Q&A: Orgasm After Hysterectomy
You may need to relearn how to feel safe in your body
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Today's question is a really important one –
Q: I am a therapist who is a working with a female patient in her late 30's who was diagnosed with appendix cancer which led to removing multiple organs including a total hysterectomy. She has not been able to experience an orgasm since her surgery. She is doing pelvic floor PT and this is helping with pain and increasing enjoyment, but no orgasm yet. I suspect there is an emotional barrier due to all of the trauma from the cancer and resulting infertility, but this is slow moving. My patient’s gynecologists have not been able to answer anything about if she should be able to have an orgasm or not. Any suggestions or thoughts on this? She has no other medical conditions.
A: You have hit the nail on the head, in my opinion. Broadly speaking, the research on the impact of hysterectomy on orgasm is like the research on the impact of birth control on sexual interest: people just vary. It can diminish orgasm, increase orgasm, or have no effect. There’s no particular reason to expect the hormonal changes of the hysterectomy will affect orgasm per se, but there is certainly reason to expect that someone who has been treated for cancer and experienced major surgery, including abdominal surgery, could be affected. Hysterectomy itself can be highly emotional, with patients experiencing a similarly wide range of feelings (PDF), from positive (like, “the procedure renewed my sexual relationship”) to negative (disgust and fear, in particular). People vary, and they change.
As I’m sure you know, enormous grief can follow even ONE of the procedures your client experienced. A cancer diagnosis is a big, big deal, and someone in her 30’s, not yet menopausal, will likely have some feelings about suddenly losing her fertility to cancer treatment. And as you say, this is slow moving. Loss is difficult. But as I always say, feelings are tunnels: you have to go all the way through the darkness to get to the light at the end.
So: how does she get through the darkness? The fundamental answer: relearning to feel safe in her body. It’s what we try to do with all trauma, right?
She’s doing the right things, with gynecological support (it’s too bad the gynecologist doesn’t know whether or not your client’s procedures have sexual side effects—seems like that’s something they should know…), a pelvic floor PT, and a therapist. With your support, she can go far.
I have three small suggestions:
First, I would suggest seeking a peer support group, whether in person (COVID permitting) or online. Knowing she’s not alone and hearing from others who have experienced a range of post-treatment issues and improvements is, in itself, helpful in restoring a sense of safety in her body.
Second, I would suggest that she frame her PT as both a physical process—helping with pain and increasing pleasure—and an emotional process of building a relationship with this new body, grieving the losses she experienced, processing the fear she felt at diagnosis and during treatment, and overall healing the trauma. Her body was not a safe place for her to be, for the duration of her treatment. It will take time and practice to relearn the ability to feel safe in her body now. Right now, it may be that the memories of the past and the sensations in the present and closely linked in her brain, so that sexual sensations may be hitting the brakes.
And finally, in addition to whatever exercises her PT gives her, perhaps you might support her in exploring a practice of self-compassion and/or lovingkindness for her body. As just one example, she might try a gentle meditation of turning her attention toward a body part that she has critical, angry, sad, or panicky feelings about, and sending that body part kindness and compassion.
There’s a beautiful little self-guided journal called Sensual Self by Ev'Yan Whitney, which guides readers toward a playful, curious relationship with their body that she might try. Workbooks like this can help especially if people prefer a little structure with their self-care and self-compassion.
One last suggestion—something I say often: What if you took orgasm off the table? What if your client could be released from all sense of failure and any performance demand, simply by not being allowed to have an orgasm? Let her process be about deepening her connection with her full self and granting herself access to pleasure; in the process she can release grief and fear. It’s so not about orgasm, it’s so much bigger than that.
Because she has already experienced reduced pain and increased pleasure, I have high hopes that her orgasms will return. But with the support she has in place, it’s possible that this experience, dreadful as it probably was, could be a moment when she connects more lovingly with herself than she has since the earliest days of her childhood.
Hope that helps!
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