Relationship Rehab: Wife feels ‘guilty for not wanting sex’

The woman tries to show affection “in other ways” but still feels bad for not wanting to spend time in the bedroom with her husband.

Welcome to Relationship Rehab, news.com.au’s weekly column solving all your romantic problems, no holds barred. This week, our resident sexologist Isiah McKimmie tackles a woman who no longer wants to have sex because it is too painful.

QUESTION: I had a hysterectomy a few years ago and since then my hormones and sex drive have been all over the place. On the odd occasion I do have sex with my husband it’s quite painful so I avoid it. I show affection in other ways but feel guilty for not wanting sex as I know it’s important to him. What can I do to get my sex drive back?

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ANSWER: I’m sorry you’re experiencing this. Changes to your physical and mental state following a medical procedure can be upsetting and challenging. I hear your care for your husband and your desire to improve your sex life together.

Sexual desire is a complex issue, being impacted by biological, psychological and social factors. There are a few contributing factors here, so I want to make sure I address them all for you.

Sexual function after hysterectomy

Unfortunately, many women experience adverse impacts to sexual desire, enjoyment and orgasm. However, some studies have shown that a hysterectomy can have positive impacts on sexual functioning and frequency.

That’s not to diminish your symptoms or experience. Many women approach me for support in changes to their libido and sex life following a hysterectomy. Your experience is real.

While the impact of hormones on sexual desire is complex, it may be a factor in reduced desire after hysterectomy. However, it may not be the sole cause.

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Sexologist and couples therapist Isiah McKimmie.

The mental and emotional effects of hysterectomy

For many women, there are significant mental and emotional changes faced following a hysterectomy.

A comprehensive study by the Mayo Clinic found that women are at higher risk of depression and anxiety following hysterectomy.

Some women also experience feelings of grief and loss following the procedure and changes in their perception of themselves as women. All of this certainly has the ability to impact your sexual desire also.

Pain during sex

Your experience of pain during sex, certainly isn’t going to be helping your desire increase.

With any form of pain during sex, there can be a number of causes. Understanding the kind of pain being felt and the reasons for it are important to its treatment.

When experiencing any kind of pelvic pain, I suggest seeing your GP or gynaecologist to support a diagnosis in what might be happening.

It’s helpful to describe where exactly in the genitals/pelvis you’re feeling the pain, what ‘type’ of pain you’re experiencing (eg, throbbing, sharp pains, burning) and at what point during sex you experience it.

Sexual pain following a hysterectomy is often due to changes in lubrication. Using a good lubricant (I recommend water-based) can be incredibly helpful, eliminating pain for many women.

Some pain may also be due to the shortening of the vaginal vault, the formation of scar tissue or nerve damage. I can suggest changes to your sexual activity that may reduce this pain, but I’ll need to know more about it first.
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Navigating different desire levels need to be done as a couple. Picture: iStock

Navigating different desire levels in a relationship

Navigating the challenge of different desire levels in a relationship is never one person’s issue to work on alone. You’ll get the best results if you and your husband work on this together.

Ways to increase sexual desire in your relationship

Given what I understand about your circumstances so far, here are some suggestions for improving the quality of your intimate life.

• Understand what’s causing your sexual pain and take steps to reduce it.

• Ensure that you and your husband feel connected outside of the bedroom and are willing to work on your sex life as a team.

• Explore physical and sexual intimacy with your husband without the pressure for it to lead to penetration sex.

• There are many reasons we can choose to have sex with someone, feeling turned on doesn’t need to come first. Consider engaging with your partner sexually in ways that you do enjoy, giving desire an opportunity to arise in the process.

• Consider seeking the support of a sexologist or psychosexual therapist to help you and your husband navigate these challenges.

Isiah McKimmie is a Couples Therapist, Sexologist, Sex Therapist and Lecturer. To book a session with her, visit her website or follow her on Instagram for more advice on relationships, sex and intimacy.