Topics of Interest

Hysterectomy Improves Sexual Response? Addressing a Crucial Omission in the Literature

Journal: The Journal of Minimally Invasive Gynecology, Volume 18, Pages 288-295, May 2011

Authors: Barry R. Komisaruk, Eleni Frangos, Beverly Whipple

Study from: University of Medicine and Dentistry of New Jersey

Problem: The prevailing view in the medical literature is that hysterectomy improves the quality of life. This is based on claims that hysterectomy relieves painful intercourse and abnormal bleeding and improves sexual response. Because hysterectomy requires cutting the sensory nerves that supply the cervix and uterus, it is surprising that the reports of negative effects on sexual response are so limited. However, almost all articles report that some women find that hysterectomy is detrimental to their sexual response. It is likely that the degree to which a woman’s sexual response and pleasure are affected by hysterectomy depends not only on which nerves were severed by the surgery, but also the genital regions whose stimulation the woman enjoys for eliciting sexual response.

Study: A review of the medical literature regarding female sexual response and the effects of hysterectomy on sexual response.

Results:

  1. While most women report improvement of sexual functioning after hysterectomy, this may be the result of relief of symptoms after removal of a diseased uterus, such as vaginal bleeding and pain with intercourse.
  2. Hysterectomy may eliminate anxiety about cancer risk (uterine, cervix, ovarian) and unwanted pregnancy.
  3. Multiple factors may be related to the negative effects of hysterectomy on sexual response including:
    1. For some women, uterine contractions are an important aspect of orgasm and hysterectomy eliminates this sexual response.
    2. Scar tissue at the top of the vagina (when the cervix is removed) may make intercourse difficult because the top of the vagina is less elastic.
    3. Internal scarring or nerve damage may cause pain or may interfere with feeling sexual pleasure.
    4. Surgical removal of some of the vaginal wall may result in decreased vaginal blood flow, which may decrease sexual arousal and the possibility of multiple orgasms.
  4. The vagina and cervix have a plentiful nerve supply. The hypogastric nerves come from the uterus and cervix, the pelvic nerves come from the vagina and the pudendal nerves come from the clitoris, labia majora, and labia minora. The ilioinguinal and genitofemoral nerves come from the mons pubis, labia, and vulvar skin.

When a woman is lying on her back, the region of the vagina near 12-o’clock (the “G spot”) is often the most sensitive area to physical stimulation and more likely to produce orgasm than stimulation of other regions of the vagina.

One study reported that 35% of 128 healthy women said they experience orgasm from penile stimulation of the cervix during sexual intercourse, 63% reported that they experience orgasm from vaginal stimulation, and 94% reported that they experience orgasm from clitoral stimulation.

Authors’ Conclusions: Based on the nerve supply of the clitoris, vagina, and cervix, it would not be surprising if responses to genital stimulation are decreased by hysterectomy. There is a glaring omission in the literature on the effects of hysterectomy on sexual response; women’s reports of their preferred source of genital stimulation have not been included in any studies and their sexual response may depend on whether a woman’s preferred genital site of stimulation is desensitized by hysterectomy.

Further research that considers these factors may help to reconcile the reported variability of the effects of hysterectomy on sexual response.

Dr. Parker’s Comments: For women who are considering a hysterectomy for severe adenomyosis or failure of less invasive treatment options, the issue of sexual response is important to think about. Unfortunately, there are no studies about sexual response following myomectomy or UAE.

Although some women report improvement of sexual response after a hysterectomy, this is usually related to the relief of symptoms, such as vaginal bleeding and pain with intercourse. However, some women note a change in sexual response for the worse. This article beautifully outlines the issues and describes why the medical literature about sexuality and hysterectomy has been so unhelpful for women. Not one study has asked women what they find pleasurable before surgery, or whether there is any difference in what they find pleasurable after surgery.

I have been discussing this issue with women for years and the conversation is interesting and sometimes humorous. I review the differences in pleasurable sexual response among women (stimulation of clitoris, vagina, cervix, and uterine contractions) and some women know exactly what gives them pleasure. And, some women say, “what the heck are you talking about?” The next step is a homework assignment – see what works for you before you decide on surgery.

Since fibroids or adenomyosis almost never involve the cervix and since removing the cervix does cut nerves and support ligaments to the pelvis, many women who chose to have a hysterectomy wish to leave the cervix. My feeling is, if the cervix isn’t broken, don’t fix it. Other issues regarding hysterectomy are discussed here: http://www.fibroidsecondopinion.com/hysterectomy-for-fibroids/

Although not explored here, if your ovaries are removed major hormonal changes are likely to occur, which can lead to vaginal dryness and loss of vaginal elasticity. Decreased sleep quality and resultant fatigue can also influence sexuality. For women who are not an increased risk of ovarian cancer due to family history, keeping your ovaries decreases the risk of heart disease, stroke, lung cancer and osteoporosis. More about the benefits of keeping your ovaries can be found at the bottom of this page: http://www.fibroidsecondopinion.com/hysterectomy-for-fibroids/

Until the proper studies are done, we will not be able to make any general conclusions about sexual response following surgery (or UAE, HIFU). However, because sexual response can be so different for different women, no matter what future studies show the questions about sexual response will always need to be considered by each woman for herself.

 

 

Share/Save/Bookmark

Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.

Fibroid Doctor William H. Parker

Dr. William H. Parker is a board-certified Fellow in the American College of Obstetricians and Gynecologists. Dr. Parker is an internationally recognized expert in fibroid surgery and research. Based in San Diego, California, he is considered one of the best fibroid surgeons for abdominal and laparoscopic myomectomy in the United States and abroad. He has been chosen for Best Doctors in America and Top Doctors every year beginning in the late 90's.

Free Email Updates

Powered by Google FeedBurner : Receive free updates right to your inbox every time new content is added to this website.


Subscribe
Schedule an Appointment Today!
Read Dr. Parker's Blog

Blog Categories