After Hysterectomy, a New Approach to Sex and Orgasm

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.

The Menopause Libido Myth: Dr. Pat’s Notebook


Menopause. Hot flashes, night sweats, sleep disruption, fatigue and crankiness. It surely can make any woman feel less than sexy. But don’t believe that “Menopause took my libido away” line as the primary reason for a loss of sexual interest.

There are often other factors at work that can diminish your sex drive long before menopause—for starters, the quality of your partnership and your attitude toward sex.

Some women have never had much of a libido. They feigned sexual interest in order to date and mate and reproduce. With children came exhaustion and the nightly prayer, “Oh Lord, not tonight,” while their partners prayed for sex. This dance of unbalanced desire continued until these women found their big out: “Menopause took my libido away.”

On the other hand, there are women who were always interested in sex, but bored or sexually frustrated in their marriage. When they reach menopause, they’re more than happy to give up unsatisfying sex. Now, they can claim “Menopause took my libido away.”

Women who liked sex and were happily orgasmic can lose interest in sex if their relationship becomes dysfunctional, or an affair has eroded the trust in the marriage. These women actually look forward to saying “Menopause took my libido away.”

It doesn’t have to be that way.

There are many women who keep their libido in great shape after they reach menopause. They like sex for the sake of sex. To them, initiating sex is both a right and a turn-on. Shared sexual power and a mutual interest in setting aside time for making love has kept their menopausal libido alive and well. Menopause did not “take their libido away.”

What can you do to take charge again and ensure a healthy libido well after menopause?

  • Plan for a fulfilled sex life well before you reach menopause. Don’t wait until a pattern of denial and poor behavior in your relationship make isolation in bed inevitable.
  • Talk to your partner about finding time for emotional and physical intimacy. Develop or continue a little public display of affection.
  • Discuss the issues of physical change that will come to both of you with age, like vaginal dryness, thinner genital tissue, and potential erectile dysfunction. Face it before it happens. Don’t let shame and embarrassment ruin your sex life later on.
  • Most importantly—and I can’t emphasize this enough: Avoid women who complain that all their husbands ever want is SEX. These women are toxic. Choose friends with happy couplings. Choose to spend time with women who like to laugh about sex and themselves, and still notice who is hot and who is not.

Sex doesn’t cost a thing. It improves longevity, quality of life, and overall health. Menopausal sex without the fear of pregnancy, the mess of the monthly cycle, or young children knocking at the bedroom door can be a spontaneous and joyful part of the second half of life.

Don’t let anyone tell you that “Menopause will take your libido away.”

The Economy Is In Real Trouble When The Upper East Side Sex Toy Shop Had To Shut Down

patlunch1croppedThe loss of sexual interest among menopausal women has clearly become no longer newsworthy in this time of falling stock prices and rising unemployment. Otherwise, why wasn’t it big news when the uptown vibrator store had to close down because of the recession?

Myla, a British lingerie, swimwear and sex-toy line, opened its shop doors just off Madison Avenue at 16 E. 69th St. in September 2004. This was very expensive real estate, and the shop was quite nicely done up. The New York Times did a big piece for the opening. Curious middle-aged women, after lunch at one of their favorite bistros in the neighborhood, came to air shop — to oooh and twitter — and then sneaked back later to buy the goods. A little sexual novelty was good for her and good for him.

Long-term monogamous relationships often run low on libido, especially when the wife has reproduced twice and then flies into the frightening 40s. During the good times, there were trips and spa weekends with the girls; Prada bags and fashion openings; gala events, and summers often spent separated during the week. It was easier, then, for certain wives to initiate sex and work at the orgasm thing, and a vibrator often came in handy. Intimacy, for many of these relationships, was never part of the package, and hot, easy sex that lasts needs some of that elusive spice.

Menopause, with its well-publicized symptoms of volatility and loss of libido, has always been convenient for those women who maybe never liked sex all that much, and for those who married someone with neither great knowledge of female anatomy nor the capacity to be a thoughtful lover.

Many women did find, though, that they missed the girl they once were, or else wondered if they could ever be the sort of woman whose orgasm is easily achieved. The booksellers’ shelves were filled with manuals on how to do it.

  • Pole-dancing classes were sold out two years ago.
  • Goddess tutors helped women find their sensual selves.
  • Physical therapists taught women how to improve their love muscles.

Partners were delighted if women showed any interest in doing it, and unless they were real cads, really wanted to be part of a woman’s orgasmic event.

And up there on 69th Street, just off Madison Avenue, Myla was having a boom time in the good times, with its sweetly sexy lingerie and vibrators that weren’t purple with multiple prongs.

Women, those of us who grew up after the sexual revolution in the late 1960s, if we were interested in sex, generally had a vibrator tucked away, somewhere where the cleaning woman and the kids couldn’t find it. But for the shy and somewhat inhibited woman, a vibrator was often a subject never discussed or acknowledged. I must confess that I visited Myla after The New York Times article — purely for professional reasons, of course. Then I began to give their name and address to patients who were having trouble re-starting the mid-life sex engine, as part of the general conversation that should be part of every visit to a gynecologist. You know, “Any pain in the abdomen? Is the bowel function normal? Any bladder problems? And, how often are you having an orgasm each week?” I am sure your gynecologist asks that question!

Women who complained that they had no libido and could no longer have an orgasm when there was no emotional or physical barrier to successful sex often just needed a bit of genital rehab with local estrogen, coaching and cheerleading and some new ideas to consider. Throw out those nightgowns or T-shirts you sleep in, buy some new lingerie, and how about a vibrator? Practice practice practice was the motto, and motivated women did indeed get their sex lives back for themselves and their partners.

Then the recession slammed households and relationships all over the country. But especially hard hit were many of the relationships that were based primarily on commercial and reproductive transactions. Women who were anywhere near “The New Menopause” grabbed the menopause label; they effectively said, “I am in menopause, honey, and I am done.” Unless these relationships can be reinvented, menopause will continue to bear the blame for this malady, as it has done for so long for other unfortunate conditions.

mylasummerWe at Womensvoicesforchange.org want women to have access to the latest knowledge about all aspects of their menopausal health. And the good news is that sex is generally free, and a mutually orgasmic relationship improves pair bonding and reduces stress. No creams or potions will give a woman’s complexion that post-orgasmic glow. And, nothing makes a woman matronly quicker than giving up sex.

Also, my favorite vibrator store still exists, but in the United States it is now only online. You can find it at www.mylausa.com.

You heard it here first.