You made it! You’ve successfully had that hysterectomy your doc recommended. As the operation's dust settles, you might be feeling relief and hope, anticipating an end to the symptoms that led you to surgery in the first place. Yet, now that you’re healing, you might have noticed sex just doesn’t feel the same.

You're in good company—experiencing discomfort during intercourse after a hysterectomy is common. The good news is there are several treatment options available to help relieve your symptoms and get your sex life back on track.

Depending on the type of hysterectomy you had, the source of your pain may differ. Plus—many people with uteruses experience pain before having a hysterectomy. In fact, pelvic pain is one symptom that often leads people to have a hysterectomy. “It is important to distinguish that, in this case, it is not the hysterectomy that is causing their pain, but rather that the hysterectomy did not solve their pain,” Dr. Sasha Davenport, MD, FACOG, IF, Director of Female Sexual Medicine at the Atrium Health Carolinas Medical Center, tells The Pelvic People.

But whether the pain led to the hysterectomy or the pain came after (or some combination of the two!), there’s no need to suffer. Let's delve into the different types of hysterectomies,  the kind of pain you might feel after getting one, and, most importantly, how to reclaim your comfort.

Understanding the different types of hysterectomies

A hysterectomy, or removal of the uterus, often comes with side effects like painful sex. The type of hysterectomy you have can impact the severity and cause of the pain. Here’s the low-down on the most common types of hysterectomies:

• A total hysterectomy removes the uterus and cervix.
• If you have a radical hysterectomy–which, according to Dr. Davenport, is typically done for certain types of cancers–your ovaries may also be removed. (Removal of the ovaries is called an “oophorectomy.”)
• A supracervical hysterectomy removes most of the uterus, but leaves the cervix intact.
• Laparoscopic hysterectomies, done through small incisions, tend to have an easier recovery with less pain overall compared to open abdominal surgeries. However, it can still take time for your body to heal and pain during sex to subside. “There is a study from the Journal of Surgery and Medicine that implies total laparoscopic hysterectomy (TLH) or a minimally invasive approach is the best modality for hysterectomy when considering sexual function,” Dr. Davenport says. “They theorized that this is because the vaginal length is more likely to be longer after a total laparoscopic hysterectomy, and there is less likely to be damage to the vaginal nerves.”

Types of post-hysterectomy pain during sex

Just like there are different kinds of hysterectomies, there are different kinds of painful sex! Broadly categorized as “deep” pain and “superficial” pain, each has its distinct causes and solutions.

Deep pain

Deep pain during sex after a hysterectomy is usually caused by damage to the vaginal cuff, the top part of the vagina where the cervix used to be attached. The cuff has to heal after being cut and sutured during surgery. This healing process can take 6 to 12 weeks. Engaging in penetrative sex too soon can disrupt this healing and cause pain.

• Scar tissue formation. Excess scar tissue may form at the cuff, causing pain during deep penetration or certain positions. Scar tissue release therapy or pelvic floor therapy may help. You might also want to try Ohnut, which helps control depth of penetration during penetrative sex.
• Oophorectomy. If your ovaries were removed along with your hysterectomy, it can reduce estrogen levels, which can cause vaginal dryness and pain during sex. Using a lubricant and taking low-dose estrogen therapy may provide relief.
• Radical Hysterectomy. Dr. Davenport also says that radical hysterectomy can “sometimes impact the vaginal length and caliber more” than other types of hysterectomy, which can subsequently lead to higher rates of painful sex. Pelvic PT, lubrication, or Ohnut may be helpful to relieve discomfort.

Superficial pain

Superficial pain refers to pain felt at the entrance of or just inside the vagina. But don't be fooled by the name! "Superficial," in this case, doesn't mean "not significant." It just means it's on the surface, rather than deep inside your body. It's often caused by:

• Vaginal dryness. Lowered estrogen can lead to vaginal dryness and irritation, especially if your ovaries were removed. Lubricants and moisturizers specifically for sensitive areas can help reduce discomfort during intimacy.
• Nerve damage or inflammation. Trauma to pelvic floor tissues and nerves during surgery may cause temporary or long-term nerve pain, inflammation, and hypersensitivity. Pelvic floor therapy, ice packs, and oral or topical pain relievers may provide relief as nerves heal.
• Lack of arousal. Feeling worried, stressed, or not fully aroused during sex can make any discomfort feel more painful. Engaging in non-penetrative sex, relaxation techniques, and open communication with your partner about what feels good can help increase arousal and make sex more pleasurable again.

Things you can do to ease post-hysterectomy sexual pain

Remember—there's hope! Painful sex after hysterectomy often improves over time. Scarring and tightness soften; nerves regenerate. While it can take several months, many people find sex becomes comfortable and even pleasurable again.

In the meantime, here are some tips for easing pain during sex.

Be patient and go slowly

The most important thing is to be patient and gentle with yourself. Don't rush into sex before you feel ready—maybe you even take penetration off the table for a while! Focus on non-penetrative sex, arousal, and lubrication to relax the tissues and increase flexibility.

Try different positions

Experiment with different sex positions to find what is most comfortable for you. Receptive partner on top and side-lying positions often cause less discomfort than missionary and rear-entry positions. Let your partner do most of the moving at first, so you have more control over depth and speed of thrusting.

Try Ohnut

Ohnut was specifically designed to help people control depth of penetration during partnered sex. If you're experiencing deep pain, it might be worth giving it a shot!

Treatment options for painful sex following hysterectomy

You might also want to enlist some professional help to speed up the healing process. Luckily, this isn't a wheel that you have to reinvent all on your own! There are a range of health professionals out there who can help.

Pelvic floor therapy

Pelvic floor therapy with a specialized physical therapist or occupational therapist can be very helpful for reducing pain during sex after a hysterectomy. Therapy focuses on relaxing and strengthening your pelvic floor muscles through techniques like trigger point release, dilator therapy, and pelvic floor muscle contractions. A therapist will evaluate your pelvic floor muscles and tailor a treatment plan to your specific needs. Therapy, especially when started soon after surgery (or even before!), can be effective at retraining your pelvic floor muscles and easing discomfort during intercourse.

Medications and creams

If pelvic floor therapy alone does not relieve your pain, your doctor may prescribe medications or creams to help make sex more comfortable. Options include:

• Pain relievers like ibuprofen or acetaminophen: Taken 30-60 minutes before sex, over-the-counter pain relievers can reduce discomfort during penetration and climax.
• Estrogen cream: If you've had an oophorectomy or you're postmenopausal, low estrogen levels can lead to vaginal dryness and irritation. An estrogen cream applied directly to the vagina can relieve dryness and improve tissue elasticity.
• Lidocaine gel: A topical anesthetic like lidocaine gel desensitizes the genital area and can relieve pain during intercourse when applied 10-15 minutes before sex.
• Muscle relaxants: In some cases, prescription muscle relaxants may be used to relax the pelvic floor and make penetration less painful. Use only under the guidance of your doctor.

Medical professionals

 If you find yourself in this category and have exhausted self-help strategies, physical therapy, medications, and creams, don't hesitate to consult with your gynecologist. They may refer you towards other professionals, like pain management specialists or sex counselors. Additional procedures like nerve blocks, botox injections, or revision surgery are sometimes recommended in severe or complex cases of post-hysterectomy pain during intercourse.

“Always ask for help,” Dr. Davenport says. “Painful sex is never normal. If someone tells you it is, find a new doctor. Pelvic pain is something that takes a lot of attention and necessitates someone who is an expert in the area to address it. You could say ‘I’ve been experiencing significant pelvic pain lately. Is this something we can address today? Do you know someone with expertise in this area?’”

If you need help describing your pelvic pain to your doc, the Pelvic Pain Assessment can be a really helpful communication tool. And if you’re not feeling supported by your current doctor, check out these directories for doctors who are well-equipped to talk about and treat pelvic pain.

So talk to your doctor about treatment options, which may include hormonal therapy, physical therapy, lubricants, and other techniques to help relax your pelvic floor. With patience, a personalized treatment plan, and a little gumption, most people can resume a fulfilling sex life after hysterectomy. The healing journey may require time and patience, but centering self-care, communication with your partner, and the benefits of the procedure can make all the difference.