hysterectomy

H is for Hysterectomy

Hi everyone!  Welcome to the A to Z of Sex.  I’m Dr Lori Beth Bisbey and I am your host.  We are working our way through the erotic alphabet one letter at a time.  Just a reminder this podcast deals with adult content, so if you don’t have total privacy, you might want to put on your headphones.  Today the letter is H and H is for Hysterectomy.

Recently, I had an hysterectomy.   I decided to do this show because of my experience and the stories I have been told by other women in the lead up to my operation and since.

I’ll start with definitions:

Hysterectomy is a surgical operation to remove all or part of the uterus.

Partial hysterectomy involves leaving in part of the uterus and/or the cervix.

Total hysterectomy involves removing all the uterus including the cervix.

Total hysterectomy with bilateral salpingo-oophorectomy is when the uterus, fallopian tubes and ovaries are all removed.

Radical hysterectomy includes removing everything plus the tissue surrounding the womb, fatty tissue, part of the vagina and lymph glands.

I had a total hysterectomy with bilateral salpingo-oophorectomy.

Reasons for hysterectomy:

The reasons are often different depending upon whether you are pre or post menopause.

Pre-menopausal reasons for hysterectomy:

Emergency ones can be done during child birth as a result of hemmorhaging.

Heavy periods:  This is only when the bleeding has a significant impact on the woman’s life and other treatments have not worked and no further children are desired.  I don’t know any women who had a hysterectomy for this reason and when we talk about it, none of us can figure out what a significant impact might look like for heavy periods.  Many of the women I spoke with had significant life impacts as a result of their periods full stop – due to changing emotions, exhaustion, and pain.

Pelvic pain:  This can be due to fibroids, endometriosis (cells from the uterus are found outside the uterus), unsuccessfully treated pelvic inflammatory disease, adenomyosis (cells from the uterus push through the uterine wall and are found on the outside of the wall).  PID when not treated causes chronic pain from damage to the uterus and the fallopian tubes.

Fibroids: Non-cancerous tumours that grow in the uterus and can cause pain, pain during sex, frequent urination and urinary incontinence, constipation,  heavy pain.  Hysterectomy is only recommended for fibroids if they are very large and attempts to shrink them has not worked, if there is severe bleeding and if no further children are desired.

Prolapse of the uterus – where it falls from it’s usual position and protrudes into the vagina – symptoms include back pain, urinary incontinence, difficulty having sex and the feeling something is coming out of your vagina.  It can occur as the result of childbirth.  It is only recommended in this case when the tissues that support the uterus are so weak that there is no other way to resolve the issue.

Cancer:  Hysterectomy can be recommended in cervical cancer, endometrial cancer, cancer of the womb, ovarian cancer and cancer of the fallopian tubes.  If cancer has spread or reached an advanced stage, this may be the only treatment option.

Reasons for hysterectomy after menopause:

Fibroids – I had mine as a result of very large and relatively fast growing fibroids.

Prolapse

Cancer

Pelvic pain – endometriosis etc.

Hysterectomies can be done laproscopically (through small incisions), vaginally or as open operations.   Ideally, you want laproscopic or vaginal as the surgery is less stressful on the body.  In my case, there was no choice but to do it as open surgery.  This means that it is a far more major operation and you can expect your body to take longer to recover.

What happens when you have an hysterectomy?  What everyone talks about is that you will go through menopause immediately if your ovaries are removed.

What they don’t mention is that even if you have already gone through menopause (as I had) – you will still have symptoms of menopause as the ovaries continue to put out some oestrogen, progesterone and testosterone long after menopause is over.    This means that if you are not on HRT – you may want to start for a while.  It means that if you are already on HRT – you may need a larger dose.  I immediately began to have hot flashes again.

Let’s talk testosterone.

Lots of women are not told that low testosterone is one of the reasons for tiredness, low libido/desire, low sexual satisfaction (problems with orgasm), depression and muscle weakness. I think we can agree that all of those are nasty symptoms that most of us would not choose to have.    Testosterone in women is produced in the ovaries, the adrenal glands.   Low testosterone can be a result of oestrogen taken as part of HRT.  And it certainly is a result of removal of the ovaries.

I spoke with my gynaecologist about this and he agreed to prescribe testosterone for me.  Initially he wanted to give me an implant but I was concerned that you cannot titrate dose so if I had side effects, my choice would be to take the implant out or live with them.    Instead, I opted for gel.  For some reason, almost no testosterone preparations are licensed for use in women despite lots of research that demonstrates the benefits, particularly in women who have had their ovaries removed.

Had I not done lots of research, I never would have found out about this.    Most of the women I have spoken with were not told anything about loss of testosterone at all.

It can take up to 4 months before things equalise.  At the moment, I am only 8 weeks post hysterectomy but I am already noticing one difference:  My libido came back!!!  This was a very real concern for me – though many women who I spoke to who had hysterectomies told me that sex would really improve – most of this was about the limitations to sex because it had been really painful prior to hysterectomy – not about any issues around libido.  I had a good libido up until about 6 weeks before the operation.    But the libido I have now is as strong as it was when I was pre-menopausal.

I am hoping it will increase my muscle strength and my energy levels – this is one area where I am having significant difficulty since the operation.  I am exhausted.  It is impossible to tell how much of this is because of the major operation and how much is because I also have autoimmune disease and I am off my disease modifying medication at the moment because of concerns about infection.  But I can sleep for England.  I slept for two weeks following surgery and then began to feel a bit better and then began to sleep constantly again after about a week.  At the moment, if I put in a full day – I sleep for a full day to compensate.   This is a real drag.

One of the things that doctors talk about is 6 to 8 weeks to recover from an open hysterectomy.  This is deceptive.  Yes this is when the upper layers of tissue have healed.  But during hysterectomy all the muscle layers and some layers of nerves are cut through.  These take far longer to heal.  Up to 12 months is the figure I have been given and Ihave been warned not to engaging in lifting much until then, not to do any strenuous exercise before 3 to 4 months and to be ultra careful until the healing has finished as if I am not, I will be having difficulties for far longer and I could need surgery to repair the internal site where I was sewn up.  Walking is advised and is good.  Sex needs to be avoided for at least 6 weeks when the cervix is left in.

And that brings me to the another area no one talked about:

If you have a full hysterectomy, you no longer have a cervix poking in at the top of the vagina.  So everything is open?

Or is it?  I began to wonder what happens in this situation.  I had already been told that pelvic floor work is essential because removing the cervix is like removing one of the load bearing beams from a wall.  You are removing a support.  This can have a huge impact!

I started to wonder what the situation was with the top of the vagina.    I read the post-surgery report but didn’t remember seeing an answer to my question.  I asked my gynaecologist and he told me that he had sewn the top of the vagina.  This is called a vaginal cuff.  This is important to know as it is one of the reasons no sexual intercourse is allowed for at least 6 weeks post surgery.  If it tears there is more surgery and the recovery is even longer.  He advised me to wait another few weeks before intercourse much to my husband’s dismay.  The most important thing to remember is to do nothing that increases intra-abdominal pressure.  I have to watch this anyway as I have a paraoesophageal hernia.  This means no lifting, not too much coughing, no straining – so constipation is a real problem.  It also means no swimming and no baths to avoid infection to the internal wound.   If you have bleeding pads only.  No inserting dildos or vibrators or eggs until you are healed.

And finally, the last area no one talked about was orgasm post-hysterectomy.  If you haven’t thought about what your orgasms are like – this is the point where I am going to ask you to do so.

If you have an orgasm – do you experience uterine contractions as part of the orgasm?   If you aren’t sure – take a break now and go find out.  If you do, then when your uterus is removed, this part of your orgasm disappears.  No uterine contractions if you have no uterus!  I was one of those people so I was really worried that my orgasms would change in a way that I would find less satisfying.  No one talked with me about this – none of the women I spoke to who told me how great sex was afterwards even thought about this.

Thankfully, for me, masturbation proved to me that my orgasms post-hysterectomy are just as intense and in fact, different in a positive way.    This is something that doctors should talk about!  Women need to know that they may have to work harder to reach orgasm, that orgasm might feel really different and they may need to adjust to the new experience of pleasure.

Let’s talk about the other things that no one paid attention to:

Depending upon how your abdomen is sewn up, your tummy will look very different.  I remembered this from my c-section – where I suddenly had a tummy roll that had never been there before.  With hysterectomy, this has happened in a different way.   If you have a roll and all or part of your scar is under the roll of flesh, you will have to work hard to keep that area dry so that the incision heals well without infection.  This can be an issues even if you are slender – it depends upon the way you are sutured.    If you sweat a lot or are suffering from hot flashes, this means making sure to clean the area multiple times a day and dry it well.  The nurse suggesting using a blow drier and it worked well.

Your skin texture may well change fairly quickly.  You may find yourself oilier or as in my case, DRY!  I am drinking 2 litres of water a day and I am still dry dry dry.  Lip balm and moisturised are your best friends now.   For some, vaginal dryness goes along with this.  For others, this is not as big a problem but still: Lube is your best friend.  Lots of lube is very helpful – especially to help avoid tearing tissues that may be less resilient now.

Your emotions will be up and down whether you were post-menopausal or not.  Part of this is because of the impact of major surgery.  Part is because of the change in hormones even if your ovaries are not removed.

I was told about changes in bowel habits by the anaesthesiologist who said that your insides don’t liked being touched so if your surgeon is heavy handed you may find your body takes longer to start working well again.  Even if your surgeon is the gentle sort – it will take awhile for your body to work normally again.

No one mentioned a loss of appetite or that food might taste different and these have definitely been issues for me.  My appetite is better now than it was last week but it is still not normal.  For me, eating less is not a bad thing but never feeling hungry causes issues.  I was always taught to try to only eat when I am hungry.  Since Ihave not felt hungry in the last 8 weeks, it has been hard to make myself eat.   Because not eating at all is certainly not the way to heal.

So, how do I feel about the hysterectomy?

I am happy I had it.  I no longer look 6 to 8 months pregnant, my back feels better since I have my centre of gravity back, I no longer leak pee if I sneeze, laugh or cough and don’t have to get up three to four times a night to pee and pee every hour during the day.    I don’t yet know whether sex will be pain free – I hope so!  I am even happy I had my ovaries removed as it turned out I had a solid tumour on one ovary that was not cancerous but was growing so it is likely that would have been a problem later.

Though I am happy, I would remind people that having a total hysterectomy with the removal of tubes and ovaries done abdominally is major surgery and no one fully understands how the body feels about losing organs even if they are not any longer fulfilling their full functions.    I would still avoid surgery if possible.

Today I talked all about hysterectomies.  If any of this has triggered you, raised any questions, please write to me at drloribeth@atozofsex.com.  I will answer questions during next week’s show and try to point you towards resources.

Thanks for joining me for the A to Z of Sex this week.

Write to me with suggestions for the show, questions you want answered at drloribeth@atozofsex.com  and I will answer on the show.  Follow me on twitter, Instagram and Facebook..  Check out my YouTube channel: Dr Lori  Bisbey.  For a free 30-minute strategy session with me, go to https://atozofsex.com/ and click the button that says Schedule Now! See you next week when the letter will be I for Intimacy.

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