Any concerns you might have about having sex after a hysterectomy should be discussed. Talking about issues early in your recovery will create more openness and honesty between you and your partner. Waiting until just prior to the first sexual encounter may be a set-up for unmet expectations, disappointments, and intimacy problems down-the-road. Honesty is the best policy. You need to be upfront about your level of desire, what it takes to arouse you, and how you can best reach orgasm. Issues you encounter as you recover might include:

What if sexual intercourse is painful?

Pain during sex is most likely caused by vaginal dryness. Lubrication might be affected either by the surgery or induced menopause. There might be decreased sensation in the vagina and clitoris, making arousal and orgasm more challenging.

Overcoming vaginal dryness will take a little planning. You can keep lubricants such as KY Jelly, Astroglide (both available in drugstore chains), or plain vegetable oil on hand for when you have sex. Lubricating during sex will help improve your comfort. If you are dry through the day, Replens (available in drugstore chains) can be used more frequently. Talk to your doctor about hormone preparations such as Estring (vaginal estrogen ring; www.estring.com), Vagifem cream (www.vagifem10.com), or bio-identical hormones. If you have persistent pain, talk to your doctor. There may be solutions that increase your comfort during sex.

What if I have difficulty getting aroused?

Unfortunately, as of yet, there are no sexual enhancement drugs on the market for women. Setting the mood can help with warm baths, massages, candles, and music. With your partner’s help, resume familiar foreplay and patterns. You might have to work up to sex. If it doesn’t happen initially, don’t give up.

Alternate arousal methods can be tried to enhance sensation in the vagina and clitoral area. Masturbation, oral stimulation, and use of a vibrator can be considered to increase arousal and intensity of orgasm.

I feel sad since my hysterectomy.

Loss of your uterus can trigger a psychological reaction in some women. Sadness and sometimes depression can occur after hysterectomy. The uterus is a symbol of womanhood, productivity, and creation. If you find yourself unable to get past being sad or depressed, talk to your doctor. A short-term medication might help to get you back on track to feeling yourself.

Proper positioning can be helpful to reduce pain during sex.

Sex Positions to Use After a Hysterectomy

A vaginal hysterectomy can change the sensation in the vagina. Scar tissue can cause discomfort. Proper positioning during sex can be helpful in reducing pain.  The missionary position (man on top, woman on the bottom) can be painful as the penis is thrust toward the back of the vagina. It may be more comfortable to assume a face-to-face position. Your partner lies on his back with you sitting on top.

Hysterectomy can significantly improve your general health and well-being. You can return to a satisfying sex life. Face the challenges your surgery presents and move on to a healthy and happy life.