Help! I’m having a hysterectomy and oopherectomy (ovaries removed) and my doctor tells me to expect “instant menopause”. I cannot take hormones, because I have a risk of cancer. What can I do so that I can enjoy sex after the operation?
There are a variety of things that you can do to address the changes that your body will go through, and provide the kind of support to your sexual systems that used to come from estrogen.
First, let’s talk about the surgery itself. If you don’t have to have your cervix removed, you may wish to request a suprapubic laparascopic hysterectomy and oopherectomy, to preserve the length of your vagina, and to avoid damage to the pelvic floor and the pelvic nerves that can occur when you have a hysterectomy that removes the uterus and cervix through the vaginal opening. This surgery is becoming more common, and will allow you to experience full penetration after healing, as well as allow more possibilities for deep pelvic floor muscle contractions to be felt during orgasm.
If you do need your cervix removed, then you should expect some shortening of the vaginal vault. If you can, ask the surgeon to preserve as much length as possible, particularly if you enjoy deep penetration during sex play. Once you are fully healed, you can use a vibrating massage wand to massage the inside of the vagina, all the way to the internal end, to prevent scar tissue from further shortening the vaginal space. See our Vaginal Renewal brochure for the details on how to do this.
The function of estrogen
Estrogen is a talented hormone that has many effects on the human body. Although mostly recognized for its effect on egg maturation, estrogen receptors (places where estrogen works) are found all over the body—in the brain, skin, muscle, and sub-skin tissues, to name a few places—and are produced in fat cells in both males and females. This means that when women lose their ovary-produced estrogen, they continue to make some level of estrogen. It also means that those of us with a little more “padding” may transition through menopause more gently than those with less.
The major functions of estrogen are:
- Priming of sensory organs (eyes, ears, nose, etc.)
- Production of pheromones
- Maintenance of skin elasticity and sub-skin tissue thickness.
- Maintenance of muscle mass
- Positive effects on blood vessel neurotransmitters that facilitate the vaginal lubrication process
Estrogen “revs up” sensory organs and helps make the world seem like a fresher, brighter, zestier place. The process of making estrogen is the same process that helps make pheromones (hormones that we smell unconsciously). Both of these effects help to make the world seem a bit sexier, and help the world think that we are sexier as well.
Estrogen also helps skin stay elastic and flexible and keeps the padding under the skin thick and lush. This extends to muscle tissue, helping maintain and repair muscle more quickly and efficiently. When estrogen circulates through the blood stream, it supports a neurotransmitter responsible for production of vaginal and mucous membrane lubrication. When estrogen ebbs, vaginal lubrication also ebbs, because estrogen isn’t there to assist its production.
What to do when you’re not making as much estrogen (aka, in menopause), after surgery:
You don’t need estrogen to maintain a satisfying sexual life; there are some straightforward habits and techniques that can help you be as sexy as you want to be! Incorporating these activities into your daily life can make a world of difference. They will also lower your incidence of hot flashes, particularly the healthy lifestyle habits that include eating a healthy diet, exercising, and getting enough sleep.
Lower your insulin resistance. Keep your blood vessels flexible and keep your sexual arousal alive. It’s easier to achieve orgasm when blood flow to the whole body is healthy. Take a walk or do some other form of aerobic exercise at a moderate pace for 30 minutes a day, every day. Take the stairs when you can (or do your armchair push-ups). Rev your engine regularly and keep the blood moving around. This also maintains the health of your blood vessels, from your major arteries to the tiny capillaries that are everywhere in you body and that contribute to sexual arousal.
Maintain your muscle mass. Consider joining a gym or finding a good video/book that will teach you basic strength training. This will help mellow the aging process, and can give you a boost of self-confidence.
Moisturize and massage your genital tissues and internal vaginal skin with a moisturizing sexual lubricant and a vibrating massage wand for internal vaginal massage. We suggest Oasis Silk lubricant, which will help maintain the moisture and flexibility of your vulva and genital tissues. Regular massage (once a day for five minutes) can help maintain the elasticity of your genital skin and the thickness of the tissue under your vulva, and help prevent tearing. (See our Vaginal Renewal brochure for more information). If you find yourself feeling uncomfortable sitting down during the day, you can preventively apply Liquid Silk to your vulva and inside your vagina (you can apply it using your fingers, a dilator, or a needle-less syringe). This can make a huge difference in allowing the vaginal walls to “slip by each other” as you bend or sit, and help you stay comfortable throughout the day and night. If you find you’re sensitive to Liquid Silk, we suggest Erosense Sync as a good alternative.
Maintain pelvic floor strength. Learn where your pelvic floor is and learn how to exercise it. This helps maintain your connection with the experience of sexual arousal. Tension of the pelvic floor is critical to most people’s experience of “feeling turned on.” When pelvic floor muscle strength starts to slip (which is accelerated by loss of estrogen), you may begin to feel as though “nothing happens down there anymore.” Strengthening your pelvic muscles is as easy as brushing your teeth (really), and it will put a big smile on your face! (See our Pelvic Floor Health brochure for instructions.)
Regularly schedule orgasms. Maintain your sexual system by giving it exercise! We recommend a minimum of one orgasm per week—really. This will help the system remember what sexual arousal is and how to do it. This will also increase blood flow to the genitals and keep your nerves functioning smoothly. No partner is required, and a vibrator can speed up the process if you wish. Orgasms are also a great way to facilitate sleep.
Think sexy thoughts. Sexual feelings are a two-way street: some of those feelings are responses to sexual changes in your body, while other feelings are generated in your mind. Don’t be afraid to “get yourself ready” to be sexual—it can be rewarding. Desire might not always occur spontaneously, especially if you are tired or stressed. Give yourself permission to call up your sexual imagination. See our Libido brochure for more information on ways to do this.
Hold on to your natural hormones. Stop smoking, and drink less alcohol. Tobacco has an anti-estrogenic effect that blunts sexual arousal, decreases bone strength, and stiffens blood vessels. These hurt the sexual arousal response and accelerate aging. Alcohol blunts testosterone production—so the less you drink, the friskier you’ll be.
Maintain touch in your life. Oxytocin, the I-am-loveable hormone, increases with touch. Hug a friend, a pet, or a loved one.
Sleep. It’s hard to be interested in sex when you’re exhausted. Sleep at least 7-8 hours every night—you’ll experience more pleasure when you’re rested and awake.
Eat the Good Sex Diet. Originally developed as an anti-cancer diet, it’s excellent for promoting sexual health as well: Most of all, remember to care for your body, and your body will return the favor.