How surgery affects your sex life

It’s completely normal to be unsure how surgery affects your sex life, and whether the changes you’re noticing will settle down again. For some, sex actually improves after surgery, because pain, bleeding or other symptoms have eased. For others, it takes time to get used to a body that feels different, and perhaps to find new paths to desire and pleasure.

There are several reasons why surgery affects your sex life. A procedure can affect tissue, nerves, muscles, mucous membranes and hormones. But the surgery isn’t necessarily where the story begins. If you had pain during sex or were already tensing up before the operation, that can also shape what you experience afterwards.

What happens in the body when surgery affects your sex life?

When the body heals after a surgical procedure, swelling occurs and scar tissue forms. Both are a natural part of healing.

Swelling is common in the early period after surgery. It can make the vagina, the entrance or the tissue around the operated area feel tighter, more tender or simply different from usual. For most people the swelling gradually subsides, though it can take longer for the tissue to feel the way you expect.

Another reason surgery affects your sex life is scar tissue. Scars can develop over a long period. In some people, a scar softens over time and causes no problems. In others, it becomes firmer, less mobile or more sensitive. Scar tissue can sit visibly on the skin, but it can also lie internally and only become noticeable when the area is touched or put under pressure, such as during sex or a gynaecological examination.

A scar might feel tight, tender, stinging or burning. Others notice reduced sensation around the scar. And a scar that’s very sensitive to begin with doesn’t necessarily stay that way.

After surgery carried out inside the abdominal cavity or pelvis, adhesions can also form between tissues. Most don’t necessarily cause problems, but in some people they can be part of the explanation for pain or a pulling sensation.

Sensation can change

Another reason surgery affects your sex life can be changed sensation. Nerves can be affected when tissue is operated on, so an area may feel different after surgery than it did before.

Some people notice reduced sensitivity or numbness. In others, the area becomes very sensitive, so that even light touch feels uncomfortable. Sensation can change again as the body continues to heal.

If the area has been painful for a long time, the body can also become more alert to touch and pressure. This means something that used to feel neutral or pleasant can now feel uncomfortable.

This doesn’t mean the pain is “all in your head”. The body’s tissue, nerves and muscles all affect one another, and it can take time to work out what’s contributing to your particular experience.

The muscles can tense up

Surgery doesn’t only affect your sex life through the tissue itself. The pelvic floor muscles can respond to pain and insecurity by tensing up. This is a protective reaction, and not necessarily one you consciously choose.

If it hurt before the surgery, during examinations, or after the operation, the body can start to tense up simply in anticipation of touch or penetration.

This can make it harder to let go around the vaginal opening, and can make penetration uncomfortable or painful.

This doesn’t necessarily mean your pelvic floor muscles are constantly too tight. Some people find it hard to let go, others lack strength or coordination, and some experience a combination of both.

Read more about The role of muscles in sexual pain

Mucous membranes and lubrication can change

Dryness and changed lubrication are another way surgery affects your sex life for some women.

The vaginal lining can become more sensitive and easily irritated, and less moisture means more friction. This can feel like dryness, stinging or soreness during and after sex.

Hormones can be part of the explanation, but they’re not the only one. Pain, worry, reduced arousal and changes in desire can also mean the body doesn’t become wet in the way it used to.

When surgery affects your sex life through desire

Desire can change too. It isn’t only about hormones.

Pain, fatigue, worry, illness and the feeling of no longer quite recognising your own body can all affect your desire for sex. If, on top of that, you’re unsure whether sex will hurt, it can be hard to let yourself sink into arousal and pleasure.

For others, the opposite happens. If the surgery has removed pain, heavy bleeding, pressure or other symptoms, there can be more room for sexuality.

So there’s no way to predict in advance how a particular operation will affect your sex life.

What your sex life was like before the surgery matters

When you’re trying to understand how surgery affects your sex life, it can help to think further back than the operation itself.

What was sex like before your symptoms began?
What was it like in the run-up to the surgery?
What’s different now?

If, for example, you had endometriosis and pain with deep penetration before the surgery, it’s not certain that pain afterwards is caused by the operation itself. If the body has responded to penetration with pain and tensing for a long time, some of that response can persist even though the surgery has treated part of the underlying cause.

Conversely, the surgery may have removed exactly what used to make sex difficult.

Which operation have you had?

How surgery affects your sex life also depends on the type of procedure you’ve had. Here are some of the situations we often come across.

Removal of the womb (hysterectomy)

After a hysterectomy, the area at the top of the vagina needs to heal. In some people there can be subsequent changes around the vaginal vault or in vaginal length. Scar tissue or altered anatomy can therefore, in some cases, be part of the explanation if deep penetration feels different or hurts.

How surgery affects your sex life after a hysterectomy varies. If pain, bleeding or other symptoms were the reason for the operation, sex can also become easier afterwards.

If the ovaries are left in place, they generally continue to produce hormones, although their function can change in some people.

If both ovaries are removed before the natural menopause, the situation is different. This brings on a surgical menopause, which can affect the mucous membranes, lubrication and desire, among other things. Talk to your doctor about what this means for you and what options are available.

Prolapse and vaginal wall repair surgery

After surgery for prolapse, or an anterior or posterior vaginal wall repair, the tissue at the vaginal entrance and inside the vagina can feel swollen, tight, tender or different for a while.

For many people this eases gradually as the body heals. If pain, tightness or problems with penetration persist, it’s worth having the cause investigated rather than simply waiting for it to pass.

Caesarean section

Many people don’t associate a caesarean section with problems during sex, because the scar is on the abdomen rather than in the vagina. But a caesarean is also surgery to the abdominal wall and womb, and for some people pain or altered sensation around the scar can be part of the overall picture afterwards.

There can also be other reasons for pain during sex after a caesarean. The body has been through pregnancy and birth, and factors such as the pelvic floor, hormones, breastfeeding, vaginal dryness and pre-existing pain can all play a part. In some people, changes around the scar in the womb itself can also be linked to pelvic pain and pain during sex.

If you have persistent pain after a caesarean, it’s therefore a good idea to have the source of the pain investigated, rather than automatically assuming it’s caused by the scar on your abdomen.

Surgery around the hymen or vaginal opening

A procedure around the hymen or vaginal opening can resolve an anatomical problem, but the area still needs to heal afterwards.

If penetration was painful before the operation, the body may also have learned to tense up as a form of protection. This doesn’t necessarily disappear the moment the anatomical problem has been treated.

Scar tissue from the operation itself can also, in some people, become sensitive or tight and need attention.

Surgery for fibroids, cysts or endometriosis

These operations can remove something that was itself causing pain or problems during sex, and some people therefore find that sex becomes easier afterwards.

But healing, scar tissue or adhesions can, in some people, bring new problems.

With endometriosis, it’s also important to remember that surgery doesn’t necessarily remove all the factors that can contribute to pain during sex. If you already had pain and tensed up during penetration before the operation, the body may need more than the surgery alone to settle again.

If surgery is still affecting your sex life

If surgery is affecting your sex life in a way that continues to bother you, you don’t need to work out on your own whether it’s down to scar tissue, muscles, nerves, mucous membranes or something else entirely.

Try to notice where the pain is, how it feels, and when it happens. You can use your [link: Vulva Vaginal Profile] to get closer to a diagnosis, and read [link: Visiting the doctor] to help you prepare for a conversation with your doctor.

So there can be many reasons why surgery affects your sex life. If you have a reasonable idea of what’s bothering you, you can move on to Help with post-surgery nuisances, where we look at what you can do yourself about things like dryness, tightness, scar tissue, muscle tension and pain.