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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 P.M.

I was hopeful but frankly skeptical when the doctor treating me for Interstitial Cystitis recommended that I go to Heather for physical therapy. Medication and diet helped control my IC symptoms, but I had never heard of physical therapy being used to treat IC. The education and treatment I received from Heather was a revelation. She explained that the pain I experienced with IC had helped create a cycle of muscle guarding which affected the entire pelvic area. I had no idea of the amount of tension being held there. No wonder my husband and I had not been able to have sexual intercourse for years!

Read more: Testimonial by P.M.

Testimonial by Lauren B.

Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I was broken and didn't have the energy to keep trying. When I got engaged a few months ago though, I realized I needed to get answers so i wasn't dreading my honeymoon.

Read more: Testimonial by Lauren B.

Testimonial by M.M.

My husband and I were married for 5 years and unable to have intercourse, but I never knew why. After numerous awful experiences at doctor’s offices (where many doctors told me I “just needed to relax”), a surgery that didn’t fix the problem, and a year of owning dilators that didn’t get me anywhere, someone finally referred me to Heather for Physical Therapy. I finally had answers and information from someone who knew exactly what I was dealing with!

Read more: Testimonial by M.M.

Testimonial by S.P., Age 26

I would like to start off by thanking Heather Jeffcoat for educating me and curing me of Vaginismus. I had been married for almost three years before I was referred to Heather. I never knew about Vaginismus until almost three years into my marriage. I knew something was wrong when I went on my honeymoon and came back a Virgin. I had always imagined how magical my first night would be but boy was I wrong.

Read more: Testimonial by S.P., Age 26

Testimonial by R.D., age 38

"I had a severe tear during childbirth that was not stitched together correctly and therefore healed poorly. Even after having a surgery a year later to remove the scar tissue, I was still having pain, and no one could explain why -- there was no overt 'reason' to explain the pain. I had tried other 'specialists' and even saw another physical therapist who had me do hip / leg stretches -- what a joke! I was about to give up and just 'live with it' until thankfully I kept searching online and found Heather.

Read more: Testimonial by R.D., age 38

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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