About last night: how will a hysterectomy affect me?

June 12, 2017

Q: I’m 42 and happily partnered.  I’ve been told that I have several large fibroids growing in my uterus, and my medical specialist has recommended I have a hysterectomy, which removes my uterus, but leaves my ovaries. I’m concerned that if my cervix is removed as part of the hysterectomy, my sexual pleasure and orgasm might be affected.  What role does the uterus and cervix play in orgasm? 

A: Fibroids are firm, compact tumours that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. It is estimated that between 20 and 50 per cent of women of reproductive age have fibroids, and up to 77 per cent will develop fibroids sometime during their childbearing years, although only about a third of these are large enough to be detected during a physical examination. Fibroids are usually benign, and are not associated with cancer, but they can cause a range of symptoms, including heavy and irregular bleeding, an increased need to urinate, or pelvic discomfort.

All women are different, and experience sexual pleasure in diverse ways. The deep network of nerve endings that make up the internal structure of the clitoris plays a major role, so surgeries that might cut through these, such as bladder surgery, can have an impact.

I showed Melbourne gynaecologist Dr Desiree Yap your letter. “That is a complicated question,” she responded. “I have always understood that some women feel their uterus contract with orgasm and some women get pleasure from stimulation of their cervix. I ask women to reflect on what they feel, as I can’t assess that.”

Consciously notice exactly what is happening in your body the next time you have an orgasm. Where is the sensation centred? Can you feel your cervix contracting? Understanding your unique arousal patterns will help you to make an informed decision.

Dr Wendy Vanselow, the head of the Royal Women’s Hospital’s Sexual Counselling Clinic, has a particular interest in this area. She says that the research indicates that most women feel their most focused sexual pleasure in the lower vagina.

This would not be affected by a partial hysterectomy. She also points out that hysterectomy research shows that overall sexual pleasure is improved with hysterectomy.

A total hysterectomy that involves the removal of the hormone-producing ovaries definitely does have a negative affect on libido, and sexual function – but this is not what has been proposed in your case.

Many women experience a hysterectomy as a major operation from which it can take time to recover. Dr Yap suggests that you get a second opinion if you’re worried.

So, double-check your options. For example, some fibroids that are about 3-5 centimetres in size can, depending on their place and impact, just be left there, Dr Yap says.

On the other hand, if surgery is necessary, but you want to keep your cervix, a subtotal hysterectomy (which leaves it behind) is possible. Ongoing pap smears would subsequently be required.

You may prefer to explore non-surgical options. “There is a new drug to shrink fibroids,” says Dr Yap. “Blood flow to fibroids can be blocked to try and shrink them, and there is an MRI treatment to conservatively treat fibroids being trialled at the Royal Women’s Hospital, so, depending on [your] circumstances, there are alternatives to surgery.”

Meanwhile, take a holistic approach to your sex life. Try not to worry, or fixate on the purely medical and physical aspects of sexual pleasure. Remember to nurture your relationship, take care of your overall wellbeing, and enjoy every aspect of your intimacy. After all, great sex is about enjoying the journey, not reaching an orgasmic destination.

Email your questions to abtlastnight@gmail.com

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