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Answered By:


Beverly Whipple, PhD, RN, FAAN

Professor Emerita Rutgers University of New Jersey New Brunswick, NJ

Q:

I am 41 and had a hysterectomy one year ago. I would like to know if that is why I can't have an orgasm when I have sex with my boyfriend. Aside from the lack of orgasm, the sex is quite good.

A: 

First, let me congratulate you on having an otherwise satisfying sexual relationship with your boyfriend. Now let's see if we can't help you find a way to make it as satisfying as you would like.

There are a few things you don't say here, so I'm going to make some assumptions. First, that your boyfriend was in your life pre-hysterectomy; second, that you can't experience orgasm during sexual intercourse but you can experience orgasm with other forms of sensual and sexual stimulation; and third, that you had your uterus and cervix removed, but not your ovaries, since your sexual desire doesn't seem to be affected. Removing the ovaries significantly decreases a woman's production of testosterone, a key hormone involved in sexual desire or libido.

There is some evidence that removing the uterus and cervix, as is done during a total hysterectomy, can affect the quality and intensity of orgasm. That's because the uterus as well as the vaginal muscles contracts during orgasm and because the nerve pathways that are involved in sexual response and orgasm with vaginal stimulation (pelvic, hypogastric and sensory vagus nerves) may have been cut or destroyed.

There's also evidence that the cervix plays a major role in orgasm. First, it dilates to improve the likelihood of conception. Second, it is very sensitive to touch, so the pressure of the penis on the outside of the cervix can stimulate nerve endings that trigger an orgasm. In women who say this pressure is a trigger for orgasm, many find they're unable to orgasm after hysterectomy.

One of the studies conducted on the issue of post-hysterectomy orgasm found about one in five women reported fewer orgasms after a total hysterectomy. Additionally, other studies find significant differences in the frequency of orgasm in women who don't have a uterus and/or cervix compared to women who still have those organs.

Ok, so now that you know there is likely a physical reason for your inability to experience orgasm during vaginal intercourse, what can you do about it? One thing I'd suggest is learning to induce orgasm through the clitoris and/or "G spot," the very sensitive area felt through the front of the vaginal wall halfway between the back of the pubic bone and the cervix. The G spot surrounds the urethra and swells when it is sexually stimulated.

For some women, the G spot plays an important role in orgasm and sexual pleasure; for others, it makes no difference. Additionally, some women find the only way they're able to experience orgasm is with clitoral stimulation. You and your boyfriend might also try changing positions to stimulate your clitoris and G spot so you can have an orgasm.

You could also experiment with your hands and a vibrator to induce orgasm this way. In some women, the results of these efforts transfer to intercourse.

If you're still unable to experience orgasm during intercourse, then I suggest you ask your boyfriend to stimulate you to orgasm manually before or after sexual intercourse, so you can still experience the pleasure in a way that provides you with satisfaction.