, then it’s probably safest to stick to external stimulation until around the 8 weeks point - just to be safe! After that there is very little risk that you can injure yourself so, although you may want to start gently, use lube and be the one in control whilst you gain confidence, you can embrace your full feminine wild side again just fine!
WHAT IF IT HURTS OR FEELS DIFFERENT?
Dyspareunia, or painful sex is one of the symptoms of the various conditions many women have a hysterectomy for, so as you resume sexual activity it’s natural to be concerned that it might still hurt. For most women the hysterectomy resolves the condition and therefore resolves the reason why sex hurt. For a small number of women the pain might continue though. In these cases there may be a psychological element at play which is causing a condition called vaginismus, where the muscles of the vagina tighten up every time intimacy, especially penetration is attempted. This can stem from past sexual trauma, fear of sexual intimacy or simply a learnt pattern by the brain that sex hurts, so even after the condition causing the reason for pain is removed, the brain can’t let go of the learnt patterns. All these require the support of a trained sexual therapist as they are unlikely to resolve on their own. If this is you, I implore you to seek the right help and not suffer in silence.
Will it feel different? Some women report slight changes, such as feeling tighter or ore snug, but when we look at the research the amount of vaginal length lost is only a few mm, which means that the feelings of difference are not really from physical changes, but a perception that it will feel different. Some women in social media groups complain that they cannot orgasm anymore and that sex is terrible, but when we look at the research we don’t really see this being the case for most women. Research now very clearly shows that the majority of women orgasm via the clitoris, not via penetration. Which is good news for about 90% of us. Having said that, there is very small minority of women who orgasm or have stronger orgasms via uterine and cervical contractions. It is very specifically these women who may suffer after the removal of the uterus and cervix. You would probably know which group you fall into as if you climax regularly via penetrative sex without needing to position yourself carefully or use toys for simultaneous clitoral stimulation then you might be in 10% and I’d suggest that spending some time talking to your consultant prior to surgery about options if you are reading this pre op would be a good idea. If you are reading it post op and thinking, crap, now what do I do… don’t despair… you still have a clitoris and it still works. Book some sessions with a sexual therapist and see if they can help you explore ways to stimulate yourself and create higher arousal. For most of us though, the relief that the condition is gone and therefore the reason of pain, heavy bleeding etc… means that our sex lives improve as does our sexual satisfaction. And if you’re single… even better news… single ladies report higher sexual satisfaction after a hysterectomy than married or co-habiting ones. The hypotheses of this surprising find being that single ladies are more likely to be experimental and open to new things… perhaps something us married gals could learn from!!
MY TOP TIP!
Sex with a partner can be a lot of pressure, whether that partner is male, female, supportive or note. There can be fear that it will hurt, that you might not be able to orgam. etc… so the first time, take the pressure off and go solo! Masterbation is healthy and a great way for you to make sure you are happy with no pressure to please someone else and only yourself.
If you have a partner, don’t be pressured into sex earlier that you are ready. You’re body and mind has been through a trauma and recovery is the most important thing. Your partner has a hand and can use it! You can tell them I said that!
For the full 40 minute discussion on sex plus other talks head to the Video Education Section.