There are a number of ways to address pain during sex after hysterectomy.

Pain During Sex After Hysterectomy: Why It Happens, and How to Treat It

by Charlotte

Dyspareunia is a big, intimidating word for something most women dread: experiencing pain during sex. Especially for women who have recently undergone a partial or total hysterectomy, painful sex can be scary and even heartbreaking. Not only is it frustrating, it also causes some women to feel embarrassed or ashamed of their bodies and prevents them from participating in fulfilling sexual relationships. These reactions can make it difficult for women to discuss their symptoms with the doctors who may be able to help relieve their pain.

If you experience pain during sex after hysterectomy, you need to know that having your uterus removed does not inherently impact your sexual function in any permanent way. Research has shown that you don’t need a uterus to have a fulfilling and healthy sex life.   

However, you also need to know that you’re not alone in experiencing pain. Due to recovery time, surgical menopause, and the emotional aftermath of a hysterectomy, many women experience painful sex for a time after this major surgery. But by honoring your body’s healing process and seeking appropriate treatment with your doctor, it is possible to ease back into pain-free sex in a healthy way.

Recovering From a Hysterectomy

Before you can address the pain you experience, it’s important to understand its root cause. Often, that cause is simple—the number one reason you might be experiencing pain during sex after hysterectomy is that you haven’t waited long enough for your body to heal.

Most surgeons suggest waiting at least six weeks before inserting anything into your vagina, including tampons, fingers, and sex toys. As such, it’s safe to assume that you should refrain from attempting vaginal sex for up to two months following surgery. Depending on how you experience recovery, you may not feel like having sex during this time anyway. If you’re experiencing pain even after six weeks have passed, you may want to wait a while longer to ensure everything has healed properly.

Keep in mind that attempting an orgasm through other methods can also cause pain during this time because contraction of the pelvic area can put tension on internal wounds or stitches. Be kind to your body and respect its limitations.

If you’re experiencing lingering or unexpected pain (specifically around the surgical site) after the prescribed healing period, you should speak with your doctor. They can assess whether your body is healing well and determine if you’re experiencing any complications from surgery.

Pain May Be Caused by Surgical Menopause

After your body has fully healed from a hysterectomy, it’s still possible for you to experience painful sex—particularly if the procedure involved removing your ovaries. Removing the ovaries creates a sudden drop in estrogen levels in the body (along with other hormones) and sends you directly into what is known as surgical menopause.

In addition to commonly-discussed symptoms like hot flashes, mood swings, and night sweats, menopause also marks the beginning of vaginal atrophy, or “atrophic vaginitis”. Atrophy means muscles and tissues of your pelvic area get thinner and weaker due to surgical menopause, causing side effects like incontinence and uncomfortable sex. Many women also struggle with vaginal dryness during menopause, which can make sex more painful.

Menopause is the most significant hormonal shift in a woman’s body, aside from puberty and pregnancy. It brings about major bodily changes and can involve a significant amount of stress, embarrassment, and discomfort even when it occurs naturally. Undergoing menopause suddenly and at a younger age than expected can be quite a shock. We know that psychological factors like these have a great deal of influence on sexual function, and it’s possible that the difficult emotions associated with surgical menopause might be contributing to the pain you experience during sex. The good news is that there are a wide variety of treatment options available to you, should your menopause symptoms become unacceptably disruptive.   

How to Prevent Pain During Sex After Hysterectomy

Regardless of why you’re experiencing painful sex, there are numerous solutions to try. We recommend progressing through these options one at a time in the order listed here. The ideas listed first are the most simple and easy to administer:

  • Wait a while longer before having sex. Even if it’s past the initial two-month waiting period, your body may take longer to heal. Honor that reality for a little while longer. There’s no point in forcing yourself to engage in sexual activity before you’re ready.
  • Go slow and use lubrication. It’s tried-and-true advice! Even if you never needed to use lubrication prior to surgery, it may help ease pain that comes from vaginal dryness. Try experimenting with fingers or smaller sex toys to see if penetration still causes pain before attempting vaginal sex with your partner.
  • Care for your mental and emotional health. Hysterectomy can trigger a host of emotions—relief and joy at being free from pain, sorrow and loss from being unable to bear children, and every combination of feelings in between. Especially if you or your partner are frustrated by this situation, you may be experiencing pain due to anxiety or emotional distress. You might benefit from reaching out to loved ones or a trusted counselor for support during this time.
  • Try hormone replacement therapy. If surgical menopause is the main reason for your pain, you’ll want to talk with your doctor about the possibility of starting HRT. Taken in the form of pills, transvaginal/transdermal creams, subdermal pellets, or patches, these medications help replace the hormones your body lost due to surgery. This can help relieve your symptoms and get you back to a normal, healthy, and happy sex life.  

Starting Hormone Replacement Therapy After Hysterectomy

If you experience pain during sex after hysterectomy, it’s normal to feel anxious, frustrated, sad, or angry. Painful sex is a deeply unsettling experience for any woman to undergo and especially for those who have recently been through major surgery. It’s common to fear you might not ever be the same again. But hysterectomy hasn’t been shown to have a significant impact on sexual function. Studies consistently show that the majority of women experienced no change in their sexual function after hysterectomy and plenty report improvements in their sexual experiences.

Painful sex can be caused by a number of other factors. Tenderness while healing, emotional stress, and hormone imbalance are just a few that could apply to your personal situation. The good news is that these factors can all be addressed by consulting with your doctor and getting the help you need.  

If hormone therapy is the right solution for you, your doctor will begin by taking extensive tests to determine your hormone levels through saliva, blood, and/or urine. They will work with you to identify the root cause of your symptoms and select a hormone medication that suits your needs. Within weeks, your body’s natural hormone balance can be restored. With any luck, painful sex will be just a temporary side effect of this time in your life—and you’ll be ready to move on to a happier, healthier, more pleasurable future.  

BodyLogicMD– affiliated practitioners are certified in hormone replacement therapy and uniquely qualified to support women struggling with hormonal health concerns. They’re passionate about helping women overcome the uncomfortable side effects of menopause, aging, and surgery in order to live more fulfilling lives. Using an integrative approach that combines hormone medications with nutritional advice and lifestyle coaching, these top medical professionals will create a personalized treatment plan that provides you with lasting results. With help from a compassionate practitioner, you’ll be well on your way toward finding a healthy balance after hysterectomy. Contact a local practitioner to learn more about the treatment options that are available to you, and take the BodyLogicMD Hormone Balance Quiz to explore how hormone replacement therapy can help you achieve optimal health.

Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended diagnose, treat, cure or prevent diseases.


  • Charlotte

    Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.