Sex After Hysterectomy

Hello, I’m Susan Bratton and today I’m answering a question from one of my fans about hysterectomy sex and orgasms. Joining me is my friend Dr. Felice Gersh. She is the medical director of the Integrated Medical Clinic in Irvine, California, and a double board-certified obstetrician and gynecologist. She is also on the faculty of a number of colleges teaching surgery including the University of Arizona, Tuscan.

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We’re talking about female orgasms and hysterectomy today. I will read to you the question and Felice, and we will answer it, sex-expert and doctor.

“This is regarding A and P orgasms. I am an RN nurse with a Bachelor’s in Science. I’m 65 years old, and I was an active member of the ‘60s and 70’s feminist movement. I feel that I have a very valid question and issue, and yet because of our misoGYNistic healthcare system, I can’t find the answer to my question anywhere. The reputable sites and clinics I’ve contacted, such as Mayo, have refused to answer, let alone acknowledge my problems. Others want money before giving me an answer. 

My issue is this. Women who have had a Total Abdominal Hysterectomy (TAH) no longer have a cervix, nor do they have A or P, anterior or posterior located just below the uterus because all of that area is removed, ‘butchered’ during the surgery. Their removal of the tubes and ovaries is a separate procedure with a different and very long name. During an old-school Trans Vaginal Hysterectomy (TAH), the cervix is cut off from the vagina, which shortens the vagina. My question/dilemma is this. What do we women do, who through no fault of our own have had this critical orgasmic area butchered out of our body? 


The anger and resentment I feel after recently learning of this are indescribable. Also, a small and fortunate percentage of women have a special kick at the end of each orgasm originating directly from the uterus as it contracts and changes positions. Now that their uterus is gone, these women no longer experience this unique pleasure. The male-dominated healthcare system could care less. For years, science has made sure to develop and perfect the nerve-sparing prostatectomy surgery. God forbid a man should never have another boner again. 

But for now, all science has to offer women is the Subtotal Hysterectomy, which is removing the uterus itself and leaving the entire cervix and vagina intact, which includes the A and P. 

I’d be interested to know if there are any TAH victims out there still experiencing an A and P orgasm and how they’re able to do so, or if they’re gone forever now.” 

– Patty

Felice, what do you have to say about that question? 


[Felice] Number one: A Simple Hysterectomy removes the cervix and uterus. This is done for cervical cancer. You take out extensive additional tissue. When you have a simple hysterectomy, which is what I believe she had, you don’t take out the anterior or posterior areas of the vagina. Those are left intact. At the top of the vagina, there is a little plug of tissue that’s the cervix. It dips down into the vagina. It cuts very carefully around the tissue of the vagina so that you should take out theoretically no vagina. You should not be removing the vagina when doing a Standard or Simple Hysterectomy. Those areas should still be intact. 


That’s in contract to a Radical Hysterectomy where they remove the top 1/3rd of the vagina. Unfortunately, when that happens it’s really necessary because that can be a life-saving procedure so we have to accept that. But I do agree that there are far more hysterectomies done than are needed. In fact, the American Academy of Obstetrics and Gynaecology which is the foundational organization, the networking and educational organization for OB GYNs actually came out a few years ago and said 17% of hysterectomies are really unnecessary.

After 65, there is natural atrophy if she’s not on adequate hormones. That will change the environment of the vagina more than a hysterectomy. I’m huge on giving sufficient hormones because the vagina doesn’t work properly; it’s not as happy if it’s withering and thinning. Estrogen supports the nerves. Aging takes a significant toll on sexual response without proper hormones. I agree that there are many unnecessary hysterectomies, and there are cases of nerve damage, which can impair sexual response. 


So, it’s certainly not an entirely benign procedure for sexual impact, and the conventional world cocoons this whole thing. When you look at the studies, they say the sexual response has improved. People are happier after the procedure. I think it’s true when they have such pathology that was causing pain; the pathology was so terrible that even though their nerves may be impacted. They don’t have a uterus that can contract any more for that final kick that some women will have. But their pathology was so impairing that their sexual response was better off. 

Every woman who’s told to have a hysterectomy, please get a second opinion. Look at the underlying reasons. Maybe their organs are malfunctioning. That’s what we do in integrative medicine. We look for the root cause and the most natural, efficient ways to heal rather than surgically removing organs. 


[Susan] I appreciate you saying that. I had a couple of thoughts about Patty as well. The first one is that she has a lot of anger. She’s furious at the system and what the system did to her. She worked in the system and so she carries the frustration of the losses of many women. I think she’s holding a lot of sadness and grief about a male-dominated system that she labored in for 30 years and saw all kinds of atrocities. So, when this hysterectomy happened to her, the whole world rested on her situation. She feels like she’s a victim. There is emotional anger and a tremendous sense of losing the pleasure parts of her body. There’s grief in her writing. 

Neither loss nor grief nor anger is conducive to orgasm. Forgiveness has to occur. A forgiving and letting go that people were working under the best training they’ve had. They were doing what they thought they should do. There also has to be a ritual, almost like when you lose a baby through a miscarriage. You have to process that loss. There is something Patty can do around ritual and closure concerning the loss of her body parts.


The next step is exploring her orgasmic potential. When a woman gets turned on and has a series of successive orgasmic contractions, the uterus balloons. What’s that muscle that pulls the vagina up called? It is a series of uterosacral ligaments that support the vagina. Those ligaments pull up. The uterus expands up and pulls the vaginal canal up higher to accommodate a penis. Those ligaments might be damaged or gone, so she might be missing the kick.

I can tell you that in my estimation, I’d say that 60% of women never get to a level of arousal that even allows them to feel that kick. Most women have perfectly reasonable sex lives without that uterus blossoming if you will. Many women are sexually satisfied and have never experienced that last mile of that contractive experience. 


The other piece I want to say is that the clitoral structure is a big meaty piece of tissue. The clitoral head, shaft, crura, the little heads that drape down over the opening to the vagina and the vestibular bulbs underneath your outer labia that area, all that tissue plus, the sphincter, the entrance to your vagina has pleasure receptors in them. Most of our pleasure receptors are out towards the edge of our bodies. They are essentially our erectile tissue. The female penis is the clitoral structure with all that erectile tissue. 

All that delicate tissue, not just the tip of the clitoris, is incredibly orgasmic as is the urethral sponge which many people call the g-spot, which is just inside your vagina, that’s still there on the top of your vagina, and the perineal sponge which is inside on the bottom on the floor of the vagina between your vagina and your rectum, all of that marvelous, sensitive erectile tissue is right there. You still have all that. You still have 99% of the good stuff. I would work on emotional forgiveness and letting go. 


I would get a Magic Wand, which is a very intense vibrator. Then, I would start rubbing it all over the mons of your clitoris, the clitoral hood, the outer and inner labia. My fingers, a g-spot vibrator, or a wand would stroke the upper and lower portion of my vagina. I would take my fingers and rub at 3 and 9 o’clock where the nerves come in. I would start enlivening all your tissue. 

Then, I would start doing orgasmic cross-training. Think about breastgasms, nipplegasms. I would kiss my lover and have orgasmic pleasure from kissing, from oral pleasuring him and getting all that erectile tissue to grow. My man or woman could give me foot massages and full-body massages to provide me with orgasms. I’d start falling in love with my body and the incredible pleasure it gives me, and I would move away from the losses and focus on the opportunities. I want to assure you that you can work with a lot of great equipment.


Your losses are minimal. Even playing with what you have will put you ahead of 95% of the women out there. I would have never thought of estrogen, testosterone, and progesterone replacement. That would not have occurred to me, but that is brilliant as well. I would adjust and balance my bio-identical hormones. I would spend time rubbing organic oil, coconut, avocado, sweet almond, into the vaginal tissue, all around the outside. Just like your skin gets dried out as you age, all that tissue is getting dried out. Get it juicy again, and you will never look back at what happened to you. You will look forward to an expanding orgasmic power. 


[Felice] I think that was phenomenal in terms of the message. Her self-image has been destroyed. She doesn’t understand what happened to her and which vaginal tissue was removed or disfigured. She has a normal vagina and she needs to embrace and recognize it. I love the idea of ritual ceremonies. She needs to celebrate the stage of life she is in and accept her body. The idea of forgiveness is so relevant. 

The doctors who did her hysterectomy, I don’t know her medical history, maybe for her, it was life-saving. Perhaps it was needed, but I can tell you that having gone through the conventional medical education system that the uterus didn’t have much of a role. Now we know so much more. You can’t convict people for a crime that wasn’t a crime at that time. 


People didn’t see the uterus in the same light as today. Her hysterectomy was probably many years ago. I think it’s time for her to learn what her body can do and have hysterectomy sex. It’s a beautiful, natural creation, and it has so much potential to let go and forgive. And enjoy the life she has. I always look at the timeline we’re on. Don’t mess it up with anger and pointless negative emotions. Let it go and enjoy every day and surround yourself with people you love, and learn to love your body again. 

Later today, I’m interviewing a person with paraplegia about how he found sex, love, and romance again after a horrible spine-severing accident. There’s always someone worse off than you. As Felice said, celebrate. Forgive, forget, move on, have more incredible orgasms! 

[Susan] I’m Susan Bratton, your trusted hot sex advisor, here with Dr. Felice Gersh. Thank you so much for writing to us with any questions that you have. I’d love to help you move on and move into more pleasure. See you on the other side.

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