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Thursday, September 28, 2017

Surgery and Sexuality

Written by  Dr. Eva Hersh, MD

Nerves grow back, but slowly

I am a 70-year-old woman. Obviously I’ve been in menopause for a long time. Because of an enlarging tumor in my uterus, I will soon be having a hysterectomy. When I asked the surgeon how the hysterectomy will affect my ability to have orgasms, he looked so embarrassed he almost blushed. I suppose it didn’t help that he looked younger than my own children. He seemed to think that old people have no sexuality. I didn’t get an answer to my question. Some of my friends who have had a hysterectomy say that they felt it decreased or changed their ability to orgasm. Others say it didn’t make any difference. My question is, does the uterus have a role in female orgasm, and what is the effect of hysterectomy for most women? Does it help if the surgeon does not remove the cervix?

Pre-Op

Dear Pre-Op,

I appreciate your persistence in trying to get an answer to this question. My answer is based both on a review of medical literature and also on my own experience with many female patients who’ve had hysterectomies.

Regarding the role of the uterus in orgasm, the uterus does play a part in orgasm but for most women it is not a major one. During orgasm, the muscles in the uterus contract repeatedly. Some women do not feel this at all or experience it as a minor part of orgasm; for others it is more important and intensifies the sensations of orgasm. Because of this variation in the sexual responses of different woman, it is hard to predict whether a particular person will notice a change in orgasms following hysterectomy. In my experience, women who had orgasms without difficulty before hysterectomy will also have orgasms without difficulty after hysterectomy.

As far as leaving the cervix in place, this is not recommended. Studies showed that leaving the cervix in did not improve women’s ability to orgasm or their sexual sensations. Also, the cervix is the part of the uterus most likely to become cancerous, so it is considered bad practice not to remove it when the rest of the uterus is removed.

Although your ability to orgasm will likely return to normal after you fully recover from the surgery, it’s important to realize that recovery may take many months. With any surgery, there is a period of recovery and healing which is often longer than the surgeon may tell you. This is because surgeons think in terms of the healing of the tissues that were cut, which is usually complete within three months. But if nerves are damaged, it takes longer for them to recover. Nerves do grow and heal, but because nerve tissue is the slowest growing type of tissue in the body (even slower than bone) it may take several months or even years for a person to fully recover sensation.

 


Dear Dr. Eva,

I’m a transman looking forward to chest reconstruction surgery. What can you tell me about how the surgery affects nipple sensation? I am having the double incision procedure where they completely cut off the nipples and then sew them back on in the right place for a male chest. My surgeon tells me most of her patients have normal or close to normal nipple sensation after surgery. This is amazing to me because the nerves to the nipples have to be cut to move them. How is this possible?

Transitioning

Dear Transitioning,

Congratulations on your surgery! I am sure you have been looking forward to this for a long time.

I agree, it is amazing. When the type of surgery you are having, a bilateral mastectomy with chest reconstruction to the male type, was first started, no one knew whether nipple sensation could be preserved.You are correct, the nerves as well as the blood vessels to the nipples have to be cut to re-position them. The body has great healing ability, and in most cases transmen who have had chest reconstruction do develop normal sensation in the nipples, including erotic sensation. Remember that nerves grow and recover very slowly. It often takes as much as three years for normal sensation to develop, so don’t be discouraged if it’s not there yet after one or two years. You can do your part to encourage healing by avoiding smoking and carefully following your surgeon’s instructions on wound care.

Eva Hersh is a Baltimore family physician. Send your comments and questions to her by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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