A radical hysterectomy is a surgery whereby the uterus and ligaments that hold it in place are removed, along with the cervix and one or two inches of vagina. This is typically part of the treatment for some cervical cancers. Surgery for uterine or ovarian cancers tend to take less tissue.

The surgery

The surgeon will remove the cervix, which is attached to the top of the vagina, and stitch up the hole left at the top of the vagina. This closes off the vagina completely.

Ovaries may remain or be removed, and this matters a great deal, since the ovaries produce our oestrogen. Oestrogen keeps our vaginal and vulvar cells plump and juicy, so without ovaries, we lack oestrogen, and we can develop atrophic vaginitis. This means a dry, irritated, easily-cut vagina. If a woman is under the age of 40, at least one ovary is hopefully kept to avoid early menopause. Women over 50 do not need ovaries, since after menopause they don’t work anyway and naturally atrophy.

The uterus is removed, so there are no more periods and no ability to carry a baby. This makes a woman infertile, though if one ovary remains, eggs can be harvested and used in a surrogate.

Your options will be discussed with you and your doctor, with the idea that you will keep your normal ovarian function so long as it is safe and beneficial for you to do so.

The aftermath

Bladder function can be affected, particularly immediately after surgery when you are recovering, due to nerve interruptions. A catheter may remain for a few days post-surgery. Long-term damage can occur during surgery, so if normal bladder function isn’t restored after a few weeks, speak to your doctor. You may need to use a catheter to drain your own urine, possibly forever.

Sex and hysterectomies

Hysterectomies are generally sparing of your sexual pleasure, though sometimes interruptions can occur to nerves to the clitoris. The vagina is shortened, so cervical sensations are obviously gone, but sexual pleasure in the remaining vaginal tissue and clitoris tends to remain as before.

If you are self-catheterising, make sure to empty your bladder before sex to avoid urinary tract infections or discomfort.

Psychologically (un)sexy

A lack of self-confidence can really put the brakes on sex, with some women feeling ‘less of a woman’ without their reproductive organs. This is a difficult idea to overcome, and therefore it’s really important to focus on what you do have (including your life), not what you don’t. It’s never coming back. By all means take your time and grieve – this is very important. Find a therapist and use them. Seek out support groups.

Physical comfort during sex

Cancer can be the cause of discomfort and bleeding during sex, so having it removed can actually free many women up from annoying, painful, or debilitating symptoms that were interfering in their sex lives. Once surgery is complete, the shortness of the vagina is usually work-around-able, with a little bit of adjusting. Dilators can also help to lengthen the vagina.

Some techniques can help give the illusion of a longer vagina, including putting the thighs together during penetrative sex, or the use of a hand gripped around a penis.

Orgasm

A Danish study examined women who had radical hysterectomies and those who hadn’t, with the following results:

  • One in 10 women who had a hysterectomy noticed problems with lubrication and pain during sex
  • Eight in 10 women reported little or no interest in sex
  • Compared with without who didn’t have the surgery, twice as many said they had problems reaching orgasm
  • One in five said they felt like their vaginas were too small
  • Most of the reported problems were gone after six months post-surgery
  • After two years, nine out of 10 women reported they were having sex again
  • Then, the number of women who reported orgasming during sex was the same as those who hadn’t had the hysterectomy

 Atrophic vaginitis

A dry, irritated vagina due to low oestrogen can be remedied with oestrogen creams and other natural phyto-oestrogens or hormone therapy as provided by your healthcare professional. Atrophic vaginitis is solvable, though it may require regular sexual activity to keep the cells plump and juicy, and oestrogen cream.

Generally, the sexual prognosis is very good for women who have undergone a radical hysterectomy.

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