Sex after Hysterectomy

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Dear Dr. Myrtle,

I am 44 year old and had a hysterectomy because of a tumor. I was not sexually active prior to the surgery. I am now in a relationship that could be sexual, but I am nervous. Will the hysterectomy affect my performance? Should I continue to have pelvic exams if I don’t have my uterus, but still have my ovaries?


First, yes you will always need pelvic exams for two different reasons. One is that you will always want a healthcare practitioner to feel the size and shape of your ovaries to check for ovarian cancer. It’s an uncommon cancer (but not rare), and pelvic exams are a good early screen. Second, you will also want to have pap smears at the inside "cuff" (inner edge) where your uterus originally was. Some practitioners feel that some cervical tissue can be left behind and could become diseased - it’s an issue to discuss with your practitioner.

But your main concern involves sexual intimacy. You are asking at the right time, because it’s best to consider your sexual health issues before you get into a sexually intimate situation and "test the equipment out". The one thing that I often ask women is whether they have done any conditioning of their vulva and vaginal walls since the hysterectomy. This means doing regular massage (with hands, a dildo or a vibrator and lubrication like Liquid Silk) to gently stretch, strengthen and condition your skin. It’s the same process you would go through if you had skin on the back of your hands that was not used to touch: you’d think nothing of using a moisturizing cream to massage the area, bringing in better blood flow. Well, this same process needs to happen for your vulva and vagina. If you have never been sexually intimate, this process may be even more important. Read our Vaginal Renewal article (linked in the right sidebar of this page) for information on how to perform this massage.

The other concern I have is about your pelvic floor muscles. If you have not been regularly touching yourself, doing Kegel exercises, or having orgasms, your pelvic floor muscles may be weak, putting you at risk for stress urinary incontinence. It also means that you may experience less sexual pleasure; these are the muscles that contract pleasurably during orgasm, and the stronger the muscles, the stronger your orgasms. If you need more information about Kegel exercises, read through our pelvic floor strength article (linked in the right sidebar on this page).

It isn’t the case that you should "expect" that you will have discomfort with sexual intimacy. I think it’s better to take some proactive steps to increase your pleasure with intimacy, since that’s what intimacy is all about. I’m so glad that you’ve written before experiencing difficulties.

Take Care.

Dr. Myrtle