Uterine Fibroids and Hysterectomy - Hysterectomy

Two procedures associated with hysterectomy may affect sexuality directly.

If the cervix is removed, the clitoris can trigger orgasm, but many experts believe that uterine contractions stimulated by sexual intercourse also cause a so-called "deep orgasm." Retaining the cervix may help to retain this sensation.
Patients who have both ovaries removed may be at higher risk for loss of sexuality. Ovaries produce small amounts of testosterone (the male hormone responsible for sexual drive) even after menopause.

Testosterone Replacement. Testosterone replacement therapy may restore sexuality in women who experience a decline in sexual drive. Occasionally, oral or injection treatments can produce male characteristics such as facial hair and voice change. A slow-release pellet inserted every six months under the skin in the hip appears to reduce these side effects. A patch (Intrinsa) is also in development. Taking hormones long term almost always carries some risks, and it is not yet known what danger testosterone replacement may pose in women. Support groups and counseling can provide important help for this problem.

Pap Smears

Annual Pap smears are recommended for all women with cervix intact who have reached the age of 18 or over or who have become sexually active. After a total hysterectomy, in which the cervix has been removed, a woman will still need Pap smears of the vagina, but because of the low risk of vaginal cancer, these tests usually do not have to be performed annually. The interval between Pap smears depends on the patient's risk factors as determined by the physician. Women with a history of abnormal Pap smears usually require annual screening. Women with a supracervical hysterectomy, in which the cervix remains, still need annual Pap smears. Annual pelvic and breast examinations are important for all women, including those with a total hysterectomy.