Hysterectomy Sex Post-Operative Guide for Comfort and Safety

Hysterectomy sex related concerns are often not not openly discussed.

How to avoid painful sex after hysterectomy?

When is it safe to resume sex?

This Physiotherapy guide teaches you:

  1. How to overcome common hysterectomy sex problems Hysterectomy Sex Guide
  2. When is sex after a hysterectomy safe?
  3. How will sex feel after hysterectomy?
  4. Will my partner notice any difference during sex after hysterectomy?
  5. How to avoid pain and improve sex after hysterectomy
  6. Key points for hysterectomy sex concerns

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How to Overcome Common Sex Problems after Hysterectomy

Vaginal pain

Ongoing vaginal or pelvic pain and discomfort associated with penetrative intercourse after a hysterectomy should be discussed with your medical specialist or doctor.

Vaginal dryness

Vaginal dryness can be problematic for women who undergo early menopause as a result of their combined hysterectomy and oophorectomy.

  • Vaginal oestrogen acts locally to thicken vaginal tissues and increase lubrication. Vaginal oestrogen can be particularly beneficial post menopause and for women having both ovaries removed (oophorectomy). Vaginal oestrogen is inserted into the vagina in pessary or cream form and is prescribed by your doctor or medical specialist having once determined your suitability for its use.
  • Using the best lubricant that avoids vaginal irritation can be useful for overcoming vaginal dryness and consequent irritation of vaginal tissues.

Pelvic floor muscle tension

Increased pelvic floor muscle tension can be caused by apprehension and pain, and as a result painful intercourse (dyspareunia) can present post hysterectomy.Dilator for increased pelvic flor muscle tension

  • Pelvic floor muscle relaxation during intercourse can be aided by relaxed slow abdominal breathing and voluntary relaxation of the pelvic floor, abdominal and inner thigh muscles during intercourse.
  • Pelvic floor muscle relaxation techniques may need to be practiced on a regular basis for some women and can be assisted with the use of a physiotherapy pelvic floor relaxation CD.
  • Vaginal dilators (or retrainers shown right) can be used to promote pelvic floor relaxation. Vaginal dilators are also used to treat vaginal scarring and/or adhesions and for gentle lengthening the vagina in cases where the vagina has been shortened during hysterectomy surgery. These can also help to reduce discomfort and apprehension about vaginal penetration after hysterectomy surgery.

Vaginal thrush

Vaginal thrush can sometimes occur after hysterectomy as a result of post-operative antibiotics. Vaginal thrush can be treated with over the counter medications and probiotics after correct medical diagnosis.

  • Breathable cotton underwear can help to prevent and overcome vaginal thrush by allowing air to the vaginal tissues.
  • Avoid vaginal irritants including soaps, sprays and vaginal washes on vaginal tissues. Use only water to wash your vagina and make this a regular practice.

When is Sex after Hysterectomy Safe?

All women should be guided by their surgeon for when to recommence penetrative intercourse after a hysterectomy. This is often from 6-8 weeks postoperatively but can vary from woman to woman according to the rate of recovery and surgical procedure. Recommencing sexual intercourse prior to tissue healing can risk complications. Always check with your surgeon at your six week check-up.

Vaginal hysterectomy involves suturing or stitching the internal tissues in the upper vagina creating an internal wound. After a vaginal hysterectomy you may look no different from the outside so it can be well worth explaining your internal wound to your over- eager partner.

Some women have combined hysterectomy and prolapse surgery. This often means that that more widespread healing is involved and sometimes longer healing times particularly with complex prolapse repairs. Once again the most appropriate time frame for resuming sex is determined by your surgeon.

How will Sex after Hysterectomy Feel?

Most women are surprised to find that despite initial apprehension, gentle penetrative intercourse after hysterectomy is usually quite comfortable and takes place with minimal if any discomfort.  There are a number of techniques and strategies for maximising physical comfort with sex and these are listed below.

Emotional issues post hysterectomy can catch a woman off guard – sense of decreased femininity, unrealised hopes for children and sense of ageing can all surface at this time. Don’t be surprised if returning to physical intimacy causes feelings to surface. Take the time to recover physically and emotionally before resuming physical intimacy and speak with a counsellor if you find you are having problems dealing with your emotions.

Will my Partner Notice any Difference after Hysterectomy?

Most men usually don’t report feeling any difference in physical sensation or sexual satisfaction after resuming intercourse with their partner after her hysterectomy. Men often express concern at causing their partner pain and/or injury so both partners may feel some apprehension and concern when resuming sex post operatively.

It can be useful to discuss any concerns you or your partner have prior to resuming intercourse. Sex after hysterectomy is a time for open understanding, reassurance and patience in a sexual relationship.

How to avoid pain with sex after hysterectomy

  • Recommence penetrative sexual intercourse only following medical approval to do so.
  • Discuss your hysterectomy sex-related concerns with your surgeon and your partner.
  • Take the time you need time to prepare yourself for sex after your surgeon’s approval – just because you are physically healed doesn’t mean you are ‘ready’.
  • Choose a time when you and your partner both feel relaxed and unhurried.
  • Progress intimacy gradually with foreplay even over a number of days/weeks.
  • Gentle digital penetration can sometimes be reassuring for both partners that sexual intercourse will be comfortable for the woman.
  • Use quality water-based lubricants – this helps to improve physical comfort and avoids the potential irritation to vaginal tissues associated with petroleum- based lubricants. This is particularly important for women experiencing menopause symptoms post-hysterectomy.
  • Choose the most comfortable position for your body- side lying is often the most comfortable position with the male partner behind the female. This position usually limits the depth of penetration when compared with the traditional missionary position however this can vary.

Key Points for Hysterectomy Sex – Related Concerns

  1. Most women resume sex 6 -8 weeks post hysterectomy and only when advised that they are ready to do so by their surgeon
  2. The best time to resume sex after hysterectomy may extend beyond this for when you feel emotionally prepared
  3. Sex is usually associated with minimal discomfort after a hysterectomy
  4. Women and men can both feel apprehensive about resuming sex
  5. Women and men usually resume their former level of intimacy without any noticeable difference
  6. A number of strategies can improve sex after hysterectomy including attention to; relaxation, foreplay, lubrication and positioning
  7. Simple strategies can avoid or minimise some common post operative hysterectomy sex problems including; avoiding vaginal irritants, wearing cotton briefs, relaxing the pelvic floor muscles and using water-based vagina lubrication.

ABOUT THE AUTHOR, Michelle Kenway

Michelle Kenway is a Pelvic Floor Physiotherapist and author of Inside Out – the Essential Women’s Guide to Pelvic Support. The Inside Out exercise DVD and book show women how to strengthen the pelvic floor and exercise effectively with pelvic floor safe exercises.

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