Beyond the Scars: Does Sex Feel Different After a Hysterectomy?

Latino man and woman couple sitting in an sofa in the living room enjoying their company and sharing their love with quality time without having children
Medically Reviewed
February 14, 2024

For many women, a hysterectomy is a life-changing experience, offering relief from chronic pain, heavy bleeding, or other health concerns. While the physical benefits are undeniable, understanding what to expect after the procedure, as well as concerns about intimacy and sexual pleasure, can linger.  

The question of “will sex feel different after a hysterectomy?” is a valid one, and the answer, like most things in life, is nuanced. The surgery can definitely have an effect on sexuality – but there are solutions.

As an integrative physician specializing in bioidentical hormone replacement therapy, I’ve witnessed firsthand the spectrum of experiences women face after this surgery. Fear, frustration, and even a sense of loss are all understandable emotions. However, it’s crucial to remember that a hysterectomy doesn’t have to spell doom for your sex life. In fact, for many women, it can be a catalyst for rediscovering and reclaiming their sensuality. 

Here’s why the landscape of post-hysterectomy sex is so unique: 

The type of surgery matters: 

  • Subtotal hysterectomy: Only the uterus is removed, leaving the cervix and ovaries intact. This usually has minimal impact on vaginal sensation or lubrication. 
  • Total hysterectomy: The uterus and cervix are removed. While the vagina may shorten slightly, this rarely affects sexual function. 
  • Ovary removal: This triggers menopause, leading to decreased estrogen and testosterone levels. This hormonal shift can cause vaginal dryness, low libido, and changes in orgasm intensity. 

Understanding the Hormonal Disconnect: 

For many women, a hysterectomy, especially with ovary removal, throws their hormones into disarray, leaving them grappling with the loss of not only a vital organ but also a sense of their sensuality.  

Moreover, even in women who retain one or two ovaries following surgery, a significant decline in hormone levels is nearly always observed shortly after the procedure, particularly if one ovary is removed.  

This decrease can be pronounced. 

And the reason is that the diminished hormone is attributed to both reduced blood flow during surgery and the removal of arteries that supply not just the uterus but also the ovaries. The result is a dual negative impact on the function of the ovaries, even if they are left intact.  

When both ovaries are removed, natural estrogen production ceases, triggering menopause.

This sudden drop in estrogen leads to a cascade of effects, including: 

  • Vaginal dryness: This makes sex uncomfortable or even painful, creating a physical barrier to intimacy. 
  • Decreased libido: The drop in estrogen dampens sexual desire, leaving some women feeling disconnected from their bodies and desire. 
  • Altered sensations: Estrogen plays a crucial role in maintaining vaginal health and blood flow, impacting sensitivity and orgasmic potential. 
  • Mood swings: Drops in Estrogen can lead to fluctuations in mood, which ultimately also impact libido.    

Enter the Power of Bioidentical Hormones:

This is where bioidentical hormone replacement therapy (BHRT) steps in, offering a beacon of hope in reclaiming intimacy and pleasure.  

The reason is that BHRT utilizes plant-derived hormones structurally identical to those produced by the human body. This eliminates the potential side effects associated with synthetic hormones and offers a more natural approach to balancing hormones.  

Rekindling the Flames of Intimacy: 

BHRT can empower women who have undergone a hysterectomy to reclaim their sensuality in several ways: 

  • Combating Vaginal Dryness: Topical or systemic estrogen therapy effectively relieves dryness, making sex more comfortable and pleasurable. 
  • Rebooting Libido: Balancing estrogen levels can rekindle sexual desire, restoring a sense of confidence and passion. 
  • Enhancing Sensation: Estrogen promotes healthy vaginal tissue and blood flow, potentially increasing sensitivity and the intensity of orgasms. 
  • Boosting Emotional Well-being: BHRT can improve mood, energy levels, and sleep, indirectly impacting sexual confidence and desire. 

The Power of Communication: 

Open and honest communication with your partner and your doctor is vital. That’s because sharing your fears and concerns allows for understanding, support, and exploring new ways to connect and experience pleasure. Moreover, your doctor, especially one specializing in integrative medicine and bioidentical hormone replacement therapy, can offer personalized guidance and solutions to address any hormonal imbalances affecting your sexual function. 

Here are some practical tips for navigating post-hysterectomy sex: 

  • Start slow: Give your body time to heal both physically and emotionally. Don’t rush back into penetrative sex if you’re not ready. Explore other ways to connect and build intimacy with your partner. 
  • Embrace lubricants: Vaginal dryness is a common symptom after menopause. Use a natural, water-based lubricant to enhance comfort and pleasure during sex. 
  • Communicate with your partner: Be open about your needs and desires. Explore new positions and techniques that work for you both. 
  • Seek professional help: If you’re experiencing significant changes in libido or orgasm that distress you, consult a doctor. They can assess your hormone levels and recommend bioidentical hormone replacement therapy or other options to restore balance. 
  • Remember, you’re not alone: Connect with other women who’ve had similar experiences. Online communities and support groups can offer invaluable advice and understanding. 

Above all, the journey to reclaiming your sensuality after a hysterectomy is a personal one. There’s no one-size-fits-all approach, and the key is to listen to your body, embrace open communication, and explore what works for you. With the right support, knowledge, and a positive attitude, you can rediscover a fulfilling and satisfying sex life, one that celebrates your body and your unique journey through womanhood. 

Remember, a hysterectomy doesn’t have to mark the end of your sexual life. It can be an opportunity to rewrite your story, rediscover your sensuality, and embrace a new chapter of intimacy and pleasure. 

Dr. Angela DeRosa

As our Associate Medical Director, Dr. Angela De Rosa is integral to the continued education and innovation here at Nava Health. Dr. Angela DeRosa, DO, MBA, CPE, is a dynamic professional on a mission to change the face of women’s health and wellness. As a respected, internationally recognized authority on women’s hormonal health, Dr. DeRosa understands the range of health issues women face leading up to and during menopause, as she was in full-blown menopause by age 35. Dr. DeRosa has more than 25 years of experience in the medical field, both on the pharmaceutical side and in clinical practice.

Dr. DeRosa’s enthusiasm for educating patients on the realities of menopause and the risk factors of hormonal health imbalances has never waned. It was the driving force behind her first bestselling book, A Woman’s Health Survival Guide: How to Prevent Your Doctor From Slowly Killing You. Her book and its controversial title caught the attention of the public, media, and the medical community.

Dr. DeRosa is on the advisory board for the European Menopause and Andropause Society, a member of the International Menopause Society International Society of the Study of Women’s Sexual Health, and a researcher on women’s health issues. Dr. DeRosa is a Midwestern University Clinical Assistant Professor and a Past Arizona Osteopathic Medical Association President.