vagina Archives - Hormones Matter

Sexual Function after Hysterectomy

by WS

Published on January 15, 2018

126928 views

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.

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.

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This article was published originally on April 10, 2014.

Breaking Sexual Taboos

by Chandler Marrs, PhD

Published on April 18, 2013

3032 views

When discussing my writing and research amongst a group of peers recently, I was struck by how quickly the conversation devolved into the more apparently, though not really, salacious articles I have written as of late. Yes, they were about sex and often cursorily about penis size. Mostly though, the articles used the phrase penis size as a vehicle to introduce bad research or media on medically-related topics. Of course, the added benefit of using one of the most popular search phrases on the internet was not lost on me and I used it to my advantage.

In these articles, I pondered our notions about sex and language; sometimes in jest, sometimes in all seriousness, but in each case, it was not the topic of the article that was most intriguing to those in this conversation, it was the blatant use of the taboo words penis size that merited the school-aged giggles from otherwise hyper-educated adults. And so it is, that I have begun to be introduced to folks, not by the serious research and commentary that I do, but by the posts on penises and sex. Yes, mom, I got a PhD to talk about penis size.

The interesting thing is, I know relatively nothing about penis size and frankly, I am learning that few of us do. The subject is taboo and like much of sexual health, riddled more with myth and misunderstanding than actual data. Do women (or men) prefer larger penises or is that merely one component of a complicated sexual dance? Are there racial or geographic differences is size, as myth proclaims or do the larger or smaller among us average out when large data sets are analyzed? Are there data sets about the size to pleasure ratio or is that just too taboo to even consider? Is this something a legitimate researcher should even consider considering (how’s that for a bit of deconstructive thought – thinking about thinking) or does the mere fact I am discussing this topic publicly, obliterate any hope of being taken seriously for my other research? Social mores what they are, it’s probably the latter. That is unfortunate and this is why.

The taboos that define what we can say, see or even know about sex or sexual health seep into every aspect of medical research and certainly political thought. In men’s health, think about circumcision for a moment. How might we approach that differently, if parents were given accurate information about male anatomy – that yes, in fact there are nerve endings that reach all the way to the tip of the penis and that yes, infants do feel pain. Might we not be so ready to lop things off for some biblical, pre-sanitation view of reality? Perhaps, but because we can’t talk about these things openly, we are left with myth to make medical decisions. Grown men know more about the anatomy and physiology of the heart muscle than they do of their own penis. Talk about driving blind.

In women’s health, it’s even worse. The powers of the magical vagina are so strong that even saying the V word can get men or women fired from jobs. Just recently, a high school health teacher was fired for teaching female anatomy and daring to ascribe the proper terminology to the female reproductive organs. In the overly litigious and ridiculously tabooed work environment, I suspect even using the word vagina in polite company might yield claims of sexual harassment (oh, our sensitive ears). And don’t even think about showing pictures of the female pelvic anatomy – that would be porn.

Even common medical imagery of the female sexual anatomy is often neutered with Barbie parts. Really, it is.

This is something that I recently and quite accidentally discovered; medical and scientific renderings of the female pelvic anatomy are not always complete (I suspect similarly incomplete imagery for male anatomy but have yet to investigate). Nerves, blood vessels, and the like, end well before reaching the magical, mystery areas of the female labia and clitoris. Indeed, in many illustrations those regions do not exist but are replaced by neutered Barbie parts. Keep the magic and mystery alive. Who knows what would happen if we were to show those sacred anatomical features. Oh no, women might realize there are nerves down there. Worse yet, physicians might recognize that there are nerves and begin understanding that the ‘psychogenic’ sex pain could be nerve compression. Gads, we’d lose the multi-billion dollar antidepressant industry.

If we can’t have adult conversations about sex or sexual anatomy or accurately portray visual images of human sexual organs without risk of repercussion, how in the world are we to treat diseases that affect said organs? A more fundamental question – would we have more fun if the tools of the trade were more thoroughly understood and appreciated? Perhaps.

Some interesting sites with complete pelvic anatomy and information about male and female nerve damage:

Health Organization for Pudendal Education – bet you never heard of the pudendal nerve. The pudendal nerve is responsible for sensation to the penis and the clitoris. Damage that nerve and you have problems.
Interactive Atlas of the Female Pelvis. This shows how incredibly complex the female pelvic region is. It makes me wonder how much damage we’re causing with cesareans and hysterectomies.

Learn pelvic anatomy. Break the taboos.

A New March Madness – Endometriosis Awareness Month

by Jordan Davidson

Published on March 4, 2013

2614 views

This March I am celebrating a different kind of madness. It has nothing to do with college basketball; nor is it related to four leaf clovers, egg shaped candy or seder plates. No, this March is for reproductive health education and raising awareness about endometriosis. There is nothing nice about endometriosis, even the word is cumbersome to say. This March, we need to talk about endometriosis and reproductive health and we are going to talk about it; because the state of reproductive care surrounding endometriosis is not OK and it’s not going to get better until more people know about endometriosis and the facts surrounding it.

It is estimated that 1 out of every 10 women has endometriosis. Endometriosis is a secondary autoimmune disease that occurs when the endometrium (the lining of the uterus) grows outside of the uterus. Common places for this tissue growth is outside of the uterus, on the fallopian tubes, ovaries, bladder, within the pelvic cavity, on the pelvic floor, and on the bowels. In extremely rare cases endometriosis can be found growing up towards and on the liver, lungs, brain and on the central nervous system. These growths respond to the menstrual cycle the same way that the lining of the uterus does. Each month, the lining builds up, breaks down and then sheds (aka ‘your period’).

When a woman gets her period the broken down lining exits the body as menstrual blood through the vagina. When a woman has endometriosis, the tissue and blood from the endometrial growths found outside of the uterus have no way of leaving the body. This results in internal bleeding and inflammation; both of which can cause chronic pain, infertility, scar tissue formation, adhesions and bladder and bowel complications. Women with endometriosis also suffer from higher rates of allergies, yeast infections, asthma, chronic fatigue, fibromyalgia, other autoimmune diseases (such as hypothyroidism and lupus and others) and increased rates of ovarian cancer, non-Hodgkin’s lymphoma and brain cancer.

There is no cure for endometriosis and treatments leave a lot to be desired. Common treatments include oral contraceptives, GnRH agonists, progesterone therapies, surgery and hysterectomy. Since endometriosis usually appears during the reproductive years, hysterectomy is not a welcomed option and yet is commonly prescribed. Surgery does not cure endometriosis, in many cases the growths reappear within five years. Hysterectomy does not cure endometriosis, with 40% of women see a reoccurrence of their symptoms. There is no cure for endometriosis.

This March we need to raise awareness. It’s not a comfortable topic but that is no reason for millions of women to suffer in silence with no known cure. The discomfort society feels in talking openly about menstruation or uteri or vaginas is no reason to deny any woman the right to proper reproductive care. 1 in 10 women have endometriosis. These women are your friends, neighbors, sisters, co-workers, lovers, girlfriends, cousins, aunts, nieces, mothers, and fellow humans. It takes an average of 7 years to get a proper diagnosis and even longer to find an effective treatment plan (if any). This is about proper reproductive care, about millions of women who are embarrassed to talk about painful periods, about millions of women who suffer in silence. It needs to stop.

This is not a call to arms but a call to uterus(es). This month lets promote reproductive care and raise awareness for endometriosis. Ask me about my uterus, ask those you care about, about their uterus. Yes, it sounds strange, but how else are we to start the discussion and break the stigma against talking about reproductive illness; especially if we can’t even say uterus or vagina without snickering or feeling as embarrassed as a third grader would. Please help us raise awareness this March; share this article, share your story, start a conversation, ask a loved one about their uterus and break the silence!

Vaginal Atrophy – The Great Wall of the Vagina

by Elena Perez

Published on August 27, 2012

6202 views

Does it hurt when you have sex? What about when you pee? Maybe just riding a bike is uncomfortable. This pain or discomfort may be attributed to vaginal atrophy.

Vaginal atrophy, or atrophic vaginitis, is a medical condition that refers to the thinning, drying and inflammation of the vaginal walls. This change in the vagina is due to a loss of endogenous estrogens and may account for discomfort and pain that women feel during everyday activities, such as sex, urination, or exercise.

This condition causes the vaginal walls to become fragile, and good bacteria in the vagina are often replaced by harmful bacteria and fungi. Since the vaginal wall is more susceptible to small tears, the possibility for infection increases.

Endogenous Estrogens

Our bodies naturally make a variety of estrogens. The most common endogenous estrogen is estradiol, which is produced in a woman’s ovaries. The remaining endogenous estrogens include estriol, which is produced by the placenta during pregnancy; and estrone, which is made by the ovaries and the adipose tissue – which is just a nice term for body fat.

Turns out, thin women are more susceptible to vaginal atrophy, which makes sense. Thinner women don’t have as much adipose tissue, so they don’t produce as much estrone. Women with more meat on their hips, however, have more fat tissue, which means they have another means of producing endogenous estrogens should they ever need backup.

Where Did the Endogenous Estrogen Go?

A woman’s endogenous estrogens can be impacted a number of ways. The simple joys of womanhood can affect hormone levels: Estradiol and especially estriol, decline dramatically following childbirth. Estradiol also declines while breastfeeding, and at menopause. In fact, the Harvard School of Medicine reported that within a few years of menopause, 50% of women have symptoms of vaginal atrophy.

Cesarean. Think you’re out of the woods because you haven’t had a child? Studies show that women who have never given birth vaginally are also more likely to have vaginal atrophy, according to Mayo Clinic. This means women who have only had cesarean sections are prone to vaginal atrophy, also.

Smoking. Don’t light up in frustration just yet: Women who are smokers are also prone to vaginal atrophy, which may be due to reduced blood circulation in the vaginal walls.

Cancer. Various cancer treatments can also decrease the production of endogenous estrogens. An oophorectomy, or the surgical removal of the ovaries, is performed to reduce the risk of ovarian cancer, and undoubtedly impacts the production of estradiol. Women undergoing pelvic radiation and chemotherapy can also experience lower endogenous estrogen levels.

Certain breast cancers are sensitive to endogenous estrogens, especially estrone, which encourage the growth of breast cancer tumors. In order to deter tumor growth, breast cancer patients may be given drugs that suppress endogenous estrogens. Sexuality, Reproduction and Menopause published a study that found 90% of breast cancer survivors report sexual problems and symptoms of vaginal atrophy.

Communicate Your Concerns

Although 50% of postmenopausal women and 90% of breast cancer survivors have symptoms of vaginal atrophy, Dr. Deborah Coady, who is the co-authored of Healing Painful Sex, said studies show only 10 to 20% of women discuss vaginal discomfort and pain with their doctors.

In the past, doctors linked vaginal dryness and dyspareunia, or painful intercourse, to emotional problems, discarding the possibility of a physical or hormonal change occurring. Now, however, more doctors are being educated on vaginal atrophy and are in a better position to discuss changes to the vaginal wall.

Oncosexology is developing to properly educate oncologists and patients alike, so they can prepare for the hormonal and vaginal changes that are likely to occur as a result of various cancer treatments.

If your doctor doesn’t bring it up first, though, don’t hesitate to speak up. Dr. Coady recommends talking about any vaginal discomfort, dryness, or pain right away. The longer the pain persists, the more likely it will result in nerve pain and dysfunction of the pelvic floor, so it’s best to diagnose the problem right away.

Treating Vaginal Atrophy

There are a slew of over-the-counter and prescriptions treatments available for women, such as vaginal moisturizers, lubricants, and low-dose vaginal estrogen. A list of these can be found on the Harvard School of Medicine website.

As for natural remedies, Dr. Coady found the application of natural oils, such as vitamin E, safflower, olive, or coconut oil effectively hydrates the vaginal wall when used three or four times a day for a month or two. A friend of mine uses coconut oil as a lubricant during intercourse, and says it works well.

As it turns out, the Harvard School of Medicine notes that sexual intercourse and/or masturbation is also good for your vaginal walls. This sexual activity stimulates blood flow to the vaginal walls, promotes vaginal elasticity, and, when aroused, increases lubrication. The Journal of the American Medical Association published a study that found women who are sexually active report less vaginal atrophy than those who are not, so feel free to get the blood flowing.

If you think you are suffering from vaginal atrophy, don’t suffer in silence. There are ways to improve this condition, and it starts by consulting your doctor and tending to your vaginal wall.

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vagina

Sexual Function after Hysterectomy

Understanding the “Anatomy” of Sexual Function

My Personal Experience Post Hysterectomy

Other Possible Sexual Sequelae Post Hysterectomy

Hysterectomy and Sexual Function

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