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Getting back to activities like sex after a hysterectomy can be intimidating.

Learn what a hysterectomy is, how it can affect your sexual function, and what pelvic floor physical therapy can do to help.

What is a hysterectomy?

Acording to the American College of Obstetricians and Gynecologists (ACOG), a hysterectomy is surgery to remove the uterus. It is a common type of surgery for women in the United States.

  • Hysterectomy is used to treat many women’s health conditions including:
  • Uterine fibroids (this is the most common reason for hysterectomy)
  • Endometriosis (although it states this on ACOG, it is more correct for this to state Adenomyosis, which is endometriosis in the uterus. Please be clear -- a hysterectomy is NOT a cure for endometriosis).
  • Pelvic support problems (such as uterine prolapse)
  • Abnormal uterine bleeding
  • Chronic pelvic pain
  • Gynecologic cancer

Source: ACOG: FAQ Hysterectomy

What structures are removed during a hysterectomy?

There are different types of hysterectomy:

  • Total hysterectomy—The entire uterus, including the cervix, is removed.
  • Supracervical (also called subtotal or partial) hysterectomy—The upper part of the uterus is removed, but the cervix is left in place. This type of hysterectomy can only be performed laparoscopically or abdominally.
  • Radical hysterectomy—This is a total hysterectomy that also includes removal of structures around the uterus. It may be recommended if cancer is diagnosed or suspected.
  • If needed, the ovaries and/or fallopian tubes may be removed if they are abnormal

Sex after Hysterectomy

Once you've had a hysterectomy, you must wait until the vaginal tissue heals completely before resuming sexual activity or using vaginal dilators. The American College of Obstetrics and Gynecologists recommend waiting six to eight weeks before inserting anything in the vagina. Talk to your doctor about any concerns you may have before seeing a pelvic floor physical therapist. Sex after hysterectomy can be complicated due several reasons.

Menopause Symptoms Can Affect Sexual Function

A hysterectomy can trigger menopause symptoms that can affect quality of life and sexual function.
Common Menopause symptoms that affect the genitals:

Pain with Deep Penetration

Although patients will have different experiences during their healing after a hysterectomy, some may experience what feels like a “shortened” vagina or tender tissues inside the vagina after surgery that make penetrative sex, particularly deep penetration, painful.

Symptoms and How Pelvic Floor Physical therapy Can Help

Pelvic floor physical therapists can help with many of the various issues that can arise after hysterectomy and help reduce the associated pain and discomfort. Licensed pelvic floor therapists are experts in dealing with a variety of symptoms that can make recovery difficult.

These include:

  • Pain management and scar mobilization
  • Pelvic floor muscle downtraining
  • Manual therapy
  • Dilator therapy
  • Visceral mobilization to maintain mobility and motility of organs, which improves bowel, bladder and sexual function and reduces pain
  • Lymphatic Massage and Complete Decongestive Therapy
  • Strengthening of the abdominal wall
  • Menopause restorative program

Give us a call at (818) 873-1403 or use our appointment form to schedule a time to see one of our licensed therapists.

Resources

American College of Obstetricians and Gynecologists, 2018. Hysterectomy.

https://www.acog.org/patient-resources/faqs/special-procedures/hysterectomy

Callan, N. G. L., Mitchell, E. S., Heitkemper, M. M., & Woods, N. F. (2018). Constipation and diarrhea during the menopause transition and early postmenopause. Menopause, 25(6), 615–624. doi:10.1097/gme.0000000000001057

Castellani, D., Saldutto, P., Galica, V., Pace, G., Biferi, D., Paradiso Galatioto, G., & Vicentini, C. (2015). Low-Dose Intravaginal Estriol and Pelvic Floor Rehabilitation in Post-Menopausal Stress Urinary Incontinence. Urologia Internationalis, 95(4), 417–421. doi:10.1159/000381989

Maltais ML, Desroches J, Dionne IJ. Changes in muscle mass and strength after menopause. J Musculoskelet Neuronal Interact. 2009;9(4):186-97

Minkin, M. J., Reiter, S., & Maamari, R. (2015). Prevalence of postmenopausal symptoms in North America and Europe. Menopause, 22(11), 1231–1238. doi:10.1097/gme.0000000000000464

Mehta, R. S., & Staller, K. (2018). Menopausal transition and bowel disturbances. Menopause, 25(6), 589–590. doi:10.1097/gme.0000000000001110

What Our Patients Have to Say

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Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

Testimonial by S.B.

As someone who suffered the debilitating physical and emotional effects of vaginismus (as well as a complicated history of back injuries) for more than 15 years, I thought a "normal" life was just a fantasy. Then I found Heather.

Read more: Testimonial by S.B.

Testimonial by Amanda W.

Heather's unique physical therapy program literally changed my life! After years of struggling with vaginismus, a condition that made it impossible for me to have intercourse and very difficult to use tampons without pain, a gynecologist referred me to Heather. I was nervous for my first appointment, but Heather's professional and friendly demeanor put me at ease. She did a great job explaining each technique she was using to help my muscles relax. Heather uses a combination of internal and external stretches and exercises to relax the pelvic floor and build muscle strength. Her specially developed home program helped me quickly recover from an issue that seemed insurmountable before meeting Heather. She was optimistic about my progress and incredibly encouraging. Less than 6 months after my first session, I was able to have pain-free sex for the first time in my life! If you are suffering from vaginismus or any other pelvic floor issues, I highly recommend making an appointment with Heather and reading her book!

-- Amanda W., 2/15/16 via Yelp!

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by S.S., age 54

Heather is the best! I saw her today for terrible hip/groin pain. I was so impressed with the safety measures in place and felt completely safe . Thanks for the healing hands.

S.S., age 54

Testimonial by Fritzette H.

I went to Heather after the birth of my third child. It was lucky, really, that I was referred to her, because my doctor had referred me to a surgeon for a possible hysterectomy or pelvic wall rebuild. Thankfully, I went to Heather before undergoing either surgery, she was able to fix the problem. She has studied extensively in women's health--even written a book about it--and was able to diagnose my problem, suggest a course of treatment (6 weeks), and then follow through with said treatment. By the end, as she said, I was as good as gold. Boy, was it worth it! Though uncomfortable to talk about, much less write about, it is worth getting the word out there. If you have painful intercourse, especially after birth or other trauma, the treatment may be as simple as Physical Therapy (with Heather, of course). I highly recommend her.

-- Fritzette H., 3/24/16 via Yelp!

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