This is a common concern for many people who are entering (or considering) surgical menopause. Being in surgical menopause can change the desire for and experience of sex. Below, we outline a few key considerations when considering sex in surgical menopause.
Reduction in Sex Hormones. The loss of the ovaries means that the main source of sex hormones (estrogen, testosterone) will be lost, and this has an impact on many areas of the body relevant to sexual function.
Low estrogen in the menopause often causes vaginal dryness or vaginal atrophy, which can make sex uncomfortable or even painful. Studies show that general estrogen HRT and/or vaginal estrogen cream can improve sexual function during surgical menopause.
Lower testosterone in surgical menopause may cause a reduction in libido. There is some evidence that testosterone HRT can reduce this problem if it arises.
Allow Time for the Normal Healing Process. It is normal and healthy to take an extended break from sexual activity following this major surgery. It is important to give yourself time to heal before masturbating or having sex again.
For partnered individuals, communication with your sexual partner is key; make sure that you tell them your medical limitations, boundaries, and preferences throughout the process.*
Non-penetrative sexual activity can resume once your body feels ready; there are no guidelines around this, and it can be self-led.
Penetrative sexual activity (or insertion of anything into the vagina) should be avoided for at least 6 weeks following surgery.
When resuming sexual activity following surgery, go slow and listen to your body. You may find you need extra foreplay to get aroused initially and good lube is recommended to make intercourse/penetration more comfortable. If you’re uncomfortable or have concerns, talk to your doctor.
Some individuals find that, even though (1) enough time has passed, (2) they want to have sex, and (3) they’re not having pain with sexual activity, they are STILL struggling to engaging in sex specifically because they are fearful that they may cause damage to their bodies. For some people, this can become a vicious cycle in which fear can cause vaginal tension and discomfort which then further increases fear. If this is the case for you, and your doctor has cleared you for sex, it may be useful to practice stress reduction techniques prior to sex. If this is not successful, a few visits with a sex therapist or a cognitive behavioral therapist specializing in anxiety may be useful for helping to reduce your fears around sex, reduce tension, and increase enjoyment.
*If you feel unsafe in your relationship or fear that your partner will not respect your medical limitations or personal boundaries around sex, consider contacting a sexual abuse hotline or center for consultation and support, and try to find a way to mention the situation to your doctor so that they can support and protect you. Below are a few examples.
Visit www.iapmd.org/surgery for lots of evidence based information and resources for those considering, going through or recovering from surgery for PMDD/PME.