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• Uterine fibroids. These noncancerous growths in the wall of the uterus can cause pain or heavy bleeding.
• Heavy or unusual vaginal bleeding. Changes in hormone levels, infection, cancer, or fibroids can lead to this.
• Uterine prolapse. This is when the uterus slips from its usual place down into the vagina. It may happen after several vaginal births but can also happen after menopause or due to obesity.
• Endometriosis. This is a condition is which the tissue that normally lines the uterus grows outside of the uterus, often leading to severe pain and bleeding between periods.
• Adenomyosis. With adenomyosis, the tissue that lines the uterus grows inside the walls of the uterus, leading to severe pain and heavy bleeding.
• Cancer (or pre-cancer) of the uterus, ovary, cervix, or endometrium (the lining of the uterus). Hysterectomy may be considered in the case of cancer or high cancer risk, along with treatment options like chemotherapy and radiation.

There are a growing number of alternative treatments for these conditions, but hysterectomies are still a fairly common choice for women who feel like they’ve exhausted their options and no longer have a need for these organs.

If you and your doctor are leaning toward a hysterectomy, doctors say it’s important to have an open and honest conversation about what this will mean for you and your life. In the meantime, here’s how a hysterectomy might impact your sex life in particular.

How soon after a hysterectomy can I start having penetrative sex?

Not all hysterectomies are the same. During a total hysterectomy, the entire uterus—including the cervix—is removed. For a partial hysterectomy (a.k.a. supracervical hysterectomy), the upper part of the uterus is removed but the cervix is left in place. With a radical hysterectomy, the uterus and structures around it, including the ovaries, are removed. This is usually recommended if a woman has cancer or it’s suspected, according to the American College of Obstetricians and Gynecologists (ACOG).

Regardless of the type of hysterectomy, doctors generally tell women not to have penetrative sex for six weeks after surgery, says Mary Jane Minkin, MD, a clinical professor of obstetrics and gynecology and reproductive sciences at Yale Medical School. “They can fool around and have orgasms after a couple of weeks, but nothing in the vagina for six weeks,” she says.

If you want to have sex before that timeframe, it might be okay, though. “It sometimes can be sooner, depending on circumstances,” says Lauren Streicher, MD, clinical professor of obstetrics and gynecology at the Northwestern University Feinberg School of Medicine and author of The Essential Guide to Hysterectomy—like the type of surgery you had and how well you’re recovering.

Basically, listen to your body (and your doctor's guidance). If you try out some external stimulation and feel comfortable with that, you can ease into penetration with fingers or small toys and see how that feels before moving on to sex. If you feel discomfort or pain, it's best to keep waiting.

Will sex feel different after I have a hysterectomy?

It probably won’t—or it may even feel better, Dr. Streicher notes. A majority of women said their sex life either stayed the same or got better after they had the surgery, found one meta-analysis of research on sex after a hysterectomy.

Dr. Streicher has also found similar results in her research. She surveyed 1,000 women who had hysterectomies for her book and found they mostly felt their hysterectomy didn’t impact their life. “For the majority of women, there was no difference,” she says. “But if a woman had painful sex or bleeding beforehand, the sex was better.”

There’s a chance that you might experience an increase in vaginal dryness, but Dr. Minkin says that’s mostly if your ovaries are removed. In that case, you will need estrogen—in the form of tablets, patches, or vaginal suppositories—to help lubricate your vagina. Using a lubricant product during sexual activity can also help alleviate dryness.

Will I still be able to have an orgasm?

Yes, but there are some caveats. For most women, orgasms “should remain unchanged,” Dr. Minkin says. And, again, if you struggled with pain and bleeding before having a hysterectomy, sex afterward can feel even more pleasurable.

However, as Dr. Streicher points out, things will feel different in women who typically feel their uterus and/or cervix contract during orgasm. “They notice that their orgasms may not feel as satisfying or deep,” she says.

Will my sexual appetite be affected?

If you have your ovaries removed during a hysterectomy, Dr. Streicher says it may lower your sex drive. (Your ovaries produce hormones, including estrogen and testosterone, that fuel your sex drive.) But if your ovaries aren’t removed, this shouldn’t be an issue, she says.

A hysterectomy may also impact you mentally, and the state of your mental well-being can definitely impact whether or not you're in the mood for sexual activity. “Having a hysterectomy is a much bigger psychological deal for some women than others,” Dr. Streicher says.

How can I make sex more pleasurable after a hysterectomy?

It’s understandable to be nervous about having sex after a major surgery like a hysterectomy, but doctors say there are a few things you can do to make the experience easier and more pleasurable for yourself.

• Use plenty of lube. This is more something to consider if your ovaries were removed, Dr. Streicher says. But being nervous about having sex again can also cause vaginal dryness. Bottom line: Extra lube can’t hurt.
• Go slowly. Again, you just had surgery. Dr. Minkin says that taking it slow and seeing how you feel is the best way to go.
• Listen to your body. While you should feel okay after six weeks, if something feels uncomfortable, Dr. Streicher recommends backing off.
• Talk to your partner. Many people are “terrified” that they’re going to hurt a partner who recently had a hysterectomy, Dr. Streicher says. Having an open conversation about what has happened and how you feel can help make easing back into sex more comfortable.
• Pay attention to your positions. Your stomach may feel a little sore from the incisions for a bit, so Dr. Streicher recommends positions where the area isn’t going to be rubbed a lot during sex.

Overall, experts stress that sex doesn’t usually change much after a hysterectomy. “Things are usually not going to be any different,” Dr. Streicher says.