A WVFC reader recently wrote to us:

My wife had a total hysterectomy about 3 years ago, and since her surgery she has not been able to achieve orgasm. She still has vaginal sensation but no clitoral sensation at all.  This has been devastating to my ego and has caused my own erectile dysfunction problems.  My wife is 55 years old and I am 59.  We married 18 years ago and had a wonderful and fulfilling sex life. We would like to continue having sex, but my entire reason for having sex with my wife was to make her orgasm—it’s the one thing I did for her that made me feel good about myself, and my wife was the beneficiary of my ability to make her feel really loved. Don’t get me wrong, I still love my wife very much and always will, but the spark and excitement is gone.  We now just exist as old married people who sit around and watch TV, go to sleep, and get up and go to work.

My wife has been an RN for over 30 years, and for the last 13 years she has been an educator who teaches medical students about ostomy and wound therapy.  She is a caring person, but like me, she feels we’re missing a major part of our life.

Is there anything that can be done to help my wife regain sensation in her clitoris? She still gets very wet and her nipples respond to touch, but that’s all. Please help us if you can.

We asked gynecologist Hilda Hutcherson, M.D., a member of WVFC’s Medical Advisory Board—and one-half of WVFC’s “Sex Talk” team—to respond. (Ed.)

Hysterectomy is the most common pelvic surgical procedure. Most women who receive a hysterectomy will continue to have an active satisfying sex life after surgery. For some women, sex is even better. However, the procedure can sometimes injure nerves that are necessary for sexual response and pleasure. The vagina and/or clitoris may become less sensitive. Orgasms may become less frequent, milder or may not occur at all. Orgasms may be particularly elusive if a woman received pleasure from stimulation of her cervix, which has now been removed, during deep penetration. In addition, if the ovaries are also removed, loss of estrogen and testosterone hormones can cause painful sex, vaginal dryness and decreased arousal.

Sex may change after hysterectomy, but that does not mean that it can’t be intensely satisfying. You can help put that spark back into sex by discovering new, exciting ways to experience pleasure. For instance, the female body is full of erogenous zones, those sensitive areas that can provide pleasure when stimulated. Massage her entire body and look for those undiscovered areas that make her moan when touched, stroked or massaged. Her nipples respond to touch, so give them particular attention.

You say that your wife’s vagina remains sensitive, and that is good. I suggest that the two of you focus on learning how to find pleasure in her G-spot. Some women find that when this very sensitive area is massaged and stroked, it may lead to an orgasm. You can locate the G-spot by placing your fingers along the front wall of her vagina, midway between the top of her vagina and the opening. Massage this area while curling your fingers in a “come hither” fashion. Initially, it may not be pleasurable. In fact, she may only feel the urge to urinate. With practice and patience, she may begin to feel great pleasure, and even orgasm.

Vaginal dryness can be a problem after the ovaries are removed due to the loss of estrogen. Using a good lubricant can make sex more comfortable and pleasurable. Likewise, her clitoris may be more insensitive because of loss of estrogen and testosterone hormones. In my practice, I prescribe estrogen suppositories or rings that are placed in the vagina, and a small amount of testosterone cream that is massaged on the clitoris. The combination of estrogen and testosterone may lead to an increase in the sensitivity of the clitoris that makes it easier to experience orgasm. (Note: Testosterone is not approved for use in women and is used off-label in select patients.) Toys may also add a new dimension to your sex life. The intense stimulation provided by a vibrator may be all she needs to reach the height of pleasure.

I applaud your desire to make sure that your wife is satisfied. I am concerned, however, that your self-esteem appears to be tied to the sexual response of your wife. Every person is responsible for his or her own sexual experience. You can’t wrap an orgasm up in a little blue box and hand it to her. You may use techniques that assist her along the way, but you can’t control it or will it to happen. And if she feels pressured to perform sexually, it will become even harder for her to experience pleasure or orgasm again.

Remember, sex is so much more than orgasm. Intimacy alone is very important in a marriage. You might find that helping around the house, massaging her feet at the end of a long day, and spooning against her body as she sleeps gives her as much, if not more, pleasure than an orgasm. Let her know that you are there to help her have the best sexual experience that she is capable of, without pressuring he to respond in any particular way. Chances are, with relaxation, patience, experimentation, and exploration, her ability to achieve orgasm will return.