I remember some years ago when I was working as a junior resident assigned to the gynecology wards, nearing the end of the surgical admissions for theatre the next day. Things had been pretty routine that afternoon … a few patients in for curettes, one woman having a vaginal repair, and a couple of women listed for hysterectomies.

The final patient on my list was a woman in her late thirties who had been putting up with very heavy periods for a couple of years and conservative treatment just wasn’t controlling the bleeding anymore. The decision had been made to do a hysterectomy. When I walked in to see her, I found her sitting on the side of the bed quietly sobbing. I thought at first that she must be anxious about the operation the next day.

Who wouldn’t be? So we got talking, and I asked her if she had any particular concerns.

She had been living with hopelessly heavy periods for a couple of years now and hormone treatment and two curettes had helped, but not for long. She had come to terms with never being able to have any more babies but there was another problem. She hadn’t felt able to discuss it with anyone but the decision to have the operation, she told me, had been a very hard one for her and her husband because it meant they wouldn’t be able to have intercourse anymore. She was worried about how her marriage would change. Whoa! Bit of an information gap here! I asked her why she thought they wouldn’t be able to have intercourse anymore. ‘Well,’ she said, ‘when they cut out my uterus, they have to stitch across the vagina, don’t they?’ ‘Yes,’ I answered. ‘But only the top end, not the bottom end. You will still have a vagina, and it won’t take long before things are pretty much back to normal.’ The relief was palpable, and it just goes to show how accurate information can make such a difference.

There is still a lot we don’t know about the effects of hysterectomy on sexual function but it probably depends on the woman’s sexual responses before the operation. Some women find that contractions of the uterus heighten their orgasm; others depend on deep vaginal and cervical stimulation to trigger their orgasm. These women may notice a change in the quality of that orgasm after the operation. Other women say their sex life improved afterwards because they weren’t tired all the time from heavy bleeding, and they no longer had to worry about contraception.

*138/17/9*

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