Planning a Hysterectomy? What You Should Know About Your Pelvic Floor, Sexual Health, and Cervical Options
This blog is for informational purposes only. All decisions regarding hysterectomy should be made in partnership with your personal gynecologist, using a shared decision-making approach that weighs your unique risks and benefits.
What Is a Hysterectomy?
A hysterectomy refers specifically to the removal of the uterus. However, there are important variations:
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If the cervix is preserved, it’s called a subtotal hysterectomy (also known as supracervical).
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If the cervix is removed along with the uterus, it’s termed a total hysterectomy.
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If the ovaries and/or fallopian tubes are also removed, the procedure may be further specified as a salpingo-oophorectomy.
It’s critical to clarify what structures are being removed. The term “partial hysterectomy” is commonly used by patients but is not a precise clinical term. Many women use it to refer to the retention of ovaries, but medically it typically implies a subtotal (cervix-sparing) procedure.
Should You Keep Your Cervix?
Some women choose to preserve the cervix for personal, cultural, or anecdotal reasons. Others have medical indications that support subtotal hysterectomy. However, current research shows no significant improvement in sexual satisfaction or continence rates with cervical preservation. In fact, studies published in The American Journal of Obstetrics and Gynecology suggest that incontinence may actually be more common after a subtotal hysterectomy compared to total hysterectomy.
If you do retain your cervix, keep in mind:
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Pap smears remain necessary following standard cervical cancer screening guidelines.
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Pelvic exams are still important to monitor vaginal and pelvic floor health.
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Retaining the cervix does not enhance orgasms; clitoral and vaginal stimulation are the primary sources of sexual pleasure.
Consider Your Pelvic Floor Health
The pelvic floor supports the uterus, bladder, and bowel. Pelvic floor disorders—including uterine prolapse, urinary incontinence, and pelvic organ descent—often coexist with the need for hysterectomy. Some women undergoing hysterectomy may also require pelvic reconstructive surgery.
A preoperative pelvic floor assessment helps:
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Identify risks for postoperative complications such as prolapse or incontinence.
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Guide decisions on concurrent repair procedures.
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Tailor rehabilitation plans to restore function.
Sex After Hysterectomy: What to Expect
Many women report improved sexual function after hysterectomy, particularly if pain, bleeding, or pelvic pressure was present before surgery. The medical term for painful intercourse is dyspareunia, and it may arise from physical changes, hormonal shifts, or musculoskeletal issues.
Painful sex can occur before or after surgery, especially in postmenopausal women due to:
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Vaginal atrophy (thinning of the vaginal lining)
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Decreased estrogen levels
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Pelvic floor tension or weakness
While topical estrogen can alleviate symptoms in about 75% of cases, some women require additional interventions. Available non-surgical therapies include:
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MonaLisa Touch (vaginal laser therapy)
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Emsella (pelvic floor stimulation)
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PRP therapy (platelet-rich plasma)
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ThermiVa (radiofrequency therapy)
Discharge, Incontinence, and Vaginal Discomfort: Know What’s Normal
If you experience vaginal discharge, urinary leakage, or discomfort, these symptoms may relate to pelvic floor dysfunction or vaginal tissue changes—not necessarily the hysterectomy itself. Many cases have treatable causes, such as infections or hormone deficiency.
As women age, especially through menopause, vaginal health becomes a key consideration. Even if you choose not to undergo hysterectomy, these changes may still occur. A comprehensive evaluation—including pelvic exam and hormone assessment—can guide therapy.
Final Thoughts
No two hysterectomies—or women—are the same. Be clear about what’s being removed, ask about long-term pelvic floor health, and discuss your concerns about sexual function. Your gynecologist is your best partner in navigating these decisions.
Keeping sex and libido intact—or even improving them—is not only possible, but expected with good planning and follow-up care.
