Sexual Loss

The uterus is a hormone responsive reproductive sex organ with important lifelong functions. There is never an age or a time when the uterus is not vital to a woman’s health and wellbeing.

Hysterectomy, the surgical removal of the uterus, causes many well documented, irreversible, life altering adverse effects. Among the most consistent problems women report, with or without removal of the ovaries (oophorectomy), and/or the cervix, include a loss of physical sexual sensation, a loss of vitality, joint pain, back pain, profound fatigue, personality change, and a 25 pound average weight gain in the first year following the surgery.

Women who experienced uterine orgasm before hysterectomy will not experience it after the surgery because the muscular uterine contractions that occur during uterine orgasm cannot occur without a uterus.

The vagina is shortened during a hysterectomy and made into a closed pocket that is sutured shut at the top of the vagina, which causes a loss of the natural elasticity of the vaginal tissue. Some women are no longer able to have intercourse because their vaginas were made so short that it has become physically impossible.

When women tell gynecologists that they are no longer able to have intercourse with their partner, often someone they have been with for many years, they are frequently told that their partner’s penis is too large. The doctor has no response when women say that it was never a problem prior to the surgery. Even then, doctors do not tell women that they shortened their vagina during the surgery.

The partners of some women try to understand and accept it, others are angry and accusatory. Several men have contacted HERS to say that their wife or partner began rejecting physical contact after hysterectomy. They were unaware that her loss of interest in sex and intimacy was related to the surgery, thought that their partners were seeing someone else and that was why they suddenly rejected them. Some thought it was because their partner felt like less of a woman, so they reassured her that she was exactly the same as she was before the surgery. Most women not only did not find that reassuring, but rather, they felt that it was a denial of their loss of sexual feeling.

The loss of uterine orgasm will only be missed by women who experienced orgasm before the surgery. The more sexual and sensual a woman is, the more she has to lose. Although a small number of hysterectomized women report experiencing slight vaginal wall contractions after the surgery, most women report a total loss of sexual feeling. One woman described it this way: Prior to the surgery her uterine orgasms were like diving off the high dive, and after hysterectomy, the slight vaginal wall contractions were like sliding into the water.

Of the 1,000 women who participated in a HERS Foundation study of the consequences of hysterectomy, 75% reported experiencing diminished or absent sexual desire following the surgery; 66% experienced diminished or absent pleasure with intercourse; 66% diminished or absent sexuality; 65% diminished frequency of intercourse; 63% diminished or absent sensuality; 62% diminished or absent pleasure with foreplay; and 60% reported experiencing diminished or absent orgasm.

It should be noted that the HERS study included women who did not experience uterine orgasm prior to the surgery. If the study excluded those women, the percentage of women reporting sexual loss would be significantly higher.

The profound physical changes women experience after hysterectomy are far reaching. One reason is that the uterus and ovaries are vital components of the female endocrine system, which includes the hypothalamus gland in the brain and the pituitary gland at the base of the skull which to the uterus through a network of nerves. The endocrine system regulates activities in every cell in the body.

The ovaries, fallopian tubes, uterus, cervix, clitoris, and vagina are interconnected with networks of muscles, ligaments, nerves, arteries, and veins. Much of the nerve and blood supply that exists throughout the female pelvis and beyond must be severed to remove the uterus.

The physical loss that results from severing the rich blood and nerve supply to the uterus, sets into motion a domino effect that impacts every cell in a woman’s body. It reduces the blood flow throughout the pelvis and legs, and damages the nerves that supply sensation to the ovaries, vagina, labia, and clitoris, as well as the legs, feet, and the nipples.

Sexual loss is the predictable outcome of severing the nerves, blood supply, and ligaments that attach to the female sex organs. And because human sexuality is part of the biological basis of a person’s personality, sexual loss relates to other changes women experience after the surgery. Personality change, loss of vitality, irritability, difficulty interacting with others, and insomnia all stem from the loss of sexual feeling, orgasm and sexual energy when the uterus is removed.

It is no coincidence that 75% of hysterectomized women report a loss of sexual desire, and almost the exact same percentage, 77%, experience profound fatigue. Each statistic from the Adverse Effects Database on the HERS Foundation website documents a loss that is inextricably related to all of the others. A 1973 study titled “Depression Following Hysterectomy” published in The Lancet, reported that 70% of hysterectomized women experience persistent, extreme fatigue and profound depression after the surgery.

These statistics, and the anatomical and behavioral basis for them, are not new to medical literature. Alfred Kinsey’s 1953 book Sexual Behavior in the Human Female and Masters & Johnson’s 1966 book Human Sexual Response have been in continuous publication for half a century, translated into dozens of languages.

In Human Sexual Response, Masters and Johnson define a four-stage model of female sexual response: the excitement phase, the plateau phase, orgasm, and the resolution phase. They say orgasm begins with vaginal contractions, which they termed the “orgasmic platform.” Orgasm culminates with strong uterine contractions which is not possible after the uterus is removed.

Women report that their libido (sex drive) and the physical response necessary to achieve excitement and attain the plateau phase are severely diminished or entirely eliminated by removal of the uterus.

A 1975 International Journal of Gynecology and Obstetrics article titled “Effect of Hysterectomy, Oophorectomy and Estrogen Therapy on Libido” said “The significant finding of the present study is the high incidence of decreased or absent libido in all groups of patients having undergone the operation of hysterectomy, irrespective of whether the ovaries had been conserved or not.”

And a 1981 American Journal of Obstetrics and Gynecology article titled “Sexual Response After Hysterectomy-Oophorectomy: Recent Studies and Reconsideration of Psychogenesis” demonstrated that dismissing the loss of sexual pleasure following hysterectomy is “no longer tenable in the light of current physiologic knowledge of female anatomy.”

In Dr. Erwin J. Haeberle’s 1981 book The Sex Atlas, he writes, “Orgasm (Greek orgasmos: lustful excitement) is the sudden release of muscular and nervous tension at the climax of sexual excitement. The experience represents the most intense physical pleasure of which human beings are capable and is basically the same for males and females.”

The pleasurable, intense contractions experienced during uterine orgasm reverberate throughout a woman’s body. Afterwards, there is a tremendous release of tension. But it is difficult for women to identify where orgasm emanates from until her uterus is removed and the sensations are gone.

The uterus is the center, the core of a woman’s body. It is no surprise that hysterectomy affects women in so many ways. But the male connection between sexual energy and overall vitality that is well known and talked about by men, is a connection women experience but is seldom discussed among women. Sexual prowess is worn as a badge, a sign of virility, especially among male politicians, soldiers, and athletes.

Rarely do women acknowledge their sexual prowess. In many ways it remains unspoken. Prior to hysterectomy, most women are unaware that orgasm, sexuality, and sensuality can be so quickly taken from them in what is often called a “routine surgery.” When they do understand what was done to them and they begin to talk about it after the surgery, they are often met with astonishment or disbelief.

A former military officer who was a Keynote Speaker at a HERS Foundation conference talked openly about her sexual prowess before she was hysterectomized and castrated. Sex was a driving force in her life. When she saw a man she was sexually attracted to, she “fantasized about dragging him to her bed to have mad, passionate, gratifying sex.” It was clear from their reactions that many women in the audience identified with her fantasy. After the surgery, though, she had a total loss of physical sexual sensation and a loss of interest in sex.

Highly sexual women have a sensuality that is both obvious and subconscious, expressed in their verbal communication and body language. How they walk, talk, and make eye contact is a part of their sexual and sensual being. With the loss of sexual feeling after hysterectomy, the desire for sexual intimacy is often diminished or lost entirely.

For many women, vitality and creativity is in part sparked by their sexual energy. When sexual energy is gone, sexual cues and sexual interaction are no longer spontaneous. It becomes intellectual – behavior that you have to think about and remind yourself to engage in. What had been as natural as breathing, like holding hands, kissing, or flirting now requires a conscious effort.

The loss of sexual feeling changes the way hysterectomized women interact, because acting on a sexual impulse no longer culminates in physical satisfaction. This changes the way women socialize, and is another factor in the isolation commonly experienced after hysterectomy.

Most hysterectomized women (79%) report personality change following the surgery. The loss of identity, the loss of who she was, the feeling that her own body has become unfamiliar to her since the surgery, is unfathomable to someone who has not experienced it. Something that you do not know you have, something that is invisible to the eye and so intrinsically linked to your personality and identity that it cannot be separated from who you are, is not missed until it is gone.

Some women need to deny the loss of sexual feeling and sexual energy in order to find a way to live with it. Some women need to pretend they are the same person they were before the surgery.

We tend to reject or mythologize what we do not understand.

Why some women say sex is “better than ever” after hysterectomy, for example, is as complex as human nature itself. Some women are more sexual than others. Because women are different, they respond to the losses and damage caused by the surgery in different ways.

Some women feel and know what they have lost immediately, as they drift out of anesthesia into conscious awareness, while others do not fully realize the loss for weeks or months after the surgery. When women realize that they have a diminished or total absence of physical sexual sensation, they want to believe that it must be temporary. They remind themselves that they are still healing, that it has only been a short time since the surgery, and the loss of sexual sensation is probably just an aftereffect of anesthesia. They can think of any number of excuses for what they are sure is going to be temporary. The weeks of sexual loss, though, turn into months and then years. And eventually women have no choice but to accept that this shattering, life altering loss is permanent.

A woman who did not enjoy sex before the surgery is not as likely to talk about a loss of sexual feeling or the loss of sexuality. If she was not sexual, if her personality was not clearly identified with her sexual energy, then she may not experience as dramatic a change in personality, creativity, and identity as a highly sexual woman will.

It is anatomically impossible for sex to be improved by removing a sex organ. It is anatomically impossible for sex to be better than ever after a surgeon severs all of the pelvic blood supply and the nerves that attach to the uterus and had provided sensation to the vagina and external genitalia.

In 1992, the journal Seminars in Neurology published an article titled “Aspects of Genital Physiology and Pathology,” which states that the nerves that must be severed to remove the uterus are the same nerves that branch out to supply feeling to the clitoris.

The role that the uterus, clitoris and related glands play in female orgasm has been studied and written about extensively.

In 2002 an Archives of Sexual Behavior article titled “The Physiology of Sexual Arousal in the Human Female…” relates how nerve signals result in sexual pleasure remains a mystery, but that it is a whole-body experience that requires a complex web of nerves from the brain that travel through the spinal column, through the uterine ligaments, and then branch out to the female genitals, which we experience as sexual pleasure.

People often ask HERS why some women say their sex lives are the same or better after hysterectomy. Even if it were magically possible for a woman’s sex life to somehow remain unchanged (let alone improved) by having her sex organs removed, one wonders why she would spend the time and energy searching for websites to tell other women that her sex life is better than ever. Did she search for places on the web to talk about her sex life before having her female organs removed?

Or is it because the loss is so terrifying and painful and she is so angry or distressed that she is obsessed with denying the loss? Not all of human nature is truthful. Not every woman feels the need to warn others of impending harm. And, unfortunately, the old saying “misery loves company” is sometimes true.

Some women talk openly about sex, others feel discomfort and embarrassment, which can make it difficult for them to speak about the loss of sexual feeling except in euphemisms. Some women say “I don’t feel anything down there.” Others say they feel “numb between the legs” after the surgery. Although many women do talk openly about their sexuality, many choose not to, because their loss of sexual feeling is a carefully guarded secret of which they say they are ashamed.

No one wants to be known as asexual. Some women live in fear that their partners will find out and will no longer be interested in them.

Most hysterectomized women who contact the HERS Foundation want to talk about the fact that their sex life abruptly changed after their uterus was removed. They are grateful to find that they are not the only one, that it is not “all in her head,” that it is not her fault. They are often angry and shocked that sexual pleasure has been permanently taken from them. It is a profound and incomprehensible permanent loss.

The female organs are vital to every woman’s health and wellbeing. Hysterectomy, surgical removal of the uterus, causes many well-documented, permanent and life-altering problems.

For more information, watch the short video “Female Anatomy: the Functions of the Female Organs.”