On Women Having Sex After Surgery

My doctors told me that I’d be able have intercourse after my surgery. But I didn’t care about just being a ‘penis receptacle,’ I wanted to know if I’d enjoy it.

I feel like I should start this story at the end, or at least tell you what kind of ending it is going to have: a happy one.

So, let me begin by saying that I could not be happier with the results of a surgery I had two years ago. I had several procedures done at one time, including a hysterectomy and repairs for a rectocele and an enterocele—the process of correcting a rectocele involves reconstructing the vagina in a way that permanently alters both its size and shape.

It was an unqualified success. Not only did it stop a few cancerous cells from taking over the joint, it restored bowel and bladder function. And, I am pleased to say, that my sexual functioning is mostly unchanged. A delightful side effect is that it has made intercourse unimaginably good.

However, regaining sexual functioning after having my vagina completely reconstructed was an experience fraught with ignorance, anxiety, and pain. The problems started as soon as the surgical procedures were proposed. Despite the fact that this was surgery on a primary sexual organ, no one wanted to talk about how it would impact my sexual health.

I had a very kind and skilled surgical team. But even when I asked direct questions, they offered only the vaguest hand-waving assurances that I would regain sexual functioning.

One of the things that made it so upsetting was that I had expected my sexual functioning would be given high priority. I expected care similar to what my friend’s husband, Doug, received when he was going through treatments for prostate cancer.

Doug’s sexual rehabilitation started before he even had the surgery. He was prescribed a nightly regimen of Viagra and given a ream of reading materials and access to a support group. There was even a class for sexual partners, telling them what to expect and informing them of post-operative instructions.

The motto in preserving male sexual functioning is “use it or lose it.” Doug was warned that if he did not stimulate his penis in the weeks and months following surgery, he could permanently lose sexual functioning. Immediately following surgery he began a program of sexual rehabilitation that included pills, pumps, and masturbation.

It was obvious that despite the aggressive nature of Doug’s cancer, restoring his sexual functioning was considered a goal of treatment equal in importance to continence. At each follow-up appointment, his doctors asked very specific questions, and when he failed to show sufficient progress, they referred him to a specialist in penis rehabilitation.

In contrast to Doug’s experience, my entire sexual rehabilitation programs was two sentences in the thick booklet of post-operative instructions that I received: 1) Try not to orgasm for six weeks after surgery 2) You may resume all normal sexual activity 12 to 16 weeks after surgery.

Those injunctions caused me much concern. Did it mean that I should discontinue Wellbutrin, a medication that helped control my depression but also had a side-effect of causing nocturnal orgasms? At what point was it safe to masturbate? And what the hell was “normal sexual activity”?

When I asked for clarification, my doctor launched into a diatribe about women who allow their husbands to talk them into sexual intercourse before they are medically cleared for it. It was as if it never occurred to him that I might be the one eager to return to sex.

Since I was also having my uterus removed, I wanted to know if that could impact my orgasms. He responded by saying he had never heard of such a thing. So I didn’t even bother asking the other questions I had, such as would my g-spot still be sensitive? Would I still ejaculate? Was anal sex off the menu forever?

Given the emphasis on “use it or lose it” in men’s surgeries, I worried about how long periods without sexual stimulation could impact my future sexual functioning. After all, a clitoris is analogous to a man’s penis. If men need to masturbate because the removal of a prostate can impact the ability of a penis to become engorged, should I be doing something to keep blood flowing to my clitoris?

In the end, I was lucky. I found one guide buried deep in the bowels of the Internet and my husband and I managed to muddle through. It was a long and tricky journey, one that I recently wrote about on my blog. But the end result was overwhelmingly positive.

Other women are not so lucky.

In a thought provoking article about how women’s sexual functioning and relationships are ignored during breast cancer treatments, Salon quotes Dr. Michael Krychman, medical director of the Southern California Center for Sexual Health and Survivorship: “Sexual health is the No. 1 quality-of-health complaint women have after breast cancer treatment. Men are studs—we’ll talk to them about sex. But we still have the attitude that a woman who survives should forget about all that and be grateful she’s still alive.”

Women’s sexual functioning is ignored even as the number of procedures that could impact it is increasing. In an effort to make various forms of surgery less invasive, surgeons are increasingly using women’s vaginas as “surgical portals” for everything from hysterectomies to appendectomies.

The problem seems to start with how women’s sexual functioning is defined. Take surgical procedures to treat breast cancer, for example. Doctors have made great strides in preserving a woman’s post-surgical appearance. They have even clued in how much nipples matter and offer nipple-sparing surgeries. But these are only decorative nipples, without the nerves that make them a part of sexual functioning. It befuddles me why nerve-sparing techniques are such a big deal for men’s prostate surgery, but not even considered for women’s nipples.

In my case, doctors were very keen to tell me that I would be able to have intercourse again. I wanted to tell them: “That is nice and all, but my sexuality is not defined by my ability to be a penis receptacle.” I wanted to know if it would still be pleasurable.

I understand that doctors do not have at their disposal the same arsenal of pills and pumps as they have for men. But it seems like the least they could do is talk about sexual functioning with their patients. And while they are talking, maybe they could collect a little data. How are we supposed to make informed choices without information?

There might be some low-tech solutions. For example, Salon writer Anne Baur wonders why women who are going through hormonal therapy, which can cause painful sex or even vaginal atrophy, are not “advised by their doctors to masturbate in order to increase blood flow to the area.” I couldn’t even find evidence that such treatment has been tested.

The medical community seems to suffer an appalling lack of curiosity when it comes to women’s sexual functioning and how it is impacted by various medical procedures. Do they avoid the subject because they fear offending their patients? Or is it “sexism, ageism, and paternalism,” as Dr. Krychman claims?

Sexual functioning is no less important for women than it is for men. We do not become Madonnas when we suffer, and taking into account our sexual functioning does not make us whores. We want to do more than just survive—we want to thrive. And we need our doctors  to share our goal of becoming whole again, in every way.

Lynn Beisner writes about family, social justice issues, and the craziness of daily life. Her work can be found on Role Reboot, Alternet, and on her blog: Two Parts Smart-Ass; One Part Wisdom. You can find her on Facebook and Twitter.

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