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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 Jackie W.

I was in multiple car accidents a decade ago, and I have been to many physical therapists through the years without success. They found the root of my lower back pain problems and after nearly a decade of barely being able to walk I finally can again without pain. They are also the best pelvic floor pts and the only ones who found the connection between my pelvic floor and lower back problems. If you need help with physical pain, they are your answer.

-- Jackie W., 1/19/17 via Yelp!

Testimonial by Carolina J.

I had tried Pelvic Floor Physical Therapy before (with another PT) and I had a really bad (painful) experience. A friend of mine and fellow patient, told me about Heather, Laureen and Femina PT (née Fusion Wellness & Physical Therapy) and I decided to try again. I am so happy I did! Femina PT have, literally, changed my life. I was able to do again things I couldn't do for over 10 years!! Their bedside manners are impeccable, their knowledge and understanding make me feel comfortable to recommend this place to anyone in pain. Specially if you have Endometriosis. 100% recommended!!

-- Carolina J., 12/28/16 via Yelp!

Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

Read more: Testimonial by Mary L.

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 S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

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