ovaries

Hysterectomy’s Best Kept Secret: Figure Changes

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There are many misconceptions about the after effects of hysterectomy. There are a number of reasons for this. First and foremost, gynecologists are not honest with women. They present hysterectomy as merely the end of our ability to have children. A bonus is no more periods. Secondly, their professional society, ACOG, has a lot of influence on government and the media. Therefore, much of the information women find also misrepresents hysterectomy as benign. And last, but not least, most hysterectomized women fail to share the after effects. So it is no wonder secrecy abounds.

Over the years, I have written about many of the deleterious after effects of hysterectomy here, here, and here. Read the comments on any of these articles and see the thousands of women who have suffered. Among the least well recognized of these effects, however, are the figure changes that develop post-hysterectomy; changes that are related to both the anatomical effects of the surgery itself and the hormonal decline that ensues. Figure changes are hysterectomy’s best kept secret.

How Hysterectomy Changes a Woman’s Figure

How does hysterectomy change a woman’s figure? The “bands” (medically known as “ligaments”) that suspend the uterus are also the support structures for our midsection. They keep the spine, hips, and rib cage where they belong. The severing of these ligaments causes our entire torso to collapse. The hips widen, the spine collapses, and the rib cage drops onto the hip bones. This causes a shortened and thickened midsection, protruding belly, and a loss of the curve in our lower backs.

These unnatural changes lead to back and hip problems, loss of mobility, poor circulation in extremities, and chronic pain. Nerve injuries are another source of pain and loss of mobility. “Hysterectomy cripple” is a term from an old gynecology textbook that reverberates in my head. Two of my articles and readers’ comments on this best kept secret can be found here and here. Some women also talk about these changes here.

Other Harms of Hysterectomy

The uterus is essential for a woman’s whole life to keep her healthy. So are the ovaries. And the Fallopian tubes. We were not made to be disassembled. Studies prove it. Yet gynecologists continue to treat the female sex organs as disposable.

Although hysterectomy’s best kept secret is figure changes, there are a number of other harms. Hysterectomy’s effects on the bladder and bowel are explained here. Many women report sexual dysfunction including loss of desire. Feelings of emotional emptiness are common. So is chronic fatigue. Even the ovaries (vital endocrine glands) don’t escape unscathed. Their impaired function causes a whole other set of problems related to the diminished supply of vital hormones. For many, these life altering changes cause break-ups of romantic relationships and families. The effects can also end careers leading to financial hardship and shattered lives. The societal effects are far-reaching.

It is one thing to have cancer and have to live with these trade-offs. But over 90% of these surgeries are unnecessary since less than 8% are done for cancer.

Why Do We Not Know About the Figure Changes?

How can we not know that hysterectomy causes figure changes? Shouldn’t we have noticed this in women who had hysterectomies? Yes and no. Women gain an average of 25 lbs. in the first year after hysterectomy according to the HERS Foundation. That can certainly mask figure changes. Not only that, the torso collapses gradually so is not immediately discernible. And women tend to dress differently in an attempt to hide their altered figures. For women we didn’t know before their hysterectomies, we have no “before” view. Conversely, how much does any woman really critique other women’s bodies anyway? Not so much. Nor can we count on women to divulge these changes just as they fail to share other effects. Proof of this association does not require studies as it is evident from diagrams of the female anatomy. Hence, the reason hysterectomy’s best kept secret is figure changes.

So Much Despair

I had a hysterectomy 13 years ago at age 49. The effects were immediate and severe – physically, mentally, and emotionally. I never could have imagined that a person could age so quickly or feel that their very heart and soul were ripped out! You can read my story here. I quickly realized that my gynecologist of 20 years was dishonest about the consequences. And my medical records show that he also lied about my diagnosis and treatment options.

The changes to my figure amplify the despair that has plagued me since that fateful day. Like the author of the book Misinformed Consent, I cannot bear to look at myself in the mirror. And I shudder to think how much more height I will lose from my already small frame. Even more unsettling is the recent onset of hip and leg pain and midsection discomfort. I fear that reduced blood flow is causing my hip joint to deteriorate (known as “avascular necrosis” or “osteonecrosis”). I know some hysterectomized women who had hip replacements in their 40s or 50s for this reason. Great… more worries about my future health. The thought of any medical treatment, especially surgery, terrifies me!

The Harm of Female Organ Removal

There is long-standing evidence of the harms of female organ removal. Yet, nothing is being done to stop the abuse. It affects almost half of U.S. women. The states’ medical boards don’t care, and neither do legislators. Even women’s health organizations don’t care. Their platform is “reproductive choice.” I guess I was naive to think any of them would care. Then along came the #MeToo movement. I thought this was our opening to make our voices heard. But no. People don’t seem to view this as a form of sexual abuse or harassment. Evidently, perpetrators of surgical crimes against women get a free pass.

The ACOG works hard lobbying Congress and the media to keep it that way. One only need look at the Advocacy menu on their website. Hysterectomy is a big money maker. So maximizing these surgeries and denying the harm is in gynecologists’ best interest. The recent increase in resident minimum requirements from 70 hysterectomies to 85 is evidence of this. There is no training for myomectomy, or removal of fibroids, despite fibroids being a common reason for a hysterectomy. A gynecologist petitioned the ACOG to mandate myomectomy training, to make this uterine-sparing option more accessible. The ACOG rejected his petition. Clearly, the Ob/Gyn specialty puts profits before women’s health.

One has to question why insurance companies continue to authorize and pay for so many unwarranted hysterectomies. What documentation are gynecologists submitting to get these authorizations? My insurance company refused to divulge what my gynecologist submitted to get authorization. I had an ovarian cyst yet my medical records show authorization for a “hysterectomy.” There was absolutely nothing wrong with my uterus or other ovary as proven by pre-op imaging and post-op pathology. He should have removed only the cyst.

Protect Yourself

Don’t allow yourself to be deceived or bullied by a gynecologist. If you do go into an operating room, protect yourself. Modify the consent form to explicitly state what can and cannot be done and removed. Have the surgeon(s) sign off on all revisions.

You certainly don’t want to endure a hysterectomy’s figure changes or any of the other negative effects. The HERS Foundation and Ovaries for Life are good resources for understanding the lifelong importance of the female organs.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, and like it, please help support it. Contribute now.

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This article was published originally on June 13, 2019. 

Hysterectomy: Bad for the Heart and Much More

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A Mayo Clinic study has shown that hysterectomy without removal of ovaries increases the risk of heart disease. Women who had a hysterectomy before age 35 are at a particularly high risk. Specifically, their risk was 4.6-fold for congestive heart failure and 2.5-fold for coronary artery disease. But this association is not new. This 1981 study showed a 3-fold increased risk of heart disease after a premenopausal hysterectomy. This would include most women who undergo hysterectomy. This 1982 study and this one from 1985 cite the uterine substance prostacyclin as the likely factor in women’s heart health. Since about 45% of women have a hysterectomy, it is no wonder heart disease is the #1 killer of women!

Heart Disease: Just the Tip of the Iceberg

Hysterectomy is bad for much more than the heart.

  • Hormone changes. Hysterectomy impairs the function of the ovaries which are part of the endocrine system. Multiple studies have shown this including this one and this one. This would logically predispose hysterectomized women to the same increased health risks and accelerated aging of ovary removal (castration). According to numerous studies such as this one and this Mayo Clinic one, the risks of ovary removal include heart disease, stroke, metabolic syndrome, osteoporosis, hip fracture, lung cancer, colorectal cancer, dementia, Parkinsonism, impaired cognition and memory, mood disorders, sleep disorders, adverse skin and body composition changes, adverse ocular changes including glaucoma, impaired sexual function, more severe hot flushes, and urogenital atrophy. Wow, what a list for such a common and rarely necessary surgery!
  • Figure changes. The uterus and its ligaments are key to the integrity of the pelvis. The cutting of those ligaments, the pelvis’ support structures, destroys pelvic integrity. As a result, a woman’s figure changes. The hips widen and the torso collapses until the rib cage sits directly on the hip bones. This causes a shortened and thickened midsection, protruding belly, and loss of the curve in the lower back making the derrière appear flat. These changes lead to back, hip, and leg problems, chronic pain, and impaired mobility. These effects are discussed here. Back pain after hysterectomy is one of the (many) “dirty little secrets” of Gynecology.
  • Organ dysfunction. The uterus sits between the bladder and bowel and keeps them where they belong. Hence, these organs drop and are adjacent to each other after hysterectomy. These changes can cause dysfunction as discussed here and here.
  • Sexual dysfunction. The uterus is a sex organ. Many hysterectomized women report a loss of sexual function – libido, arousal, and ability to orgasm – with or without ovary removal. Many also report feeling asexual and emotionally empty. This may explain why a renowned gynecologist referred to the uterus as a woman’s “heart center.” How ironic that the uterus is also essential to heart health!
  • Cancer risks. Last but not least, removal of the uterus increases the risk of some cancers. These include thyroid, renal cell (kidney), bladder, rectal and brain cancers.

The Devastating Toll of Hysterectomy

Women’s experiences are also compelling evidence of the devastating effects of hysterectomy. It can affect every relationship and aspect of life having far-reaching societal repercussions. Here, here and here are some heartbreaking stories of shattered lives. The Bleeding Edge documentary chronicles the stories of a few women who were harmed by Essure (tubal sterilization coils) and subsequently had hysterectomies. The HERS Foundation’s recently launched “In My Own Voice” project includes some women’s stories. Hopefully, more will come forward and share their experiences.

The uterus and ovaries are essential to a woman’s whole life. Female organ removal has been proven over and over again to be incredibly harmful as far back as 1912. Yet 45% of women end up having a hysterectomy. And over half are castrated at the same time which further increases the risk of heart disease. Additionally, more women have ovaries removed during separate surgeries. It is no wonder heart disease is the #1 killer of women.

Female organ removal is the biggest healthcare con as discussed here. Lack of informed consent is standard. And even worse, gynecologists commonly use unethical tactics such as instilling fear of cancer and intentionally misinforming women about the consequences. If women knew the facts, very few would consent to hysterectomy or oophorectomy.

In conclusion, the medical industry can no longer put its head in the sand or deny the horrific harm of these surgeries. Only 10% are done for a cancer diagnosis. Yet, it appears that they are gearing up to do even more. The Graduate Medical Education (GME) hysterectomy minimum was recently increased from 70 to 85. When will the ethical medical professionals or authorities address this intentional harm and sexual assault of almost half of U.S. women?

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, and like it, please help support it. Contribute now.

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Image from PxHere; CCO public domain.

This article was published originally on February 12, 2019.

Uterus and Ovaries: Fountain of Youth

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Numerous studies have shown a strong correlation between removal of both ovaries / bilateral oophorectomy (castration) and accelerated aging as measured by an increased risk of chronic health conditions. Hysterectomy / uterus removal with preservation of both ovaries is also associated with some of these chronic conditions. These include heart disease, stroke, metabolic syndrome, osteoporosis, hip fracture, lung cancer, colorectal cancer, dementia, Parkinsonism, impaired cognition and memory, mood disorders, sleep disorders, adverse skin and body composition changes, adverse ocular changes including glaucoma, impaired sexual function, more severe hot flushes and urogenital atrophy. Wow, that’s quite a list!

Ovaries: Health Powerhouses

This 2016 article titled “Study: Remove ovaries, age faster” sums up the findings of Mayo Clinic researchers proving yet again the harmful and unethical practice of ovary removal. The study found that ovary removal (oophorectomy) is associated with a higher incidence of 18 chronic conditions and should be discontinued in women who are not at high risk for ovarian cancer. Although this study cites the increase in chronic conditions in women who undergo oophorectomy before age 46, other studies have shown that oophorectomy even after menopause does more harm than good. Here is one that showed that to be true up to age 75.

The ovaries have both reproductive and endocrine functions as detailed in this International Menopause Society article. After menopause, the ovaries produce mostly androgens, some of which are converted into estrogen. Testosterone levels are more than 40% lower in women without ovaries compared to intact women. Women without their uterus likewise have lower levels but not as low as women without ovaries per this article. Estrogen therapy mitigates some but not all of the increased health risks of oophorectomy. But estrogen further reduces androgen levels increasing risk of osteoporosis and fracture. Nothing can replace the lifelong functions of the ovaries (and uterus).

The Uterus / Ovaries / Tubes Connection

The harms of ovary removal would also apply to ovarian failure that commonly occurs after hysterectomy and some other medical treatments. As previously cited, women who have had a hysterectomy have lower levels of testosterone. According to this 1986 publication, 39% of these women showed signs of ovarian failure. This study showed a nearly 2-fold increased risk of ovarian failure when both ovaries were preserved and nearly 3-fold when one was preserved. This likely explains the increased risk of heart disease and metabolic conditions as shown by multiple studies including this recent Mayo Clinic one. However, per this 1982 study, the uterus itself protects women from heart disease via the uterine substance prostacyclin. Loss of bone density is another harm of hysterectomy as shown by multiple studies such as this one.

Removal of even one ovary (unilateral oophorectomy) without hysterectomy is also harmful. Studies out of the Mayo Clinic showed increased risks of cognitive impairment or dementia and parkinsonism. Colorectal cancer is another increased risk according to this Chinese study and this Swedish one.

The Fallopian tubes appear to impair ovarian function to some degree as evidenced by Post Tubal Ligation / Sterilization Syndrome. This study shows an increase in Follicle Stimulating Hormone (FSH) after tube removal (salpingectomy).

Ovarian impairment after hysterectomy or salpingectomy is thought to be the mechanism of the reduced risk of ovarian cancer which is already rare.

The Uterus: Anatomy, Sex, Cancer Prevention

Hysterectomy is associated with other harms besides impaired ovarian / endocrine function. The uterus and its ligaments / pelvic support structures are essential for pelvic organ integrity as well as skeletal integrity. The effects on these structures and functions are detailed here and here. This article shows the many hysterectomized women lamenting their “broken bodies” – changes to their figures, back, hip and midsection pain, pelvic pain, bladder and bowel issues, and effects of severed nerves and blood vessels.

The uterus and associated nerves and blood vessels play a key role in sexuality and vibrancy. You can hear the desperation in women’s comments about the devastating sexual losses and feelings of emotional emptiness.

There is an increased risk of renal cell, thyroid, and colorectal cancers after hysterectomy. How ironic when cancer fear tactics are commonly used to market hysterectomy and/or oophorectomy.

Adhesions that commonly form after these surgeries can cause serious problems especially in the long term. Surgical complications – nerve injuries, bladder, bowel and ureter injuries, vaginal cuff dehiscence, a too short vagina, infections, hemorrhage – are more common than indicated by gynecologists.

Although “The Miraculous Uterus” article fails to mention the anatomical harms, it is otherwise “spot on.” It talks about the “ovarian conservation scam” and that “passion, love, ecstasy, the emotional essence that drives human achievement, forever after elude them.” This explains why “there’s no effective outrage against the barbarism of hysterectomy.”

Compelling Evidence of Harm

Clearly, there is compelling medical evidence that both hysterectomy and oophorectomy are destructive surgeries. Unfortunately, some hysterectomy forums censor negative posts giving a slanted view of the life shattering effects. Here is a sampling of women’s experiences on the Gyn Reform site.

The medical literature on the harms of these surgeries dates back over a century. Listed below are a small number of the numerous publications (minus the ovarian failure studies cited above). The Gyn Reform website has a fairly comprehensive list of resources on oophorectomy. Its Ovaries for Life sister site provides a good overview of the lifelong importance of our ovaries.

1912 – The Physiological Influence of Ovarian Secretion

1914 – Nervous and Mental Disturbances following Castration in Women

1958 – The controversial ovary

1973 – Osteoporosis after Oophorectomy for Non-malignant Disease in Premenopausal Women

“Oophorectomy before the age of 45 years was found to be associated with a significantly increased prevalence of osteoporosis within three to six years of operation.

1974 – Endocrine Function of the Postmenopausal Ovary: Concentration of Androgens and Estrogens in Ovarian and Peripheral Vein Blood

1978 – The emotional and psychosexual aspects of hysterectomy

1981 – Premenopausal hysterectomy and cardiovascular disease

1981 – Sexual response after hysterectomy-oophorectomy: Recent studies and reconsideration of psychogenesis

1981 – The role of estrogen and oophorectomy in immune synovitis

1982 – Prostacyclin from the uterus and woman’s cardiovascular advantage

1989 – The effects of simple hysterectomy on vesicourethral function

“The results show that simple hysterectomy is associated with a significant incidence of post-operative vesicourethral dysfunction and that there is an identifiable neurological abnormality incurred at operation which is pertinent to the subsequent disordered voiding.

1990 – Effects of bilateral oophorectomy on lipoprotein metabolism

1994 – The climacteric ovary as a functional gonadotropin-driven androgen-producing gland

1996 – Urinary incontinence in older women: who is at risk? Study of Osteoporotic Fractures Research Group

“Urinary incontinence is a common problem in older women, more common than most chronic medical conditions. Of the associated factors that are preventable or modifiable, obesity and hysterectomy may have the greatest impact on the prevalence of daily incontinence.

1997 – Bladder, bowel and sexual function after hysterectomy for benign conditions

1998 – Ovaries, androgens and the menopause: practical applications

1998 – Impairment of basal forebrain cholinergic neurons associated with aging and long-term loss of ovarian function

1998 – Influence of bilateral oophorectomy upon lipid metabolism

1999 – Estrogen and movement disorders

2000 – The hypothalamic-pituitary-adrenal and gonadal axes in rheumatoid arthritis

2000 – Risk of myocardial infarction after oophorectomy and hysterectomy

2000 – Hysterectomy, Oophorectomy, and Endogenous Sex Hormone Levels in Older Women: The Rancho Bernardo Study

2005 – Ovarian conservation at the time of hysterectomy for benign disease

Ovarian conservation until age 65 benefits long-term survival…. There is sustained, but decreasing, benefit until the age of 75, when excess mortality for oophorectomy is less than 1%.

2007 – Ovarian conservation at the time of hysterectomy for benign disease

Approximately 78% of women between the ages of 45 and 64 years have prophylactic oophorectomy when hysterectomy is performed for benign disease. Therefore, the decision to perform prophylactic oophorectomy should be approached with great caution for the majority of women who are at low risk of developing ovarian cancer.”

2009 – Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses’ health study

In no analysis or age group was oophorectomy associated with increased survival.

2010 – Current indications and role of surgery in the management of sigmoid diverticulitis

A previous history of hysterectomy is a valuable clinical clue to the correct diagnosis as colovaginal and colovesical fistulas are rare in females with their uterus in place, as the uterus becomes a screen interposed between the inflamed colon and the bladder and vagina.”

2012 – Oophorectomy for whom and at what age? Primum non nocere

2016 – Study: Remove ovaries, age faster

2017 – Cardiovascular and metabolic morbidity after hysterectomy with ovarian conservation: a cohort study

A Harmful Practice That Won’t Die

Ovary removal / castration was introduced by Robert Battey in 1872 and “was practised widely for several decades….. Better insight into female physiology and ovarian function finally pushed the sinister operation of Robert Battey from the scene.” This publication refers to Battey’s operation as “barbaric.”

Despite the long-standing and compelling evidence of harm, these surgeries continue at alarming rates. Publications are misleading in that they report inpatient surgeries despite the large majority being outpatient (70% in 2014). This 2008 article reported that oophorectomies “more than doubled in frequency since the 1960’s.” According to results of a FOIA request by Ovaries for Life, there are over 700,000 oophorectomies every year despite there being only ~22,000 cases of ovarian cancer. Hysterectomy figures obtained by Ovaries for Life are also shocking at 830,000 in light of less than 70,000 cases of endometrial and cervical cancers.

Many media reports have questioned the high rate of these surgeries since gynecologic cancers are rare. The oldest one I could find was dated 1969. I found about three articles per decade in the mainstream media since then. According to the Athena Institute, half of U.S. medical schools in 1986 “had changed their suggestions and were now recommending a reconsideration of the common practice of ovariectomy.” Evidently, that never took hold.

Congress held two hearings on hysterectomy, one in 1976 and one in 1993. The 1993 transcripts state that the hysterectomy rate increased 250% in women ages 15 to 24 and 186% in ages 25 to 34 from 1965 to 1984! Despite these shocking statistics, it appears that no action was taken after either hearing.

According to this “Reassessing Hysterectomy” article, the Agency for Healthcare Research and Quality sponsored research and conferences on the overuse of hysterectomy in the 1990’s. This article is packed with information on the prevalence and harms of hysterectomy and oophorectomy as well as alternative treatment options. Yet, the high rate of hysterectomy has continued such that 45% of women will end up having one. Citing 2006 data, the oophorectomy rate was 73% of the hysterectomy rate.

How to End the Harm?

I’ve been researching this subject for over 10 years and sharing my experience and knowledge on various websites. It’s shocking how many women are misled and deceived into these surgeries. Age doesn’t seem to matter; younger and younger women are undergoing these surgeries. This appears to be the biggest surgical racket and women’s healthcare con as discussed here.

There are a number of issues that perpetuate the gross overuse of these harmful surgeries. These include:

  1. These surgeries and “forever after” care are very lucrative.
  2. The public has been led to believe that the female organs are disposable after childbearing is complete.
  3. Medical education and decades of practice have made these surgeries “a standard of care.”
  4. Informed consent is seriously lacking.
  5. Gynecology consent forms are open ended giving surgeons “carte blanche” to remove organs unnecessarily.
  6. We still live in a climate of gender disparity / male dominance.

As you can see from the list of publications above, some study authors have called out the practice of ovary removal as unethical. Numerous professional societies have issued guidelines discouraging its use in most women. But most have been silent on the overuse of hysterectomy despite its many harms.

Why has our government not stepped in to address this egregious harm? Women who have contacted their legislators have been met with indifference. Gyn Reform reported on their experiences with legislators and other authorities who can effect change. The non-profit HERS Foundation has been educating women and advocating for informed consent legislation since the 1980’s.

Why do insurance companies approve so many of these surgeries that are rarely necessary? Not only are the surgeries themselves expensive, treatments for the chronic after effects are costly. Reining in unnecessary treatments especially those that cause lifelong harm would go a long way towards making healthcare more affordable.

Why has Graduate Medical Education (GME) not changed their surgical requirements to favor organ preservation? Each resident must do at least 70 hysterectomies but there is no requirement for myomectomy (fibroid removal). Residents don’t need to do any cystectomies (cyst removals) either which is partly why so many women lose ovaries for benign ovarian cysts. Here are the GME ob/gyn requirements.

A popular mantra at Tufts in the 1970’s – “There’s no room in the tomb for the womb” – reflects this culture of the disposable uterus and gynecologists’ obsession with its removal. Insurance reimbursement rates are also to blame as they incentivize hysterectomy and oophorectomy over myomectomy and cystectomy. In many cases, medical management versus surgery is the appropriate course. The “Reassessing Hysterectomy” article cited above lists a number of treatment options for gynecologic problems. Revamping reimbursement rates to strongly favor organ preservation should eventually force GME to change their requirements. But how do we make that happen?

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

Lucas Cranach the Elder, Public domain, via Wikimedia Commons

Sexual Function after Hysterectomy

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Whether a hysterectomy will affect sexual function is a common concern amongst women considering the surgery, as well it should be. Sex is a vital part of life and the loss of sexual function can be devastating. Whether and how hysterectomy affects sexual function is not very clear, however, and depends upon a number of variables, not the least of which is sexual function pre-hysterectomy, and particularly, pre-gynecologic problems. In many cases, women have a hysterectomy to rectify conditions associated with heavy bleeding and/or excessive pain like fibroids, endometriosis, adenomyosis and cysts. Reducing pain and bleeding should positively affect sexual frequency; however, effects on function may vary. Hysterectomy can diminish sexual function either directly because of the disconnection of the nerves and blood vessels that supply sexual energy or indirectly via the loss of critical hormones when or if the ovaries are removed or cease to function. And for many women, those with endometriosis, the hysterectomy itself provides only temporary relief from the disease process.

When evaluating the possibility of having a hysterectomy relative to sexual function outcomes, there are a few things women must consider.

Understanding the “Anatomy” of Sexual Function

According to Masters and Johnson, there are four phases of sexual response – Excitement, Plateau, Orgasm, and Resolution.

Sensation to any body part requires proper nerve conduction and adequate blood flow. Many nerves, blood vessels, and ligaments are severed to remove the uterus. The uterus and its ligaments themselves are rich sources of blood supply. As a result, sensation to the vagina, clitoris, labia, and nipples can be diminished by hysterectomy. This loss of sensation can hamper sexual function.

The Excitement phase is triggered by sexual stimuli, either physical or psychological. The stimuli triggers increased blood flow (vasocongestion) to the genitalia. With a blood vessel and nerve network altered by hysterectomy, this process may be hampered.

Contractions of the uterus are listed as a part of the Orgasm phase. So without a uterus, orgasm is not complete. Hence, it would make sense that orgasm is negatively impacted by hysterectomy, ovary removal or not. I have read, however, that some women do not experience uterine orgasm. So for them, a hysterectomy may not affect their orgasms.

My Personal Experience Post Hysterectomy

I realized very quickly after my hysterectomy that my libido, arousal, and ability to orgasm were broken. A steamy sex scene in a novel or movie or a hot looking guy no longer elicited sexual feelings. And the thought of sex was repulsive. That was a very sad day for me and I still mourn the loss of my intact sexuality. Some may question whether these changes are really due to the loss of my uterus or more so from the loss of my ovaries. When my hormone replacement was inadequate, the thought of sex was repulsive. However, I did have occasional orgasms but they were difficult to achieve and very infrequent as well as disappointing compared to before hysterectomy. Before my surgery, I had a good libido and an intense uterine orgasm every time I had intercourse. I have been on a good hormone regimen for over 6 years now. Sex is no longer repulsive but I do not have a libido or feel sexual in any way. Arousal takes much longer and orgasms are still weaker than before hysterectomy, do not always happen, and rarely occur during intercourse. Testosterone did not improve libido or arousal nor improve orgasm frequency or quality. Nipple sensation has been absent since surgery. These losses to my sexuality have affected my marriage relationship as well as social and professional relationships as I lack what I would call “sexual energy” and confidence.  

Other Possible Sexual Sequelae Post Hysterectomy

Removing the Cervix. The changes to the vagina after hysterectomy can further hamper sexual function. The removal of the cervix (the lower part of the uterus) requires that the vagina be shortened and sutured shut. This is called the vaginal cuff. The shortened vagina can present problems with deep penetration. Also, the vaginal cuff sutures can tear (dehiscence) which is a serious medical problem, although this is rare. Retaining the cervix eliminates these concerns and may preserve some of the nerves and sensation. During sex, the tip of the penis is “grabbed” by the cervix enhancing the man’s pleasure. However, even if the cervix is retained, this “grabbing” sensation may not occur without the uterine contractions.

emale sexual function after hysterectomy

Reduced Lubrication. Many women report diminished vaginal lubrication post-hysterectomy even when ovaries are not removed. Lubrication is critical for sexual activity as well as sensation. When the ovaries are removed or fail from the loss of blood flow, lubrication is lost and the vagina atrophies making sex painful. Over time, the vagina may prolapse as it no longer has the uterine ligaments to anchor it. Changes to bladder, bowel, and vagina position and function post-hysterectomy can likewise affect sexual function and satisfaction. A falling vagina and urgency and incontinence are certainly not sexy!

Body Changes. The hysterectomy induced changes to a woman’s figure which include a thick, shortened midsection and protruding belly are another source of sexual dysfunction and anxiety. Appearance changes from hormonal effects such as hair thinning, graying, and texture changes, skin dryness and aging (including loss of plumpness and pinkness in the genitalia), and loss of muscle mass and tone can also negatively impact sexuality. I have written about the anatomical and skeletal effects of hysterectomy here and here.

Emotional Changes. Many hysterectomized women with whom I have communicated report a loss of feeling connected to others including their loved ones. At first I thought the loss of my romantic and maternal feelings was solely attributed to the loss of my ovaries (despite taking estrogen). But after hearing from other women who still had functioning ovaries and reported the same feelings, I realized that maybe our uterus is what makes us loving and social beings. A renowned gynecologist on a talk show a few years after my hysterectomy referred to the uterus as “a woman’s heart center.” And for women love and sex are very much intertwined.

Hysterectomy and Sexual Function

Why is it that so many dismiss sexual problems post-hysterectomy as psychological? If a man has his prostate and/or testicles removed or penis shortened (heaven forbid!), sexual problems are attributed to the loss or surgical alteration of his SEX organ(s). So why would it be any different for women?

Although there have been some studies on sexual function after hysterectomy, I have not been able to make much sense out of them. It seems that most use a benchmark of (impaired) sexual function shortly before hysterectomy when gynecologic problems impede sexual activity and function versus prior to the gynecologic problems that are the reason for the hysterectomy. This observational study compared sexual pleasure, activity, and problems by type of hysterectomy at 6 months post-operative. It concluded that “sexual pleasure significantly improved in all patients, independent of the type of hysterectomy.” However, it also concluded that “the prevalence of one or more bothersome sexual problems six months after vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy was 43% (38/89), 41% (31/76), and 39% (57/145), respectively.” With these high rates of “bothersome sexual problems” I cannot imagine how this could have been an improvement. However, if the benchmark was based on the time frame when pre-operative heavy bleeding, discomfort, or pain impaired sexual activity and function, then it would certainly be possible for sexual function to improve post-operatively. That does not mean it was an improvement over NORMAL sexual function (pre-gynecologic problems).

This Boston University School of Medicine article discusses post-hysterectomy sexual dysfunction. It says,

“Desire, arousal, orgasm and pain disorders may all be seen post-hysterectomy…..Internal orgasms are often changed significantly after hysterectomy. This is observed in part due to the inability to have rhythmic contractions of uterine muscles without the uterus present. Also, internal orgasms are changed after hysterectomy due to injury to the nerves which pass near the cervix. Surgeons should try to spare these nerves, but efforts to spare them are limited at the present. The result is that after hysterectomy, many women lose the ability to have an internal orgasm.”

Changing the Mindset: Removing a Woman’s Sex Organs Impairs Sexual Function

First and foremost, we need to stop referring to women’s sex organs as reproductive organs since they have vital, lifelong functions far beyond reproduction. In addition to the sexual functions, these include endocrine/hormonal, bladder and pelvic floor and anatomical and skeletal as detailed in my articles and the HERS Foundation’s video.

Secondly, women need to be more open about the effects hysterectomy has had on their health and quality of life, sexual and otherwise. It seems that some do not connect their problems with the surgery and many others choose not to talk about it. Before surgery, we are likely to believe that hysterectomy is fairly harmless since it is such a common surgery (second to c-section). No surgery is harmless. One that removes a woman’s sexual organs cannot help but cause problems with sexual function.

Some other factors that may be in play are that women seem to value their sex lives less than men. We tend to shortchange ourselves in other areas as well, putting others’ needs ahead of our own. Women of older generations were taught to trust and obey authority figures. So we typically trust our doctors and follow their recommendations. We are particularly vulnerable with gynecologists as we tend to have a long history with them through annual well woman checkups and pregnancies and deliveries. We are easy prey for hysterectomy marketing.

Clearly, there are far too many women being harmed by unwarranted hysterectomies and castrations. According to this 2000 study, 76% of hysterectomies do not meet ACOG criteria. Yet the rates have not declined and the use of robotics seems to be fueling even more hysterectomies with promises of quicker recoveries. Hysterectomies are big business with revenues rolling in to the tune of over $16 billion annually. With so much money at stake, we cannot count on the medical establishment to restrain themselves. It is up to us to spread the word.

Does Hysterectomy Affect Sexual Function?

Yes, it does. How can it not, given the nature of the surgical procedure? Whether the effects are generally more negative or positive is not clear. It largely depends on the reason for the hysterectomy including the severity and prolonged nature of those gynecologic problems. There is very little research and even less consideration or conversation regarding women’s pre- and post- hysterectomy sexual functioning. That is something we can change together by sharing our stories and communicating our needs.

Additional Resources

I highly recommend the non-profit HERS Foundation’s video “Female Anatomy: the Functions of the Female Organs.” It taught me most of what I know about the consequences of hysterectomy and/or ovary removal (castration). When I first discovered the video, some of it did not make sense. But as more time elapsed, the changes became clearer. My body and life have changed in ways I never could have imagined. I only wish I had found the video prior to my unwarranted hysterectomy.

We Need Your Help

Hormones Matter needs funding now. Our research funding was cut recently and because of our commitment to independent health research and journalism unbiased by commercial interests we allow minimal advertising on the site. That means all funding must come from you, our readers. Don’t let Hormones Matter die.

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This article was published originally on April 10, 2014. 

Why Hormones Matter

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I’ve been writing for Hormones Matter for several months now and I’ve been thinking a lot about just how much hormones really do matter. After all, we’re all only alive because of hormones when you get right down to it. Yet, most of us give very little thought to our hormones or why they matter until we’re forced to do so for some reason.

As young adolescents, we’re taught mostly in health class that hormones prompt our bodies to develop into those of men and women. We recognize that underarm and pubic hair growth is an indication that all is going well. Boys voices deepen and girls develop breasts. New sexual feelings slowly emerge and the world takes on new meaning and all things become more colorful. We become alive as it were and suddenly have another purpose – that of connecting sexually and of reproducing at some point. There’s a good amount of information about how hormones influence sex and reproduction. Sadly, the information seems to mostly end there. It wasn’t until my hormone-producing organs were removed through an unconsented hysterectomy and bilateral salpingo oophorectomy that I began to realize how much my hormones had mattered.

In simplest terms, hormones are chemical messengers which travel through our blood and enter cells, tissues and organs where they turn on switches to the genetic machinery that regulate everything from reproduction to emotions, overall health and well being. Certain hormones have an effect on particular cells known as ‘target cells’. A target cell reacts to a particular hormone because it bears receptors for that hormone. This is why there’s never a time in a woman’s life when she doesn’t need hormones. Hormones can be thought of as the life giving force that ‘animates’ us physically, mentally, emotionally and even spiritually. When a woman undergoes hysterectomy, hormone-producing organs are permanently removed and hormones are lost forever. It’s important to know that hormones aren’t only involved in the production of a new life (as in baby in the womb new life), they sustain all life.

Realizing How Much Hormones Matter

At the time of my father’s death from a massive heart attack in 2009, I was still reeling from hysterectomy and ovary removal in 2007. I’ll never forget the first time I saw my father’s body after he passed away. It hit me really hard to see him full of life one day and then see him completely and utterly lifeless the next. It hit my son Christopher even harder I think. I’ll never forget his comment as he looked at his grandfather’s ‘lifeless’ body just before the dreaded funeral. He said matter-of-fact like “Papaw’s spirit is gone. There’s no more animation.” Christopher’s observation was a very profound one indeed. In a very real sense, I suppose that is what death means – no more animation. I’d never thought of it exactly like that before.

Suddenly, I couldn’t help but think about how much I had changed since hysterectomy. It was as if the very life had been sucked right out of me too. I wasn’t dead, but I wasn’t really alive either – at least not in any way that mattered. Along with the loss of my female organs, I had lost my animation in many ways too. My eyes no longer sparkled. My skin no longer glowed. All things became dry, dull and lackluster. Everything became an effort and ‘feelings’ were no longer present. Remember how it felt when you became sexually aware? Well think of the opposite of that. While I once viewed the world in living color, things appeared mostly grey to me after hysterectomy and the loss of hormones. In short, I lost my animation.

Beyond reproduction and the other physiological functions ovarian hormones control, in many ways, these hormones animate us. They provide the subtle nuances that make life interesting – a life giving force that colors our physical, mental, emotional and even spiritual selves. To be animated is to have life, interest, spirit, motion and activity. What happens when a woman undergoes hysterectomy and castration? Pretty much the same thing that happens to a man who is castrated, she loses her animation, her color – everything that makes life interesting and worth living disappears. And this is on top of the health issues that arise from the loss of hormones.

There can be no question that hormones matter. It is too bad that we don’t know this until after they are gone. Please give this much thought before ever agreeing to removal of your hormone-producing and life-sustaining organs. Always weigh the benefits and risks.

Hysterectomy Research

Hormones Matter is conducting research on hysterectomy outcomes. If you have had a hysterectomy, please take a few minutes to complete The Hysterectomy Survey.

Gynecologists, What’s Your Problem With Our Ovaries?

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The New York Times recently reported that only 37% of women receive proper treatment for ovarian cancer, mostly because gynecologists do not follow guidelines set out by ACOG (American Congress of Obstetricians and Gynecologists) and the NCCN (National Comprehensive Cancer Network). This information was taken from a study led by Dr. Robert E. Bristow, director of gynecologic oncology at the University of California, Irvine. Sadly, the study revealed that most women with ovarian cancer or a suspicion of ovarian cancer are simply not being directed to surgeons who specialize in treating cancer and specifically, gynecologic cancers.

According to Dr. Bristow, just making sure women get to the people who are trained to take care of them would improve the odds in the fight against ovarian cancer than any new chemotherapy drug or biological agent. Even ACOG agrees that women with pelvic masses indicating a high suspicion for ovarian cancer should be managed by physicians with the training and experience that offers the best chance for a successful outcome. Generally speaking, OBGYN’s lack this type of experience because ovarian cancer is so rare. Shockingly, more than 80% of the women in the study were treated by what the researchers call ‘low volume providers’ – surgeons with 10 or fewer cases a year and hospitals with 20 or fewer.

This story really hit a nerve with me for many reasons, but mainly because the guidelines are being ignored. Most women do not know that they need to be referred to a gynecologist specializing in oncology and it appears most docs are none to keen to tell them. These aren’t the only guidelines gynecologists ignore, by the way. When one considers that only 30% of OB/Gyn clinical practice guidelines have actual evidence behind them, it makes me wonder what the heck is going on with women’s healthcare today.

When I read that only 37% of women with ovarian cancer were receiving the proper care, I immediately thought of how I was subjected to improper clinical care. You can read my full history here.

Briefly, my healthy ovaries were removed during a routine hysterectomy, placing me at a much greater risk for heart disease. The removal of my ovaries and in fact the hysterectomy itself, was against clinical guidelines.

Women with ovarian cancer rarely receive proper treatment while women with no cancer often receive radical over-treatment.

Houston, we have a problem! When it comes to women’s ovaries, gynecologists too often just can’t get it right. Or maybe they just don’t want to… Of the 600,000 hysterectomies performed each year, 73% are estimated to involve ovary removal. Since 90% of all hysterectomies are considered to be medically unnecessary in the first place, this is a huge problem. Even more disturbing is the fact that less than 1% of women whose healthy ovaries are removed have a family history of ovarian cancer. One has to ask why gynecologists are routinely removing healthy ovaries from so many women – especially given the many serious health risks.

There are guidelines in place regarding the indication for hysterectomy and ovary removal. Yet, those guidelines are not followed. A whopping 76% of hysterectomies do not meet ACOG’s own criteria. The most common reasons hysterectomies don’t meet criteria and are considered to be inappropriate are lack of adequate diagnostic evaluation and failure to try alternative treatments before hysterectomy.

Gynecologists routinely rush women into surgery without trying other options first, including doing nothing other than ‘watch and wait’ in some cases. Clearly, women aren’t receiving proper care all the way around regarding ovarian cancer nor are they being properly informed about the alternatives to hysterectomy. Whether we’re talking about birth control, HRT, ovarian cancer or hysterectomy, it pays for women to become educated about their health and their healthcare options. It may save their life.

Of Stocks and Hormones: Why Your Ovaries Are Like the Dow

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Starting a company is always difficult; starting one during the great recession is just mad. And then to launch the website and blog days following one of the largest stock market downturns in history…well that’s just damned unfortunate. Or is it? Maybe there is no better time to build something than when everything else is failing.

Why talk about the market as an introduction to a website about women’s hormones? In some strange way there are similarities. A negative earnings report from one company or civil unrest halfway around the world can send the entire U.S. market into chaos for reasons that even renowned economists can’t completely explain. Hormones have similar, intricate connections with one another. Even a small change in one hormone can cause widespread disruptions throughout the endocrine system and have major health consequences. And much like market fluctuations, even experts have a hard time explaining exactly what happened.

The market is fluctuating wildly because of underlying structural inequities and a failure to measure and manage the appropriate indices. Women’s health suffers because of inequities in funding and access and the failure to measure and manage the appropriate indices – hormones. While pundits and politicians are eager to assign blame for the latest economic crisis, debates in women’s hormone research often devolve into accusations of ‘fringe science’ and ‘poor methods’. We all see the same problem, but we argue over ideology instead of just doing something about it.

At Lucine, we’re doing something. We’re launching a company devoted entirely to understanding women’s hormone health…in the worst economy since the great depression. Neither the puns nor the obstacles escape us.

So here we are, at the inaugural publication of Hormones MatterTM. We don’t have all the answers. We don’t know if what we’re doing will work. All we know is that it’s time to act. And we need your help.

As a first step, we are changing the conversation. I think, as women, we can all agree; hormones matter. It’s a simple concept, but one not readily accepted in all circles. Once we show that hormones matter, then we can move to the next premise; stuff that matters merits research, measurement and, above all, respect.
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