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As the word “hysterectomy” fell so casually from Dr. Y’s lips, I sat on the table somewhat relieved yet a little anxious. After all, having a hysterectomy signified the beginning of the end or did it…

This dreaded, depressing procedure has long been touted as the final stage of womanhood and sexuality. In addition not only are you expected to feel less than, this procedure is super duper secretive so you dare not discuss it with anyone other than your doctor. Not even your spouse can know the low-down dirty details of this God-forsaken procedure. this unwomanly mystery must only be shared between you and your doctor in the confines of their office.

These thoughts, beliefs and attitudes are embraced by lots of woman. In fact many women that I know, both young and old, have had hysterectomies in secrecy and silence. It’s almost as if having a hysterectomy is like joining a secret society or sorority that you only learn about once you have undergone the procedure. And of course I have my theories on this especially given the fact that sexuality is still so taboo, so misunderstood and still something that we aren’t not to discuss openly and honestly….but I digress.

With all these thoughts, beliefs and attitudes swirling around this procedure, how could one not wonder or have a long list of questions. So of course being who I am, I did extensive research! In the past, I had done research about hysterectomies for my clients and my family members but this time my research would impact me in an extremely personal way.

After doing my extensive research, I had to make an informed decision that would changed the trajectory of my life as I knew it.  I had to gather up all the tools in my tool box, myself be you now this is the same tool box that I had and send to empower so many women in my 25 years of being in the field of sexology and use them to empower my self.  More importantly, as a clinical sexologist and sex therapist it is my duty to share with you my experience in an effort to shed light, shatter myths and share tips with you about this unnerving procedure.

A hysterectomy is an operation to take out the uterus (womb), and sometimes the cervix and occasionally other reproductive organs. Although hysterectomy is the second most common surgery for women in the United States, that doesn’t mean it’s a breeze. The procedure can take a toll on your body, and depending on the type of hysterectomy you have. A hysterectomy can be done in several different ways. It will depend on your health history and the reason for your surgery. The different types of hysterectomy include:

  • Total hysterectomy involves the removal of the uterus, including the cervix. The ovaries and the fallopian tubes may or may not be removed.
  • Supracervical hysterectomy involves the removal the uterus without the cervix. The cervix is the area that forms the very bottom of the uterus, and sits at the end of the vaginal canal.
  • Radical hysterectomy involves removing the uterus, cervix, the tissue on both sides of the cervix, and the upper part of the vagina. A radical hysterectomy is most often used to treat certain types of cancer, such as cervical cancer.
  • Hysterectomy with oophorectomy and salpingoophorectomy. Oophorectomy is the surgical removal of the ovary(s), while salpingoophorectomy is the removal of the ovary and the fallopian tubes. If the ovaries are not removed during the hysterectomy, a woman should not experience symptoms of menopause because the ovaries produce the hormone estrogen, which helps to manages symptoms of menopause. However, if both ovaries are removed during the hysterectomy, a woman will no longer have periods and may begin to immediately experience symptoms of menopause because hormone levels drop quickly without ovaries. In addition the symptoms may be more intense than with natural menopause.

There are also many different procedures used to perform a hysterectomy. Usually your physician will decide which procedure you are the best candidate for based on the following including but not limited too: reason for the hysterectomy, medical history, lifestyle, fitness level, job functionality, support system, etc. The different types of procedures include:

  • Abdominal hysterectomy.  An abdominal hysterectomy is the most common type of hysterectomy. During this procedures, the doctor makes either a horizontal or vertical incision, in your lower abdomen, usually in the bikini area. The abdominal hysterectomy allows the whole abdomen and pelvis to be examined, which is an advantage in women with cancer or investigating growths of unclear cause. It also allow the physician easier access to remove the uterus and ovaries and fallopian tubes, if needed.
  • Vaginal hysterectomy. A vaginal hysterectomy is involves removal of the uterus and the cervix, if necessary through a small incision at the top the vagina. If the cervix is not being removed, the incision is made around the cervix, which is then reattached when the surgery is finished. Women who have not had children may not have a large enough vaginal canal for this type of procedure.
  • Laparoscopic hysterectomy.  A laparoscope is an instrument with a thin, lighted tube and a small camera that allows the physician to see the pelvic organs during the surgery. This special surgical tool is used to assist the physician in operating through small incisions in the abdomen and vagina. During a laparoscopic hysterectomy the uterus is removed through the small cuts made in either your abdomen or your vagina. Laparoscopy-assisted vaginal hysterectomy (LAVH) is similar to the vaginal hysterectomy procedure described above, but it adds the use of a laparoscope. If a woman has such a history of prior surgery, or if she has a large pelvic mass, a regular abdominal hysterectomy might be considered.
  • Robotic-assisted hysterectomy.  The robotic is a minimally invasive hysterectomy that involves the use of a robotic arm. The physician(s) use a computer to gently guide the surgical tools to remove the uterus, in tiny pieces, through small incisions in your lower abdomen. This technique is more accurate and precise utilizing the magnification of a 3-dimensional camera.The 3-D magnification enables the physician the ability to get into tiny spaces more easily and have a better view of the operation than with conventional laparoscopic surgery. The robotic-assisted hysterectomy is fairly new and requires specialized training of the robotic tools.

When decided to have a hysterectomy, it is extremely important that you talk with your doctor about the different types of hysterectomies as well as the side effects, recovery and after care of the procedure. This will help you to make an informed decision based on your specific health care needs and/or concerns.

There are many reasons a woman may need to have a hysterectomy. Some reasons include:

  • Fibroids
  • Endometriosis
  • Heavy menstrual periods
  • Prolapsed uterus
  • Uterine polyps or endometrial polyps
  • Adenomyosis

For me the decision to have a hysterectomy was rather easy. I was tired of being in pain. I was tired of having surgeries. I didn’t want to try anymore hormonal procedures. I was tired of having a never ending period. I was tired of buying tampons. I was tired of birth-control pills and the list goes on. I could no longer deal with the heavy periods, shooting abdominal pains and large uterine fibroids were exhausting. My periods were so heavy that on some days I was concerned about leaving the house because I did not want to soil my clothes.

So for me, the decision to have a hysterectomy was a the right one. In collaboration with my physician and my husband, I opted to have a total, laparoscopically assisted vaginal hysterectomy. We decided the removal of my ovaries and fallopian tubes were not necessary. And beside, I was not exactly ready to be forced into menopause and I’m sure my husband went either.

I checked into the hospital on December 1st all ready for my procedure. My husband, mom and dad and a few friends were there to support and assist in my recovery process.

How long will it take to recover?

The morphine will have you fooled!

My procedure only required me to stay overnight in the hospital. Immediately after surgery, I was given medication to prevent infection, plus a pain reliever. I was placed in the recovery room for a couple of hours so the hospital staff could monitor my vital signs. Shortly after waking up in the recovery room, i was transferred to a hospital room where I was met by my husband and mother. I felt fine other than the fact that I was a little drowsy from the anesthesia. I was hooked to an IV that administered morphine approximately every 15 minutes as needed. I was also waist cincher to help support my abdominal muscles. Since I could not get out of the bed, I also had a catheter and compression socks to prevent the blood from clotting in my legs. That night I slept pretty good.

The morning following my surgery, Dr. Y came to check my incisions, the IV and catheter were removed and I was given a pain medication in a pill form. I begin moving around – including walking around the hospital to decrease the stiffness, reduce the likelihood of blood clots and to promote bowel movement. I was released as soon as my body produced bowel sounds. When I was released, I felt pretty good considering I just had surgery.

My First night home was absolutely ridiculously uncomfortable!

I tossed and turned, turned and tossed. Did I say, I tossed and turned? I could not find a comfortable position. Not too mentioned, I was in pain.

Recovery time is based on the type of hysterectomy that you have. Generally, the less invasive the hysterectomy procedure, is likely to cause less pain and lose less blood than is typical with open abdominal surgery. Additionally, a woman is more likely to be able to resume normal daily activities more quickly than if she had an abdominal hysterectomy.

Most women are released from the hospital two to three days after having an abdominal hysterectomy, however complete recovery takes weeks. Because vaginal and robotic hysterectomies are less surgically invasive than an abdominal hysterectomy. Most women who have this type of of procedure leave the hospital the next day. In some cases, a woman may be released the same day. The hospital will provide instructions regarding driving, bathing, and showering.

During the recovery period, plenty of rest is need to ensure that the body properly heals. It’s not unusual to have a few cramps or feel a little bloated following a hysterectomy. Most women also have a bloody vaginal discharge after a hysterectomy that is normally a brownish color and may have a slight odor. This can continue for a few days to several weeks. It is important to refrain from house work and heavy lifting, 10 pounds or more, for the first few weeks. Increased movement and activity such as walking is encouraged. Abstain from sex or putting anything in the vagina, including tampons. It usually takes three to six weeks for a full recovery and return to normal activities, including sexual intercourse.

Speaking of Sex….

Hysterectomy the death of a sex life

Over the years, having a hysterectomy has been synonymous with the end of sex. Virtually every woman expresses concerns, unfortunately, studies have shown that only half of gynecologists initiate a discussion of sex and few patients are brave 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 connection 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:

  • Become intimately acquainted with your body. In order to experience pleasure, you have to be intimately acquainted with your body. Understanding your sexual response cycle and how your body changes during each cycle is the hallmark of sexual pleasure.
  • Communicate with your partner. The first time you engage in intercourse after having a hysterectomy may be weird, so its important to communicate with your partner. It is important to let your partner know if you are experiencing any discomfort or pain. Pain is an indication that something is not right with the body.
  • Start out slow. Keep in mind that your body has undergone a major transition over the past few weeks, therefore it is extremely important to take it nice and easy.
  • Engaging in more foreplay. Women need foreplay to help get their vaginal flowing, lengthen the vagina and help the body to relax.
  • Use more lubricant. It is always a good idea to keep lubrication nearby. The more the vagina is lubricated, the less likely the lining the friction from intercourse will cause pain and/or ripping and tearing from intercourse. Rips and tears in the vagina help create a portal of entry for bacteria and other infections.
  • Change how you feel about sex. Sex is more than physical. It is emotional, mental, spiritual, biochemical, etc. The mind and the body work together to optimize the sexual experience. Any negative attitudes, thoughts or beliefs we have been taught regarding sexuality or our bodies can contribute to unpleasurable sexual experiences.
  • Watch your position. Certain sexual positions can cause pain during sex. Most positions that allow for deep, thrusting penetration can be painful for a woman, especially after a medical condition, medical procedure or if her partner is well endowed. Generally, positions that allow the woman to control the pace and penetration, e.g., woman on top, tend to be more comfortable for a sufferer of painful sex. In order to find out what works, experiment with different positions, techniques and props (i.e., pillows) to find out the one(s) that offer the most stimulation with the least amount of pain.

At the end of the day, whether having a hysterectomy effects your sexuality and sex life more negatively or positively depends on you.

The journey ahead……

Having a hysterectomy is just as much a spiritual, mental, emotional, biochemical, and social as it is physical, however it is not the end of life. Let’s be clear having a hysterectomy is NOT the defining factor for womanhood or sexuality. Nor is having a hysterectomy a death sentence for your sex life However it is important to note that the recovery and healing experience for each woman will be different depending on a variety of factors such as: support system, patient-physician relationship, medical history, thoughts, attitudes and beliefs, fitness levels, overall level of health, pain tolerance, medical adherence, etc.

To help with your recovery and healing, here are some additional helpful tips:

  • Do not try to be a superwoman. Resist the temptation to work.
  • Accept the help. Allow your family and friends to assist you with chores.
  • Listen to your body. Do not over do it! Allow your body the time to heal properly.
  • Take medication (s) as prescribed to stay ahead of the pain.
  • Get plenty of rest. Remember you just had major surgery and your body is adjusting to the change.
  • Walk it out. Get up and walk around after your hysterectomy as soon as you get the go-ahead from your doctor — even if you need assistance.
  • Wear comfortable clothes that do not irritate your incisions.
  • Keep incisions clean and dry so that they do not become infected.
  • Watch the kids, cats and dog. Sometimes kids, cats or dogs will just plop down unexpectedly. Keep a pillow on your stomach to protect your abdominal area.
  • Get support. Talk to others who’ve had a hysterectomy. Not only is it a comfort to know that you’re not alone, but you can also learn from others who had the same or similar procedure.
  • Just chill! Enjoy your down time doing absolutely nothing at all!

    Now of course, I am not minimizing the seriousness of this surgical procedure, the recover and healing process and the effects it can have on a woman’s life. I am however, stating that an amazing quality of life can exist post hysterectomy. Forming a great partnership with your physician, learning as much as you can about your specific procedure including side effects and recovery time and enlisting the assistance of a great after care support team with help to make all the difference in your experience and healing!

As for me personally, Thank God I had a very patient and loving husband who was very supportive and understanding about my condition. My physician was great, I did my research, understood my procedure, including side effect and recovery time, and had a amazing after care support team. I made an informed and empowered decisions! And finally for the first time in years, no pills, no period, no pain equals great life for me…well except for this one stubborn stitch that just wont dissolve!

Happy Healing! I sure know I am!