The first thing to say is that getting back to a normal sex life after a hysterectomy (removal of the womb) for cancer is perfectly safe and healthy. Except for the first few weeks after the operation, there is no risk of intercourse ‘damaging’ the tissues as a result of the previous surgery.

Surveys have shown that a majority of women actually find that they enjoy sex more after a hysterectomy but for some there are problems. These may be physical, or psychological, or both.

Physical problems can include:

• formation of scar tissue: this occasionally happens around the site of the stitches at the top of the vagina and can lead to discomfort or even pain during intercourse and for a short time after. If this interferes with your sex life a further operation to remove the scar tissue may help
• women usually reach orgasm by stimulation of either the vagina or the clitoris, or both. These sensations won't be affected by a hysterectomy but for some women part of the pleasure of orgasm is the feeling of contractions of their uterus and this element of sexual fulfilment will be lost after a hysterectomy
• similarly, for some women, stimulation of their cervix during intercourse is part of the pleasure of sex and as most hysterectomies for cancer will involve removal of the cervix as well as the body of the womb this sensation is also lost.

Psychological problems tend to centre on feelings of loss of femininity and the fact that it is no longer possible to have children. These feelings can sometimes be made worse by worries about how partners may feel or react after a hysterectomy. Knowing that the operation was needed because of a cancer can also increase anxiety and tension and cause a reduction in, or loss of, sexual pleasure. Sometimes women will be worried about having sex in case it is painful, or partners may be concerned about causing his partner discomfort. Very often these emotions will settle with time as life begins to get back to normal after the surgery but if they do persist then your doctors should be able to help, possibly by arranging counselling, which can often make a difference.

Another thing to mention is that if a hysterectomy is done for cancer the operation may include removal of the ovaries. In younger women this will bring on the menopause. This can lead to symptoms, like vaginal dryness, thinning of the vaginal tissues, mood changes and alterations in hormone levels which can combine to make sex either uncomfortable or unappealing. Usually it will be quite safe to take HRT (hormone replacement therapy) until you reach the age of 50, and this will normally reverse these changes and help to get things back to how they were before. After 50 the use of vaginal oestrogen (as a cream or pessary) may help. A number of studies have caused concern when it is taken over the age of 50 for more than 1-2 years, it is important to talk to your doctor about the possible benefits and risks of taking HRT after this time.

Sexuality is a very personal and individual part of all our lives. Studies have shown that the best predictor of reactions to sex following a hysterectomy is how your sex life was before the operation and if it was enjoyable and satisfying then this is likely to still be so after surgery.

So for the great majority of women having a hysterectomy as part of cancer treatment should not make a great difference to their enjoyment of sex.