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Reproductive Health - Ovarian Health | May 5, 2021, 11:36 CDT

Sex After Surgical Menopause
You can still enjoy being intimate despite the changes in your body and sex life.

Going through menopause can be tough, but most women have decades to shape their expectations and plans for this life stage. When it happens sooner than you’d expect—in the case of surgical menopause rather than through the natural aging process—it can be scary, jarring and full of unknowns.

Surgical menopause is triggered by an oophorectomy, or the surgical removal of the ovaries, which are the main source of estrogen production in the female body (and often requires removal of the fallopian tubes or uterus as well).

Someone would have these reproductive organs removed for various reasons. Sometimes it’s prompted by ovarian cysts or tumors; other times as a treatment for endometriosis or uterine fibroids. Either way, “if a woman has both ovaries removed, she is put into instant menopause,” explained Brooke Faught, a nurse practitioner and the clinical director of the Women’s Institute for Sexual Health in Nashville.

Women in surgically induced menopause are likely to experience standard menopausal symptoms—but they can be even more severe when the change is brought on suddenly, a 2019 study in the journal Medicina found. Plus, the researchers reported, they’re more at risk for osteoporosis, cardiovascular disease, cognitive decline and dementia because of the lack of estrogen.

What does all this mean for your sex life? Questions such as “Will everything feel different?” and “How do I communicate my own needs?” are absolutely legit. But surgical menopause (or menopause in general, for that matter) doesn’t have to be the death of sex, said Jessica Cline, a certified sex therapist in Appleton, Wisconsin. It might even lead to new experiences and possibilities.

Yes, sex might feel different when reproductive organs are removed and fewer hormones are present. “But that doesn't mean a woman can no longer achieve orgasm,” Faught said. “She just might have to get a little more creative to find gratification.”

Great sex is possible at any life phase or with any condition.

After all, sex isn’t just about penetration. Start by identifying where on your body it feels good to be touched because it might not be in the same locations that felt good before surgery or surgical menopause. Explore any new erotic zones via self-massage or masturbation, then, when you’re ready, bring your partner into the conversation. “Sex is like a recipe,” Cline said. “It can change after having a baby or medical menopause, but that just means it’s time to update your preferences.”

For women who undergo an oophorectomy to help with chronic pelvic pain or bleeding, sex might actually feel better after surgery because their problems have been addressed. That’s because “the removal of the ovaries can actually reduce or eliminate structural pain being caused by cysts, as well as endometrial pain, which is fueled by estrogen and progesterone,” Faught explained.

Either way, healthcare providers have a diverse arsenal of therapies and treatments to help improve the sex lives of women after surgical menopause. In addition to using systemic hormone replacement therapy to replace lost estrogen, which can help alleviate any acute symptoms, according to a 2016 report in the journal Fertility and Sterility, the topical application of estrogen or DHEA, a hormone involved in estrogen production, can go a long way toward making intercourse more comfortable, said Anita Sadaty, M.D., a Long Island, NY-based OB-GYN.

There are also new non-hormonal creams and gels that contain hyaluronic acid, which can help replenish moisture in vaginal tissue, and lasers that stimulate collagen and elastin down there. Both can relieve the pain triggered by natural and surgical menopause. The more you can be forthcoming about what you’re experiencing, the more options a doctor can find to help you, Sadaty said.

Great sex is possible at any life phase or with any condition, but it starts with understanding what feels good to you and your body now, not holding on to what you might have once found pleasurable. And taking that first step is worth it because it can get you excited to be sexually active again, Cline said: “You crave more sex when you're having sex.”

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