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Dear Drs. Lewis and Gail Wyatt:

I am a 44-year-old married mother of three. A year ago, my doctor advised me to have a hysterectomy. My research and a second opinion proved him correct. I had the surgery but kept my cervix and ovaries. Since then, my husband complains that sex is not the same. He hints that I am not the woman I used to be. Did the hysterectomy affect my ability to sexually please my husband? —Jodi F.

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Many women worry about sex after a hysterectomy. We assume by your question that it is your husband, not you, who thinks sexual functioning has changed since your surgery. It would be interesting to know if your husband accompanied you to any visits with the doctor before your surgery. He should have. Learning about what to expect can ensure a good recovery.

Studies indicate that women’s sexual functioning before hysterectomy is the same after the procedure, unless they were inadequately prepared or there were complications at the time of surgery and during recovery. Some women report that their sexual functioning actually improves after hysterectomy. After all, they no longer have a fear of pregnancy, no menstrual periods, relatively less or no pain with sex and no constant bleeding that most likely contributed to why a hysterectomy was recommended in the first place. Incidentally, women did not report that having their uteruses removed had an effect on sexual functioning if the cervix was removed or left in place.

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It appears that your partner’s attitudes and beliefs are diminishing his pleasure, but those beliefs are not based on facts.

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Most sexual problems smolder long before a hysterectomy. It may be easier to blame the surgery than to admit that the two of you may have needed to work on your sex life before now. Think back and try to recall if your husband had similar complaints about sex before the hysterectomy. Here are some issues that may influence your husband’s attitudes and beliefs:

1. Some believe that part of the vagina is removed with surgery. You or your doctor may need to explain that that is not the case with you because your cervix is intact.

2. In some cultures, women who have had hysterectomies are viewed as less womanly, or less sexual, since they can no longer have children. If this is the case and your partner’s view of you depends on your ability to have children, this issue needs clarification. If a woman’s status increases in the eyes of her partner because she can have children, that is a belief often based on two potentially overlapping roles of women: one, that their sexual functioning is for the purpose of having children; the other, that their sexual functioning is for pleasure only. Actually, women’s sexuality includes both procreation and recreation. They can enjoy sex and never have children and they can have children and rarely enjoy sex.

3. It is possible that, depending on how your partner defines his sexual attraction to you, having the hysterectomy might have cut short dreams for more children. It is possible that the two of you might need to discuss adding to your family. If you both agree about this, there are still options for you to consider. You still have your ovaries. You can seek advice from an infertility specialist referred by your primary care physician.

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Ask to be evaluated for your eligibility to donate an egg to be fertilized by your spouse. A surrogate woman would carry and deliver the child. If your eggs are no longer eligible to be used for fertilization, an egg can be donated by a surrogate, fertilized by your husband’s sperm and delivered by her. Having more children who are the biological child of at least one of you is still a possibility.

4. It is also possible that you and your husband have yet to accept that while your uterus is gone, your sexuality is not. The more you feel like a woman, the more you can express your sexuality. Can you do more to enjoy sex after surgery and please yourself and your partner? We bet that you can!

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For answers to your questions about sexual health, write to us at justsex@theroot.com. Be sure to include your age, gender, any medications you’re taking and the nature of your sexual problem.

Gail Wyatt, Ph.D., is a licensed clinical psychologist and sex therapist. She is also a professor at UCLA and director of the university’s Sexual Health Program. Lewis Wyatt Jr., M.D., is a board-certified obstetrician-gynecologist in private practice in Beverly Hills, Calif. He specializes in sexual health and bioidentical hormone treatment.