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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We Welcome Your Comments


  1. I have read so many different articles and have yet to learn what pelvic floor exercises are… I have my 6 week check up tomorrow. I had my uterus removed and a posterior repair.

  2. I am 5 months post laproscopic total hysterectomy with retention of one ovary and every time I have sex, I orgasm fine, I get wet, but when he is deep, I end up bleeding slightly and I am in pain and feel like my bladder is sore and like I have to have a bowel movement, but I can’t. If it helps, I was on top and it was fine and enjoyable until after my second and his first orgasm. I don’t know what to do. This is getting me a little worried. The bleeding has already stopped and I am urinating normally. I am just getting over my second bout with granulation tissue and finished my antibiotics for a bladder infection and am currently recovering from a yeast infection. Please advise.

    • Author: Michelle Kenway Pelvic Floor Physiotherapist says

      Hi Carolyn
      Bleeding with intercourse needs to be discussed with your doctor so best to go and get this thoroughly checked out. Sometimes the vagina is shorter after a hysterectomy and this can cause some women problems during intercourse. Having said this you need to be absolutely sure about the cause and appropriate management which will require a medical assessment. Hope this helps

  3. 4/2 TAH/BSO … Got out of hospital on 4/4 went to work 4/5 … Did a few hours everyday at my desk …going into week 3 … Feeling tired occasionally …but otherwise good … Have self pleasured externally with no problem climaxing … Glad about that after all I’ve read … Lol can’t wait for the 6 week mark … Lol

  4. I had a TAH four weeks ago. doctor did not prepare me for that. Now my husband is mad. Is there anything that can be done? Av no kids. Waire

  5. Hi Michelle,
    I’m 7 weeks post and have found my orgasms are very weak. Will pelvic floor excercises help with improving blood flow to achieve a stronger orgasm?
    Thank you!

    • Michelle Kenway Physiotherapist says

      Hi Alicia

      Yes more intense sexual sensation is one of the benefits of pelvic floor exercises, I can’ t say that it’s due to improved blood flow, improving the strength and tone of the pelvic floor muscles can be part of the reason.


  6. Hi Michelle,
    10 weeks ago I had TAH, appendectomy, removal of omentum layer, via midline incision, then 4 weeks ago completion surgery 28 lymph nodes removed via keyhole
    (which took 7 and a half hours!) I am am fully mobile although it feels like its taking longer to recover from this op, however I seem to be experiencing circulation problems ie pain after walking (left hip to knee) left foot and calf hot while the right is cold, will this go or do I need to be checked over?

    • Michelle Kenway says

      Hi Maggs
      Anything like this post op get checked over immediately. Clots can develop post op and this needs to be medically assessed.
      All the best

  7. I had laparoscopic hysterectomy done april 22 of this year. I strangly have 5 incisions one incision is low bikini line and is still showing up with new dark bruises should I be worried that I have done something to hurt the internal incisions or pelvic floor?

    • Michelle Kenway says

      Hi Laurie

      Bruising can show up after hysterectomy however it is a good idea to phone your doctor’s rooms and ask if he/she wants to see you about this issue if you feel concerned. Bruising around the wound is unlikely to be pelvic floor damage. Always check post op if you are concerned about new symptoms.


  8. I will be 9 weeks post op TAH with ovaries retained on May 15. Will my vaginal cuff and bikini cut be sufficiently healed to cope eith a 17-24 hour flight?
    Thank you

    • Michelle Kenway says

      Hi Marjorie

      This is a good question to check with your surgeon as some women are at increased risk compared with others.

      The big issue to bemindful of is DVT (i.e. deep venous thrombosis) post op after TAH – this is a clot in the deep veins of the legs, usually the calves. Swelling in the abdomen after TAH does increase the risk of TAH as this swelling can reduce the venous return to the heart. DVT can happen anyway during long flights so it would be wise to contact your surgeon about this issue just to be sure (some medications and health conditions can increase the risk of DVT). I am not sure of your exact risk, just a factor for you to consider. Very important to move the legs and ankles regularly as well as squeezing the thigh muscles during a long flight with calf to stimulate blood flow in the legs in addition to getting up and walking around the cabin when possible during the flight.

      Using a pillow under the lap strap when up in altitude can also stop the belt digging into the abdomen while you are travelling. I usually suggest asking the flight attendant for an extra pillow when being seated or take a small cushion or even a folded towel in your hand luggage for this purpose.

      Always keen to hear back if you feel inclined to reply comment

      Best of luck