Everything You Need to Know About Sex After a Hysterectomy  

While patients experience bodily changes from the surgery, their sex lives can still be just as fulfilling.  

A hysterectomy can bring on major life changes, especially for younger women who haven’t yet gone through menopause. One of the most frequently asked questions is whether a hysterectomy will affect sexual function.  

While the surgery does bring an end to fertility and menstruation, it does not mean the end of a fulfilling sex life. For some women, they may even find sex more enjoyable than before. 

“Doing a hysterectomy should not affect your ability to orgasm or to enjoy intimacy,” reassures X. Mona Guo, MD, a gynecologic oncologist with Keck Medicine of USC. 

Will sex feel different following a hysterectomy? 

A hysterectomy is a surgery to remove the uterus, and “as far as we know, the uterus itself does not have any pleasure sense,” Dr. Guo says. 

There are several types of hysterectomies, and Dr. Guo adds that “none of them affect the clitoris, so the hysterectomy should not impact how you feel from external stimulation.” Most patients can also still achieve pleasure from penetration. 

For some patients who undergo total or radical hysterectomies, which include removal of the cervix, it’s possible sex will feel a bit different because deep penetration can stimulate the cervix. Patients who enjoy this sensation will no longer be able to feel this once the cervix is gone. 

For the patient’s partner, the majority of the time sex will not feel any different no matter what type of hysterectomy was performed. One exception is if a patient had a radical hysterectomy, which can shorten the vagina and change how sex feels for both partners. 

Many patients may actually find sex more enjoyable post-surgery. A hysterectomy, which is the second most common surgery performed on women in the U.S. after cesarean section, is used to treat abnormally heavy bleeding and chronic pelvic pain. Resolving those conditions can bring significant physical relief, leading to improved quality of life and more enjoyable intimacy.  

Does sex drive change after a hysterectomy? 

Postmenopausal patients are unlikely to experience changes to their sex drive following a hysterectomy. If the hysterectomy includes removal of the ovaries, then premenopausal patients may experience reduced sex drive. Removing the ovaries causes the body to enter surgical menopause, which can cause a sudden decrease in hormones. A possible side effect of this change is low libido 

“The drop in hormones during menopause can cause many problems beyond hot flashes such as weight gain, mood issues and sleep disturbances that affect intimacy. The lining of the vagina may also become thinner and cause discomfort,” Dr. Guo says. “Hormone replacement therapy can help patients feel a lot better. It’s one of the first things you should talk about with your doctor.” 

Some patients have a preexisting condition that makes them ineligible for hormone replacement therapy, such as heart disease or a hormone-responsive cancer. In those cases, Dr. Guo recommends discussing non-hormonal management options with your provider. Often, vaginal estrogen can still be used for vaginal dryness. Specifically for libido, cognitive behavioral therapy and couples counseling are also important. After that, medications to treat hypoactive sexual desire disorder could be another option. 

How long after a hysterectomy can you have sex? 

A general guideline is to wait 6-8 weeks to have sex after a hysterectomy to allow the body to heal.  

Patients may recover faster from a minimally invasive laparoscopic procedure. As Dr. Guo explains, this technique means a shorter hospital stay, smaller incisions and less blood loss during surgery.  

Full healing may take longer after a radical hysterectomy, which often involves a resection of the vagina of about a couple of centimeters. The surgery can also temporarily affect nerves controlling the bladder and/or rectum. Patients may be sent home with a Foley catheter — a thin, flexible tube inserted into the bladder to drain urine into a drainage collection bag outside the body — to allow those nerves time to recover. 

Patients should wait to be cleared by their doctor before resuming normal activities including intercourse. The first time having sex after a hysterectomy, patients may experience soreness or tenderness, and it’s advisable to take it slow and use lubrication.  

However, sex should not be painful or cause bleeding. “We should not be bleeding after sex. It means something is getting irritated,” Dr. Guo says. 

After a hysterectomy, Dr. Guo encourages all patients to try pelvic floor physical therapy. It targets the pelvic floor muscles that are disrupted during surgery. Strengthening those muscles can then help boost sexual function and pleasure. 

“If you have concerns or symptoms after a hysterectomy, don’t keep them to yourself,” says Dr. Guo. “If you don’t feel normal, it’s probably not normal. Talk to your doctor and we can find a solution.”

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Erin Laviola

Erin Laviola is a freelance writer for Keck Medicine of USC.

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