Sexual health
Sex After a Hysterectomy: Where Does Sperm Go When the Uterus is Gone?
At its simplest, hysterectomy is the surgical removal of the uterus. The procedure may also include removal of the cervix and one or both sets of ovaries and fallopian tubes. The vagina, clitoris, and labia remain.
Now think back to middle school sex education, if you were lucky enough to get it. You probably learned that when a man or person with a penis ejaculates into a vagina, the sperm and the semen which carries it "swim" through the cervix toward the uterus. That's how babies are made! But if there's no uterus or cervix to "swim" toward, where does semen, and therefore sperm, go after a hysterectomy?
As anyone knows who's ever changed the sheets after a sexual romp, some of that semen will inevitably flow back out of the vagina. But let's talk about the spunk that remains inside.
What happens during sex after a hysterectomy?
To understand sex after a hysterectomy, it helps to know the type of hysterectomy done and the surgical procedure used. There are three different types of hysterectomies and four different types of surgical procedures to do them.
A partial hysterectomy is the simplest. The uterus is removed but the cervix remains. The vagina is not affected. Surgical recovery is likely to be fairly quick and simple.
A total or complete hysterectomy removes the cervix, and possibly, one or both sets of ovaries and fallopian tubes. The surgeon will also create a "vaginal cuff" to close the top of the vagina as the cervix is no longer there. It is possible that the vagina might be slightly shortened as a result.
A radical hysterectomy removes all of the reproductive organs, parts of the vagina, and possibly, nearby lymph nodes. Vaginal cosmetic surgery might also be necessary afterwards. This procedure is typically only done when a systemic disease, like cancer, is impacting the reproductive organs.
The four types of surgery are vaginal, with no abdominal incisions; open abdominal surgery (the most invasive and usually the most potentially difficult in terms of length of recovery); laparoscopic surgery, which involves very small incisions and is minimally invasive; and robot-assisted laparoscopic surgery, which is extremely precise and minimally invasive. It is not unusual for a person to recover quite quickly from laparoscopic and robot-assisted surgeries.
Depending on what organs are removed, the patient's remaining abdominal organs will shift slightly and all is usually well. Sometimes though a patient may experience an organ prolapse. This happens when the muscles surrounding the pelvic organs become too weak to hold the organs in place and the organs shift within the pelvic cavity. Pelvic floor strength and function is key to preventing or mitigating this problem. Pelvic floor exercises, and/or a good pelvic floor therapist, is essential after a hysterectomy.
So, if you're getting the idea that post-hysterectomy sex might be more complicated than just wondering about where the sperm (and semen) goes, you'd be right! Sex after a hysterectomy requires a patient, informed, and communicative approach.
Where does sperm go after a hysterectomy?
Now that you know what internal changes happen after a hysterectomy, let's talk about those little swimmers and their new destination.
During penis in vagina penetrative sex, semen is usually ejaculated close to the cervix, which is the entrance to the uterus. After a hysterectomy, semen will still probably deposited near the top of the vagina during intercourse.
If the cervix is still present (even without a uterus), some of the sperm will move through it and into the remaining part of the reproductive tract. This will be a very tiny amount of what has actually been ejaculated, which is probably no more than a teaspoonful anyway. For those who've had a total or radical hysterectomy, the semen will probably be deposited the top, near the vaginal cuff (the surgical closure site).
In any case, a certain amount will simply flow back out of the vagina again, onto sheets or a sex blanket or toilet paper if you're peeing after sex (which you should be!).
As for what's left, the vagina typically absorbs several male-generated hormone compounds from the seminal fluid including testosterone, dihydrotestosterone, estrone and estradiol, follicle stimulating hormone and luteinizing hormone, prolactin, and 13 varieties of prostaglandins. The vagina can also absorb less desirable chemicals carried by semen, such as tetracycline and cocaine.
Can my partner feel the difference after a hysterectomy?
These days, most surgeons who perform hysterectomies are aware that their patients will want to resume sexual intimacy and want as little structural disruption as possible. They will do what they can to preserve the vagina's length and capacity. This is easiest to do with a robot-assisted laparoscopic hysterectomy.
If you are scheduled for a hysterectomy, don't make any assumptions. Have an explicit conversation with your surgeon about your expectations for your post-hysterectomy vagina.
A man or partner with a penis usually will not feel a physical difference in their partner's vagina during intercourse, unless they become aware of the lack of a cervix during deep penetration. If you have concerns about having a shorter vagina than before, discuss this with your doctor and surgeon ahead of time, or at least afterwards. If you find that you can't tolerate deeper penetration once you are cleared for penetrative vaginal sex, you can also shop for sexual aids that control depth of penetration.
Except for some worries about hurting their partner, they will most likely have the same physical enjoyment that they've always had.
Sex and Climax After Hysterectomy
It might take some adjustment, but it is entirely possible and probable that you will continue to enjoy sexual pleasure and orgasm after a hysterectomy. However, some people do notice a change in sexual function and orgasm after a hysterectomy. It may take you longer to orgasm and your orgasms might not feel as intense as before. This is because removing the uterus and cervix can cut or affect some of the nerves that enable orgasm. If this is the case for you, remember that you still have many other pathways to pleasure. It just might take awhile to discover them.
Some post-hysterectomy patients may also experience temporary changes in libido due to hormonal fluctuations or emotional adjustments to surgical recovery.
The best thing you can do in all cases is to be patient, take your time, be experimental and playful, and communicate honestly. Also, keep a bottle of lube on hand.
Frequently Asked Questions About Hysterectomy
Can you get pregnant without a uterus?
It's rare, but yes it is possible to get pregnant if you still have ovaries and fallopian tubes. However, there is no chance of having a viable pregnancy as there is no uterus to carry a developing fetus. If a fertilized egg attaches to a fallopian tube, this is a dangerous condition known as an ectopic pregnancy and it requires immediate emergency intervention and termination of the pregnancy.
Can you get pregnant after a partial hysterectomy?
The answer is the same as above. However, a few people have gotten uterine transplants after a hysterectomy, which could allow for pregnancy. This is still largely experimental and very risky.
Is sex different after a hysterectomy?
It can be. But according to a 2015 published in journal "Sexual Medicine Reviews," the majority of hysterectomy patients experienced "unchanged or improved sexual function," no matter what kind of surgery they had. And that's good news! But it's going to take time before you know how things will be for you or your partner.
Most surgeons ask the patient to abstain from penetrative vaginal sex of any kind (partnered, manual, or toy'd) for six to twelve weeks, to make sure that vaginal healing is complete. If there is a vaginal cuff, it is important to prevent any tearing of the sutures. The admonition "nothing in the vagina for twelve weeks" can be frustrating, as the recovering patient may want to know what, if anything, might feel different, but it's important to take the time to heal.
It's also usual for people to worry about desire, sensation, and lubrication, and to also be nervous about potential pelvic and vaginal pain after a hysterectomy. It's important to share your concerns with both your partner(s) and your medical team, so that you can return to your usual enjoyments sooner rather than later.
Other post-surgical changes may include temporary fecal or urinary incontinence, gas and bloating, or constipation. A post-hysterectomy patient may feel embarrassed and decidedly not sexy if experiencing any of these effects.
If the ovaries are removed before natural menopause, you'll experience premature menopause because the ovaries are a major source of sex hormones. This can lead to changes in libido and vaginal dryness. You might want to ask your doctor about bio-identical hormone replacements.
The Bottom Line
Once you have penis in vagina sex again after a hysterectomy, sperm will most likely be ejaculated close to the top of the vagina or the surgical closure site after a hysterectomy. If there is still a cervix, a few sperm cells might make it through to an area where some reproductive organs remain if any were left after the procedure. The remaining semen will generally flow out of the vagina, though some hormonal compounds will be absorbed through the vaginal walls.
The post-hysterectomy surgical recovery period can be frustrating, but once given the green light for penis in vagina penetrative sex, most people find that sex and pleasure are still possible and possibly even better than ever. Patience, playfulness, and a willingness to explore will make all the difference.
And remember to communicate honestly and frequently with partners and healthcare providers for any concerns or questions you may have.
