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Painful Sex After A Hysterectomy

by Allyson Augusta Shrikhande, MD, CMO

Painful sex can be a difficult thing to talk about. The millions of women who experience pain during intercourse, or dyspareunia, can have feelings of frustration and embarrassment. It can be particularly frightening for those who experience these symptoms after undergoing a total hysterectomy. Surgical removal of the uterus is sometimes a necessary procedure - hysterectomies are the second-most common surgery for women - but the post-surgery effect on the body can be distressing and disorienting.

While painful sex in the aftermath of a hysterectomy is not entirely uncommon, it is also not something that should be ignored. Some pain and discomfort while recovering from surgery is to be expected, but debilitating pain that prevents you from having a fulfilling and enjoyable sex life is a medical issue. It’s important to know what to expect from sex after your procedure, and to be aware of the signs that something is wrong.

How long should you usually wait to have sex after getting a hysterectomy?

After a hysterectomy you need to wait until you receive clearance from your surgeon to have intercourse again. In most cases, your surgeon will clear you to have sex again during follow-up 6-8 weeks after the surgery. However, everyone heals at a different pace and every surgery is unique. You know your own body best. Don’t try to rush attempting intercourse before you’re comfortable and not in pain.

How do hysterectomies change the way you have sex? Will I still experience an orgasm?

It depends on multiple factors, including the reason for your hysterectomy and your level of pelvic floor function prior to the surgery. After healing from the procedure, most people return to their baseline level of sex life and are able to achieve orgasm just as before. If the ovaries were removed, menopause may be induced and the hormonal changes may contribute to discomfort with intercourse or a lack of arousal.

What causes dyspareunia after a hysterectomy?

Sexual pain after a hysterectomy may be due to scar tissue that may be irritating muscles and nerves. It may also be caused by pelvic floor muscle and nerve dysfunction that was present prior to surgery. This will still be present as a hysterectomy will not treat pelvic floor muscle and nerve dysfunction. Pre-existing conditions such as endometriosis and hypermobility may increase your likelihood of experiencing painful intercourse following hysterectomy. Rehabilitating your pelvic muscles and nerves after a hysterectomy can help you enjoy sex again and improve the function of your pelvic muscles and nerves.

How can these issues be treated?

In many cases, there are non-medicinal routes you can take to make sex more pleasurable. Natural lubricants such as emu oil or coconut oil can help reduce entrance pain during intercourse, and a yoga regimen focused on rehabilitating the pelvic floor can speed recovery following surgery (Dustienne Miller’s Your Pace Yoga has been helpful for many of my patients).

If medical intervention is necessary, there are a number of non-invasive treatment routes available. Pelvic floor physical therapy can help relieve the muscle spasms that frequently cause pain. Your physical therapist can also guide you through a home exercise program. For nerve pain, suppositories can be prescribed to deliver muscle relaxers or other medications. In some cases, patients have seen positive results from alternative methods such as acupuncture and craniosacral therapy.

At Pelvic Rehabilitation Medicine, we also offer external ultrasound guided trigger point injections in combination with peripheral nerve blocks, a state-of-the-art protocol designed to improve blood flow to the pelvic floor muscles and nerves. This is a functional, restorative approach to post-operative rehabilitation of the pelvic floor.

You can have a healthy sex life after hysterectomy.

A hysterectomy can have profound and confusing effects on your body, but there is generally no reason why you shouldn’t be able to have a fulfilling sex life following your operation. If post-hysterectomy pelvic pain is preventing you from enjoying intimacy, don’t be afraid to reach out for help - treatment options are available, and a pelvic pain specialist can help find the right one for you.

Dr. Allyson Shrikhande, a board certified Physical Medicine and Rehabilitation specialist, is the Chief Medical Officer of Pelvic Rehabilitation Medicine. A leading expert on pelvic health and a respected researcher, author and lecturer, Dr. Shrikhande is a recognized authority on male and female pelvic pain diagnosis and treatment.