Facing a Hysterectomy

My wife, who is only 43, just learned she needs a hysterectomy. What can I do to be supportive of her and reaffirm her sexuality? I'm also wondering if a hysterectomy will adversely affect our sex life. I'm not sure what to expect.

A hysterectomy is a major surgical procedure as well as a life change for your wife and, indirectly, for you. It is one of the safer surgeries, and many women find the quality of their lives improve afterward. We recommend you take several steps to prepare yourselves before your wife's hysterectomy.

First, make certain the hysterectomy is necessary. Some medical authorities believe that some of the hysterectomies performed are unnecessary, so seek a second medical opinion. Also, get as much information as you can--from other women who have had hysterectomies and from reading. One source would be Dr. Joe S. McIlhaney's book 1250 Health Care Questions Women Ask (Focus on the Family). McIlhaney addresses the issues of necessary and unnecessary hysterectomies.

Second, take charge of other factors that will affect your wife's recovery and sex life after her hysterectomy. Before the surgery, she should get herself in as good physical condition as possible. Afterward, she should explicitly follow her doctor's instructions for recovery. Support her in taking time to get back on her feet, and be certain she does no lifting and does not have sexual intercourse until her doctor approves these activities.

Third, the two of you should discuss with her physician what other surgical procedures will be involved. Will her ovaries need to be removed? Even though the ovaries decrease in their production of estrogen and progesterone as a woman goes through menopause, they excrete small amounts of testosterone until a woman is in her eighties. Since testosterone stimulates sexual desire, some women's sex drive may lessen noticeably when the ovaries are removed. Even so, if there is a history of ovarian cancer in your wife's family, keeping her ovaries may not be recommended.

Will she need a cystocele repair for a sagging bladder? If your wife is responsive sexually to G-spot stimulation (stimulation of the front wall of the vagina just beyond the inner ridge of the P.C. muscle--the muscle that controls the opening and closing of the vagina), surgery for a cystocele repair may interfere with that source of stimulation.

Another question to ask is if your wife will be on hormonal replacement therapy after her surgery. If she has not started menopause and will be keeping her ovaries, hormonal replacement therapy is unlikely. However, if she has started menopause or her ovaries will be removed, hormonal replacement therapy (estrogen and testosterone) started immediately will maintain her sexual desire and enhance her sexual experiences after surgery.

Fourth, know your wife's sexual response now. Some women are very aware of the sensations of the uterine contractions that occur when they experience orgasm. These women have to shift the focus of their sexual sensations after a hysterectomy from the uterine contractions to the vaginal contractions. The vagina is not affected by a hysterectomy so the sensations of the penis in the vagina will not be disturbed, nor will vaginal lubrication be affected.

All these issues must be addressed to ascertain how your wife's sexual experience will be affected and what your role needs to be as you support her. In general, more women find their sexual experience is improved after a hysterectomy than those who find it is negatively affected because they simply feel so much better. You can be supportive in gathering data, making decisions, giving your wife time to recover adequately, and positively participating in any new sexual discoveries and adjustments that become necessary.

For Further Exploration:
Sex Facts for the Family

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