Sexual problems and solutions / Discomfort of vulva and vagina during intercourse:

After a hysterectomy - i.e. removal of the uterus –, you can have sex again and enjoy it once more. Sometimes this takes a little time and practice.

What happens to the vagina during a hysterectomy?

During a hysterectomy, the vagina is affected differently depending on the type of hysterectomy you have had:

• supracervical or subtotal hysterectomy: the cervix is preserved. The vagina remains completely intact. You will probably feel no difference in your vagina compared to before.
• total hysterectomy: the cervix is removed, leaving a small scar in the vagina at this point. This can lead to changes in sensation during sex, especially if the cervix was an important source of arousal.
• radical hysterectomy: the entire uterus and the adjacent section of the vagina are removed. In addition to the removal of the cervix, this also changes the length of the vagina. This means adjusting to new sensations and a "new" vagina.

Can I still have an orgasm?

The good news is that the physical conditions for sexual arousal and orgasm are still there after the surgery.

There are different ways to increase sexual arousal. If you are mainly aroused by external sexual stimulation or right behind the entrance of the vagina, you may not notice any difference even after a total or radical hysterectomy.

The situation is different if you enjoyed stimulation at the back of the vagina and on the cervix. It's helpful if you understand sexual learning and know that you can rediscover pleasure and sexual arousal inside your vagina.

How can I rediscover my sexuality?

It's understandable if you're irritated if stimulation feels different after a total or radical hysterectomy. Maybe it also makes you sad. It's okay to mourn the old and feel unsettled by the change. When you're ready, you can try the exercises below to build up something new.

The good news is that you can build something new. The secret is not to focus on what is no longer there, but to turn your curiosity toward what is there. Acceptance an curiosity help you discover new pleasure and rekindle desire.

If your ovaries have also been removed, you may be entering menopause. This may be accompanied by a sharp drop in hormones. You may notice for several or months that your desire for sex and your enjoyment of sex are somehow not as exciting as they used to be. Don't give up! Your body needs some time to get used to the change. Try to enjoy what you have – even if it's not the same intense experience as before.

When can I have vaginal intercourse again?

Talk to your doctor about when you can have sex again. It might be after a month, or it might take longer. It depends on the type of surgery and how long it takes your body to heal. Once the scar has healed, you can have vaginal intercourse like you used to. You can also use a dildo or other toy inside your vagina again.

Since the uterus between the vagina and bladder is missing, you may initially feel a stronger urge to urinate during sex, or you may experience a slight “burning” sensation on the front wall of the vagina. Through repetitive stimulation, your brain will eventually learn to distinguish this more intense stimulation from the urge to urinate.

When can I become sexually aroused again?

If you want to stimulate your clitoris or other parts of your body, you can of course do so before you are allowed to have vaginal intercourse again. You can also have an orgasm. Some women experiment with this as early as one week after the surgery. Experiencing pleasant and arousing feelings in your genitals can help with any discomfort during the healing process.

Your vulva does not have to be a taboo zone for your partner before you are allowed to have vaginal intercourse again. It is important that you talk to each other and carefully explore what is possible and what feels good.

Re-awakening the vagina

Even after a total or radical hysterectomy, you still have your vagina. The scar itself and the area around it still have the excitable nerve endings that you had before the hysterectomy. You can “tickle” them awake once more. You could call this “eroticizing the scar.” This means that the scar and the area around it can become an interesting source of arousal.

It is normal for touch to feel rather lukewarm at first. But lukewarm is better than nothing. And with practice, lukewarm can become hot. Please read this text about practicing for sex to understand this better.

What if I have a poor relationship with my vagina?

Perhaps you did not have a good relationship with your vagina before the surgery. If so, it is even more important that you treat your vagina with love and care after the surgery. It is a part of you, and it has just been through quite a lot. Please read our tips on exploring your vagina.

Pelvic movement and use of pelvic floor muscles

We recommend that you practice for vaginal intercourse on your own. To accommodate a penis, dildo, or finger, we recommend pelvic swinging movements in combination with pelvic floor muscle activity. The vagina is arousable everywhere, not only in the area around the cervix. Pelvic floor muscles have arousable nerve endings in themselves. It't helpful if you discover and lern to perceive as many of the nerve endings in the vagina as possible. This can be achieved through repetitional stimulation.

Tips for vaginal intercourse

When you resume vaginal intercourse after a total or radical hysterectomy, you should take control at first. We recommend pelvic swinging movements, as these allow you to move your vagina and reduce the amount of movement required from the penis. You dictate the pace and decide how deep you want to take in the penis. We particularly recommend this after a radical hysterectomy, where the vagina is no longer the same size.

Foreplay that allows the vagina to become aroused is also very helpful. This means that you should include the vagina in foreplay – let your partner stimulate it with his fingers and tongue. An aroused vagina becomes wider, larger, and more moist. This way it's well prepared for  taking in a penis.

You can find more tips for vaginal intercourse in this text.