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Thursday, Feb. 23, 2012

Sex After Hysterectomy

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My wife and I have been together for over ten years. Sex was fine before her hysterectomy five years ago.  Now, we hardly ever have sex.  She says it hurts, and she just doesn't have the desire anymore. I have asked her to see her doctor, because it could be something wrong if it hurts. She finally went to her doctor, and he prescribed her some medicine; well, needless to say, it didn't work.  So a couple years, later she went to her gyno, and he prescribed her some medicine. She took it for a week and stopped because of one of the side effects (rapid weight gain – she gained twelve pounds in one week!).  When we do have sex, all she wants to do is give me a hand job. Nothing else. All she will allow me to do to her is play with her clit until she gets off.  She has joked before about finding me a girlfriend to fulfill my sexual desires.  I just can't do it, though, because that is cheating, even with her permission. Do you have any advice?

Thank you so much for writing, since this issue – a change in sexual activity in a relationship following a hysterectomy – is not uncommon. There are three separate issues at play here, all of which I'll try to touch on: first, the physical and psychological changes that can accompany a hysterectomy; second, how couples with discordant levels of sexual desire negotiate how often they'll have sex and what they'll do when they have it (which is an issue for many couples, not just those who have experience hysterectomy); and third, whether opening up a sexual relationship is a workable solution to the problem of discordant desire (spoiler: I think it can be, if done properly).

Hysterectomy, which is the surgical removal of the uterus and sometimes the cervix and/or ovaries, can have positive, negative, or no effects on sexual desire and activity. If the ovaries are removed, the drop in hormone levels may cause a lessening of sexual desire. Some women may feel differently about their bodies after a hysterectomy, which can also impact desire. For some women, uterine contractions are an important part of orgasm, and orgasms after the uterus is removed can feel weaker. Some women also derive pleasure from thrusting against or pressure on the cervix, and if the cervix has been removed, sex can feel less pleasurable. If surgery has caused scarring in the vagina, sex can be painful. If a woman experienced pain or cramping before a hysterectomy, sex can feel better afterwards.

In short, there are multiple, unpredictable ways that a hysterectomy can impact sex. While you're correct that it's important to consult a health care professional when pain is involved, there's not a “quick fix” or single medicine that is going to return your sex life back to the way it was pre-hysterectomy.

Now, let's talk about what “having sex” means. You say that you and your wife are engaging in mutual masturbation – hand jobs for you and clit stimulation for her. It sounds like this results in orgasm for both of you. There's no law that says that sex between a man and a woman must include vaginal penetration in order to be satisfying – we're just raised to think that penis-in-vagina sex is “real” sex and everything else is just foreplay.

This is unfortunate. If vaginal sex is painful for your wife or if she simply isn't interested in it anymore, there are an endless variety of other types of fun sexual activities you can try. I suggest starting a conversation with her with the agreement that vaginal sex is (at least for the time being) off the table, and seeing what other types of sex both of you are interested in trying. Oral sex, playing with sex toys, tantric sex, roleplaying, anal play, learning new mind-blowing hand job skills – there are many options. Books like Kidder Kaper's Sex Is Fun can give you ideas and even worksheets to fill out together.

Finally, what about the idea of having a girlfriend or other sexual partner outside of your marriage? Just as we have been raised to believe that there's only one type of “real” sex, we have also been raised to believe that the only type of “real” relationship is a lifelong, mutually monogamous, heterosexual marriage. In truth, people have many different types of sexual and romantic relationships, including ones where they have more than one sexual partner at a time. The most important parts of any relationship are honesty and mutually negotiated and understood agreements.

As long as you, your wife, and any additional parties involved feel good about it, it's perfectly possible to have an above-board sexual relationship outside of your marriage that is not “cheating.” For more information about open or non-monogamous relationships, I recommend Tristan Taormino's excellent book  and companion website , Opening Up.

Laura Anne Stuart owns the Tool Shed, an erotic boutique on Milwaukee's East Side. She has a master's degree in public health and has worked as a sexuality educator for more than a decade. Want Laura to answer your questions in SEXpress? Send them to laura@shepex.com. Not all questions received will be answered in the column, and Laura cannot provide personal answers to questions that do not appear here. Questions sent to this address may be reproduced in this column, both in print and online, and may be edited for clarity and content.