Does a hysterectomy affect sexual function?

Impact of Hysterectomy on Sexual Function

Hysterectomy generally does not negatively affect sexual function, and in many cases may lead to improved sexual function due to relief from symptoms that previously impaired sexuality. 1, 2

Effects on Sexual Function

Overall Impact

• Most women (approximately 80%) experience either unchanged or improved sexual function after hysterectomy for benign conditions 3
• A significant minority (about 20%) report deterioration in sexual function post-hysterectomy 3
• Sexual function improvements are often related to the relief of symptoms that previously negatively affected sexuality, such as pain and heavy bleeding 2

Specific Sexual Function Domains

• Hysterectomy can affect various aspects of sexual function:
  • Desire/libido: Generally unchanged or improved after surgery
  • Arousal: May improve due to removal of painful conditions
  • Lubrication: Can be affected, especially if ovaries are removed
  • Orgasm: Usually maintained, though some women report changes
  • Pain: Often improved when dyspareunia was a pre-surgical symptom

Factors Affecting Sexual Outcomes

Type of Hysterectomy

• Total vs. Subtotal (supracervical) hysterectomy:
  • No significant difference in sexual outcomes between total and subtotal hysterectomy 1, 2
  • The belief that preserving the cervix improves sexual function is not supported by current evidence 2

Oophorectomy Impact

• Bilateral salpingo-oophorectomy (BSO) with hysterectomy:
  • Associated with significantly less improvement in lubrication and orgasm compared to hysterectomy alone 1
  • Can lead to hormonal changes affecting sexual function 3
  • Estrogen replacement therapy may not fully reverse these effects 3

Surgical Approach

• No significant differences in sexual function outcomes based on surgical approach (abdominal, vaginal, or laparoscopic) 2

Indication for Surgery

• Hysterectomy for benign conditions: Generally positive or neutral effect on sexual function
• Hysterectomy for malignancy: More likely to have detrimental effects on sexual function 4

Physiological Mechanisms

• Potential mechanisms for sexual dysfunction after hysterectomy include:
  • Disruption of local nerve supply
  • Changes in pelvic blood flow
  • Altered anatomical relationships
  • Hormonal changes (especially with oophorectomy)
  • Vaginal shortening or scarring

Patient Education and Satisfaction

• Pre-surgical education about potential sexual outcomes significantly improves patient satisfaction with hysterectomy, regardless of whether negative sexual outcomes occur 5
• Discussing potential sexual changes before surgery is an important part of pre-operative counseling 5

Special Considerations

Cancer Survivors

• Female cancer survivors who undergo hysterectomy may experience sexual dysfunction related to:
  • Hormonal changes from oophorectomy
  • Effects of radiation on vaginal tissues
  • Surgical alterations to genital anatomy 4
• Assessment should include evaluation of genital sensation, dyspareunia, vulvar pain, and domains of sexual functioning 4

Dyspareunia Management

• For women experiencing pain after hysterectomy:
  • Position modifications during intercourse
  • Pelvic floor exercises
  • Use of lubricants for vaginal dryness 6

Clinical Recommendations

1. Provide thorough pre-operative counseling about potential sexual effects of hysterectomy
2. Consider ovarian preservation when medically appropriate, especially in premenopausal women
3. Address sexual concerns both before and after surgery
4. Evaluate for specific causes of sexual dysfunction if it occurs post-operatively
5. Consider referral for sexual therapy or pelvic floor physical therapy when indicated

Conclusion

While hysterectomy is generally associated with maintained or improved sexual function for most women, healthcare providers should be aware that a minority of patients may experience sexual dysfunction following surgery. Proper patient education and addressing sexual concerns both pre- and post-operatively are essential components of comprehensive care.