WOMEN'S HEALTH
February 10, 2000

Hysterectomy and Sex: The Good News

When a doctor tells you that you need a hysterectomy, or any major surgery, it is not normally considered good news. A study by the University of Maryland Medical School, however, found that hysterectomy has a surprisingly positive effect for most women: better sex.

"We realize that our findings may be controversial," says epidemiologist Dr. Kristen Kjerulff, Ph.D., a principal investigator for the study, which was published in the November 24, 1999 issue of the Journal of the American Medical Association (JAMA). "The common perception has been that hysterectomy leads to sexual problems, but our study shows the opposite." These results are particularly welcome because earlier studies had confirmed most doctors' experience that fear of sexual problems is the number one concern of women facing a hysterectomy.

These results are particularly welcome because earlier studies had confirmed most doctors' experience that fear of sexual problems is the number one concern of women facing a hysterectomy.

"There is a common perception that total hysterectomy does have an adverse effect on sexual function," comments Susan C. Stewart, M.D., past president of The American Medical Women's Association and TheDoctor's Women's Health Editor, "possibly because of shortened vaginal capacity or because of the loss of nerves around the cervix (neck of the uterus) that participate in internal orgasm. This careful prospective study examined four specific areas of female sexual function: desire, lubrication, orgasm and frequency. The conclusion that there is, for most women, not a loss of sexual function, but rather an improvement, is strongly validated by the careful design and the large numbers of women studied."

Hysterectomy is the surgical removal of the uterus. Normally, the purpose is to treat uterine fibroids, or benign tumors within the uterus. Hysterectomy may also be recommended for menstrual problems or endometriosis, a disorder which can cause pain, bleeding and infertility. It may also be used to treat cancer, although the University of Maryland study excluded surgeries performed for this reason. With 600,000 performed in the United States yearly, hysterectomy is the most common major surgical procedure for women that is unrelated to pregnancy.

This study followed thirteen hundred Maryland women from all walks of life over two years. Most were between 35 and 50 years old. They were interviewed shortly before surgery and then at intervals of 3, 6, 12, 18, and 24 months following surgery. At each stage, the women were interviewed only about the present state of their sex lives in order to avoid any distortion caused by the filter of memory. Among the questions asked were how frequently they "experienced pain during sexual relations," "experienced orgasm during sexual relations," "experienced vaginal dryness" and "desired sex."

The results show that women enjoyed significant improvement in every aspect of their sexual functioning. Along with an increased desire for sex, they had sex more often, had stronger and more frequent orgasms and experienced less pain during intercourse.

The number of women having sex increased from 70.5% before hysterectomy to 77% a year after the surgery. 72% said they were experiencing orgasms after the surgery, compared to 63% before and the percentage who said they had strong orgasms increased from 45% to 57%. The percentage of women experiencing pain during sex declined dramatically, from 40% before hysterectomy to 15% two years later. The study also found that levels of sexual desire increased quite a bit after hysterectomy. Before surgery, 35 percent said they desired sex at least one day per week. That increased to 50 percent, a year after surgery. As for women who had not been sexually active in the month before surgery, a significant number resumed having sexual relations after the operation.

Dr. John Morley, Dammert Professor of Gerontology at the St. Louis University School of Medicine and TheDoctor's Senior Living Editor, believes that the findings are very encouraging, but that they underline the delicate nature of sexual response and the complicated nature of its interaction with physical and psychological problems. "Hysterectomy often has a positive effect on a woman's sex life," Dr. Morley says, "but there are other factors than the surgery itself. Good outcomes are especially likely when the patient has a good relationship with their sexual partner going into the surgery, no diagnosis of depression, proper pre- and post-operative counseling and, when necessary, hormone treatment after surgery." Morley notes that European gynecologists believe that leaving the cervix intact (or subtotal hysterectomy) results in even better sex lives for patients, although the risk of cervical cancer must be taken into account.

So should women with flagging sex lives go out and get hysterectomies? "Of course not," says Dr. Stewart. "The women in the study had significant gynecological problems, not cancer, but severe bleeding, fibroid tumors and endometriosis, that were expected to be relieved by hysterectomy. That most did not experience the side effect of impaired sexual function is indeed good news."

The researchers agree that relief from pain and discomfort, as well as freedom from vaginal bleeding and the elimination of worry about pregnancy, may have played a major role in restoring interest in sex for the women in the study. "They feel a lot better after surgery, and their desire for sex improves along with their overall health and quality of life," says Julia C. Rhodes, M.S., a co-author of the study. "When you look at the numbers in that context, the results are not surprising."

Reviewed by: John E. Morley, M.D., Susan C. Stewart, M.D., and Bruce S. McEwen, Ph.D.
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