How to enjoy sex after a hysterectomy

18th Aug 2023 Dating & Relationships

A hysterectomy doesn't have to spell the end of your sex life. From HRT to lifestyle changes, this is how to increase your sex drive after a surgical menopause

Every year, 55,000 women in the UK have a hysterectomy. Last year, I was one of them. And while recovery from the operation was simple, I found the procedure had an unexpectedly negative impact on my sex life.

Before my operation, my bedroom had gradually turned from the set of an erotic drama into a slasher film. I was bleeding almost constantly. I had cramps, anaemia and perimenopause mood swings that made Annie Wilkes from Misery seem chilled.

After my operation, as I spent my eight-week recovery ordering racy white lingerie and panting through Bridgerton, I assumed my sex life would be phenomenal.

It wasn’t.

My hysterectomy put me straight into surgical menopause. When I wasn’t tearing my hair out over the slightest stress, it was falling out by itself.

"A year later, sex is better than it’s ever been"

I felt lonely. I cried all the time. My brain fog meant I could never remember why I’d walked into a room, but my rage meant I could recall unfinished arguments from years ago.

When my terrified husband did pluck up the courage to touch me, my body didn’t respond. Nothing worked. Those lovely big orgasm waves had gone, replaced by an apologetic little flutter. As we lay in bed afterwards in silence, I knew we were both thinking, “Is this it?”

It wasn’t.

A year later, sex is better than it’s ever been. Honestly, if you lived next door to me you’d be complaining to the council. I tried everything but all the improvements came down to two simple changes.

Here’s what they are, and how you can use them to improve your sex life after a hysterectomy.

Do pelvic-floor exercises like they’re an Olympic event

Use exercises and toys to strengthen your pelvic floor muscles

A lot happens during a hysterectomy that might impact your enjoyment of sex. Nerves can be damaged during the operation, reducing how much you feel during sex (these usually recover after about four months).

If you have your cervix removed, that can lessen your sensations too, as many women have sensitive cervixes that respond to touch or pressure.

The deep, shuddering internal spasms that turn your climax into an almost whole-body event? They usually come from your uterus. When your uterus is removed, your main sensations come from the clitoris and labia, and those aren’t as strong.

Your best defence against these passion-killers is a Rocky-strength pelvic floor. The more you work your pelvic-floor muscles, the more blood flows to your genitals. That promotes healing, but also hugely affects how much you feel during sex.

Strong pelvic muscles also respond more powerfully during an orgasm, helping to replace some of the lost uterine and cervical feels.

During the first six weeks of your recovery, focus on doing gentle exercises. My physiotherapist gave me this regime. Try it while you’re lying on your back, on your front, or perching on the edge of a chair.

Beginner pelvic-floor exercises

Identify your pelvic-floor muscles—the ones you’d use in a long toilet queue.
Inhale.
As you exhale, draw those pelvic-floor muscles in and up.
Hold for three seconds.
Inhale while you lower and relax.
Repeat five times, three times a day.

If you’re struggling to find your pelvic-floor muscles and want someone to coach you through the process, videos or audios can be useful.

Pelvic-floor physiotherapist Michele Conway has a really helpful audio coaching session (£8). Don’t add it to your music library unless you want Alexa booming it across your room during a dinner party.

More intense pelvic-floor exercises

After you’ve fully recovered from surgery, you can move on to more intense exercises. You want to keep up this exercise regime for life.

It’s excellent protection against pelvic-floor dysfunction (like prolapse or incontinence) but—more importantly—it can turn your sexual experience from a weekend in Bognor to a round-the-world cruise.

Download the NHS Squeezy app (£2.99 from the App Store or Google Play), which comes with a pre-set exercise plan, and prompts you with reminders to work out.
Try an electronic pelvic-floor exerciser, like the Kegel 8 V20 Ultra 20 Electronic Pelvic Toner (£139.99) which comes loaded with a 12-week exercise plan devised by a women’s health physiotherapist.

Embrace your inner Gwyneth Paltrow

Ovaries produce the majority of our oestrogen and testosterone, which are linked to sex drive and response

How healthy was your lifestyle before your hysterectomy? If you were like me, your “five a day” referred to glasses of wine, and your 10,000 steps was an annual target. All that must change if you want a great sex life after a hysterectomy.

A total hysterectomy involves removal of the ovaries and the uterus, while a partial hysterectomy keeps your ovaries intact.

Sadly, both can impact your mojo. The ovaries produce most of our body’s oestrogen and testosterone, which give us our sex drive and our sexual response.

"The ovaries produce most of our body’s oestrogen and testosterone, which give us our sex drive"

If you lost your ovaries, you’ll go into surgical menopause. Even if you kept your ovaries, research has found that you’ll go into natural menopause several years early.

Some women find that their ovaries fail just months after a partial hysterectomy, possibly due to a lessened blood flow.

As soon as your ovaries aren’t functioning properly, your levels of oestrogen will decline.

Sexual symptoms of low oestrogen

Vaginal dryness and vaginal atrophy
Low libido
Mood swings
Weight gain

Hot, huh? It gets worse when your testosterone also starts to drop.

Sexual symptoms of low testosterone

Low libido
Weaker orgasms
Fatigue
Lack of motivation or arousal

If you’re experiencing any of these—and I experienced all of these—your best course of action will probably be HRT. Talk to your GP and/or your gynaecologist about starting HRT as soon as you can.

I felt emotionally stable after two weeks of taking oestrogen, and sexually revamped after three months taking testosterone.

"I felt emotionally stable after two weeks of taking oestrogen, and sexually revamped after three months taking testosterone"

But if your hysterectomy was due to cancer, you might not be able to take HRT. And even if you can, it might not be enough to get you firing on all cylinders. That’s when lifestyle changes really help.

Always consult your doctor before adopting lifestyle changes or taking supplements.

How to boost your oestrogen levels naturally

Eating foods rich in phytoestrogens, like tofu and sesame seeds, can give your sex drive a boost

Eat soybeans, tofu, flax seeds and sesame seeds

These foods are all rich in phytoestrogens, which mimic the effects of oestrogen in the body (again, if you have a history of cancer these might not be recommended, so consult your doctor).

Take vitamin D, boron and B vitamins

B vitamins help your body create and use oestrogen, while boron and vitamin D all help your body to effectively use what little oestrogen it has.

Try black cohosh, chasteberry and red clover supplements

Black cohosh stimulates oestrogen receptors in the brain. Chasteberry contains phytoestrogens, and red clover contains plant compounds that mimic oestrogen in the body (it’s especially good for night sweats, if they’re the only thing setting your bedroom on fire at the moment).

How to boost your testosterone levels naturally

Gentle exercise like yoga is linked to higher levels of pleasure during sex

Eat eggs, almonds, pumpkin seeds, spinach, kale and beans

To raise your testosterone, eat foods that are high in protein, zinc, magnesium and vitamin B6.

Try Tribulus tea

In one 90-day study, post-menopausal women who were given Tribulus terrestris reported increased sexual function and response.

Take ashwagandha

This herb is well known to increase testosterone in men and has hormone-balancing qualities. It’s also believed to lower levels of the stress-hormone cortisol, which can impact testosterone levels.

I find it calming, and it seems to stop me following my husband round the house criticising everything he does—which (naturally) improved our sex life.

Exercise

Avoid strenuous activity because it will stress out your adrenal glands, which can lower your testosterone levels (nearly half your testosterone is produced by your adrenal glands).

But don’t just lie on the sofa. Low-impact exercise, like walking and yoga, are hysterectomy-safe and will raise your testosterone naturally.

Also, women who exercise report much higher levels of sexual response and satisfaction than those who don’t. Plus, it’ll improve your body confidence.

Other healthy lifestyle changes

The more sex you keep having, the higher your libido will be

I’ve also found these really helpful. Warning: you might not like the first one.

Reduce your drinking

If you can stop drinking alcohol, stop. If you can’t, then keep your consumption to the recommended 14 units per week (that’s around one and a half bottles of wine—or, as I used to call it, Tuesday).

Alcohol can limit the amount of blood flowing to your undercarriage, which will lower your arousal and keep your orgasms on the “I’d rather read a good book” side.

Keep having sex

The more sex you have, the more sex you’ll want. Sex naturally raises your testosterone.

Another lovely side-effect is that skin-to-skin contact releases oxytocin (the bonding hormone) that will smooth out a lot of your emotional storms.

Regular sex is also your best protection against vaginal atrophy. If dryness is a problem, then use a good water-based lube like Skyn, or try a natural moisturiser like Vagisan.

Get lots of sleep

Yes, I spend a lot of time in bed now, one way or another. Sleep really helps your mood, your energy and your sexual response.

If you find it hard to get to sleep, try taking magnesium glycinate 30 minutes before bed, drinking valerian or chamomile tea, or using lavender-scented body moisturiser.

If you find yourself waking up at 3am, that can be a sign that your cortisol levels are too high, so increase your low-impact exercise during the day

Or just wake your partner up for a quickie.

How to increase sex drive after hysterectomy

To enjoy sex after a hysterectomy, the two best things you can do are:

Tone up your pelvic floor, and then keep it toned.
Adopt a very healthy lifestyle, fuelled by vitamins, supplements and exercise.