Many women feel unsure how surgery affects your sex life, and whether the changes they notice will settle over time. For some, sex actually becomes better after surgery, because pain, bleeding or other symptoms have eased. For others, it takes time to get used to a body that feels different.

There are several reasons why surgery can affect your sex life. An operation can affect tissue, nerves, muscles, mucous membranes and hormones. But the surgery itself is not necessarily where the story begins. If you had pain during sex, or tensed up beforehand, that history can also shape what you experience afterwards.

What happens in the body when surgery affects your sex life

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

Swelling typically appears in the first period after surgery. It can make the vagina, the entrance or the tissue around the surgical site feel tighter, more tender, or simply different from usual. For most women the swelling gradually subsides, but it can take longer before the tissue feels the way you expect it to.

Scar tissue develops over a longer period. In some women it becomes soft and causes no problems at all. In others, a scar becomes firmer, less mobile or more sensitive. Scar tissue can sit visibly on the skin, but it can also form internally, only becoming noticeable when the area is touched or put under pressure during sex or a gynaecological examination.

A scar can feel tight, tender, stinging or burning. Some women notice reduced sensation around the scar instead. And a scar that is very sensitive at first does not necessarily stay that way.

After surgery inside the abdomen or pelvis, adhesions can also form between tissues. Most do not cause problems, but in some women they may be part of the explanation for pain or a pulling sensation.

Read more about scar tissue.

Sensation can change

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

Some women notice reduced sensation, 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 an area has been painful for a long time, the body can also become more alert to touch and pressure. That means something that used to feel neutral, or even pleasant, can now feel uncomfortable.

This does not mean the pain is “in your head”. Tissue, nerves and muscles all influence each other, and it can take time to work out what is playing a role for you specifically.

Muscles can tense up

Surgery does not only affect your sex life through the tissue itself. The pelvic floor muscles can respond to pain and unease by tensing up. This is a protective reaction, not something you consciously decide to do.

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

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

It does not necessarily mean your pelvic floor muscles are constantly too tight. Some women find it hard to let go, others lack strength or coordination, and some experience a combination of both.

Read more about pelvic floor muscles and pain during sex.

Mucous membranes and lubrication can change

Dryness and changed lubrication are another reason why surgery affects sex life for some women.

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

Hormones can be part of the explanation, but not the only one. Pain, worry, reduced arousal and changes in desire can also mean the body does not become moist the way it used to.

Read more about vaginal dryness.

Desire can be affected too

When surgery affects your sex life, desire can change as well. Desire is not only about hormones.

Pain, fatigue, worry, illness and the feeling of not quite recognising your own body can all affect desire. If you are also unsure whether sex will hurt, it can be difficult to let go into arousal and pleasure.

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

So it is not possible to predict in advance how an operation will affect your sex life.

What your sex life was like before matters

When trying to understand why surgery affects your sex life the way it does for you, 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 period leading up to surgery?

And what feels different now?

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

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

Which operation did you have

How surgery affects your sex life also depends on which procedure you had. Here are some of the situations we see most often.

Removal of the womb (hysterectomy). After a hysterectomy, the area at the top of the vagina needs to heal. In some women, this can lead to changes around the vaginal cuff or in vaginal length. Scar tissue or altered anatomy can therefore be noticed by some women during deep penetration.

This does not mean a hysterectomy necessarily leads to a worse sex life. If pain, bleeding or other symptoms were the reason for the surgery, sex can also become easier afterwards.

If the ovaries are preserved, they continue to produce hormones as a starting point, although their function can change for some women.

If both ovaries are removed before natural menopause, the situation is different. This brings on surgical menopause, which can affect 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 pelvic floor repair surgery. After surgery for prolapse, or an anterior or posterior repair, the tissue at the vaginal entrance and inside the vagina can feel swollen, tight, tender or unfamiliar in the early period.

For many women this gradually eases as the body heals. If pain, tightness or difficulty with penetration continues, it is worth having the cause investigated rather than simply waiting for it to pass.

Caesarean section. Many women do not connect a caesarean scar with changes to sex, because the scar sits on the abdomen rather than in the vagina.

For some women, though, altered sensation around the scar, pain, or tension in the abdominal and pelvic area can still be part of the overall picture after birth. There can also be many other reasons why sex feels different after having a baby.

If you have ongoing pain after a caesarean, the cause is worth investigating rather than automatically assuming it is the scar.

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 surgery, the body may also have learnt to tense up as protection. That does not necessarily disappear the moment the anatomical problem has been treated.

Scar tissue from the procedure itself can also become sensitive or tight in some women, and may need attention.

Surgery for fibroids, cysts or endometriosis. These operations can remove something that was itself causing pain or discomfort during sex, and some women find that sex becomes easier afterwards.

But healing, scar tissue or adhesions can bring new symptoms for some women.

With endometriosis, it is also important to remember that surgery does not necessarily remove every factor that can play a role in pain during sex. If you already had pain and tensed up during penetration before the operation, your body may need more than the surgery itself to find ease again.

Read more under living with endometriosis.

When should you seek help

If sex continues to hurt after surgery, you do not need to work out on your own whether it is caused by scar tissue, muscles, nerves, mucous membranes, or something else entirely.

Talk to your doctor or a pelvic health physiotherapist, especially if the pain is new, getting worse, or not easing the way you expected.

Try to describe it as precisely as you can.

Where is the pain? At the entrance, or further inside? Does it feel burning, stinging, tight, pressing or sharp? Does it come with light touch, with penetration, with deep penetration, or afterwards?

You can prepare by filling in your vulva and vagina profile and reading our guide on visiting the doctor.

If you already have a fairly good idea of what is bothering you, you can go straight to our guide on getting help with symptoms after surgery, where we look at what you can do yourself for dryness, tightness, scar tissue, muscle tension and pain.