Is there sex after hysterectomy?

Q: I had a hysterectomy in 1996  at the age of 34 due to fibroids on the uterus. I regret that decision and wish I had gotten a second opinion. The doctor did not tell me what to expect, nor that there were other options. Since that time my sex drive has ceased to exist. My new OB/GYN tells me that it is all in my head. I disagree. Am I correct in thinking that something happens to the libidos of women who have hysterectomies? Is there anything I can do to get my sex life back?

A: You raise a lot of good questions. Fibroids are the leading indication for hysterectomy in this country, and if a woman has finished her childbearing and has large symptomatic fibroids, taking out her uterus is a reasonable option. However, if she wants to keep her uterus, a procedure known as myomectomy, or just removing the fibroids, is usually possible.

The major issue is how uterine removal affects a woman. If a woman has uterine contractions as part of her orgasmic response, that will go away with a hysterectomy. However, the removal of the uterus should not affect vaginal contractions with orgasm.

Hormonal changes are also an issue. Some gynecologists believe that hysterectomy can lead to earlier menopause, by altering blood flow in the pelvis. If that happens, you will lose estrogen and testosterone earlier too. The average age of menopause is 51, so it is entirely possible that now, at 50, your levels of both hormones are fairly low. Nobody knows exactly what mediates sex drive, but most physicians believe it is a combination of estrogen and testosterone. You would be a good candidate for supplementing a combination of both hormones, either in oral form (a medication such as Estratest), or estrogen patches and topical testosterone cream, applied to the labia directly. It is likely you would have a good response.

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