Effects of Surgery on Sexuality

The rate of recovery and return to sexual activity after surgery varies. Thorough explanation of surgical procedures, practical advice, and emotional support before and after surgery can enhance recovery and the return to previous levels of sexual activity.

Candidates for coronary artery bypass surgery may already have sexual dysfunction due to physical symptoms, adverse effects of drug treatment, or fear of sudden death from physical exertion. After surgery, patients are usually advised to avoid sexual activity for a reasonable time (based on the type of sexual activity and the type of surgical incision) to prevent straining the surgical repair. Self-stimulation or mutual masturbation may be a less strenuous alternative to intercourse and usually can be started earlier in the recovery period. Exercise programs to improve cardiac function (eg, increasingly strenuous walking or exercise in a gym) can reassure patients who are afraid to resume sexual activity. The effort involved in having intercourse can be moderated and need be no greater than that required to climb two flights of stairs.

After hysterectomy, patients are usually advised to avoid sexual activity for 6 to 8 weeks to allow their surgical wounds to heal. Depression is common and usually lasts a few days to a few months, although some women remain depressed much longer. Hysterectomy per se does not usually impair sexual function. However, women who are highly sensitive to cervical and uterine sensations during orgasm may be aware of the loss. Although oophorectomy decreases testosterone and other androgen levels (as well as estrogen and progesterone levels), its effects on sexuality have not been well studied. However, most women who have had a hysterectomy have also had oophorectomy; most of these women continue to be sexually active, and many, because they are relieved of the fear of pregnancy, become even more sexually active.

Mastectomy may lead some women to feel sexually mutilated. They may lose sexual desire because of embarrassment, concerns about being less feminine, or fear of being less attractive to a partner. Periodic depression is common during the first 1 or 2 years after mastectomy. Rehabilitation programs can help women and their partners deal with the physical, psychologic, and cosmetic concerns of breast surgery. Patients and their partners should be encouraged to share feelings openly and support each other emotionally.

After prostatectomy, patients are usually advised to avoid sexual activity for 6 weeks. Transurethral resection of the prostate, the most common form of prostatectomy, may affect potency, and retrograde ejaculation is common. At least 10% of men lose some ability to achieve an erection, although most men return to their presurgery level of sexual functioning. Most erectile dysfunction after transurethral resection of the prostate is psychologic; about 3 to 5% of men develop nonpsychologic erectile dysfunction. Suprapubic or retropubic prostate surgery may result in erectile dysfunction.

Orchiectomy in elderly men is usually performed to treat prostate cancer. Its psychologic effects can be devastating. Counseling before and after surgery is essential. Physiologic erectile dysfunction may occur, but most men can have normal erections.

In men, removal of the rectum and anus may result in total erectile dysfunction because of damage to nerves serving the genital organs. In women who undergo this procedure, capacity for sexual arousal and orgasm is usually retained, because essential nerves are further from the surgical site. Sexual activity is possible after colostomy or ileostomy, although the adjustment can be complex. Patients and their partners should be given medical guidance and psychologic counseling. Ostomy support groups are widely prevalent and can provide information and help.