DOCTOR'S ADVICE - Will the operation spoil her sex life?

Q. Doctor, my husband and I have always had a great sex life. We still make love around three times for the week. But now I have a problem. You see doc, I am facing a hysterectomy operation soon. And I greatly fear that this will be the end of our sex life. My mother has told me that no woman who has had a hysterectomy can have sex. Is this true? It would be a tragedy if our sex life together was over. Also, how do they do this operation? I do not understand.

A. Please don't fret. What your mother has told you is NOT correct, though I am sure that she believes it. Such ideas were common when she was younger.

Let me explain. Hysterectomy is simply removal of the womb. But the womb is not actually involved in sexual intercourse. So that means that it is perfectly possible for the woman to have intercourse after the operation, although she must first have time to recover while her tissues heal up.

Hysterectomy is a real common operation, and at one time around one in eight of all women ended up undergoing it. These days, it has become a little less frequent because of the arrival of new treatments which avoid the need for surgery. However, in your case it is clear that a gynaecologist has decided that you need to take this 'op'. There are three ways of doing it:

1. The first involves making a cut in the lower part of the belly, and taking the womb out that way;

2. The second is to operate through the vagina, so that there is no need for a cut in the skin;

3. The third is to use 'keyhole' or laparoscopic surgery, by putting telescope-like instruments through tiny holes in the belly.

Now, the parts of a woman that are mainly involved in sex are the vagina and the clitoris. They are NOT affected by a hysterectomy, except in rare circumstances.

However, I must explain that there are various types of hysterectomy:

• a) Total hysterectomy - removing the womb;
  
• b) Subtotal - removing the womb, but leaving the woman's cervix where it is;
  
• c) Radical hysterectomy - removing the womb and much of the surrounding tissues. This is done only in cases of cancer, and it is unusual.
  
• d) Hysterectomy with Oophorectomy - removing the womb and the ovaries.

I feel you should ask the gynaecologist to tell you precisely which type of hysterectomy will be done. But unless you have womb cancer and are going to take the radical hysterectomy, you should have no difficulty in returning to sex, probably around a couple of months after the surgery. I wish you well.

Q. Can you explain to me about rectal examinations? I am a man, and I have had some minor health problems recently. As a result, my doctor says that I must have a 'DRE'. When I asked him what this was, he replied that it meant 'digital rectal examination'. But I am not so sure about this! Why is he going to do it? Is it very painful? And is there any danger that I might actually like it?

A . There is no need to fret. Doctors do DREs every day, and they try to do them in such a way as to cause as little discomfort as possible for their patients.

What is the point of this examination? Well, it enables the doctor to feel if there is anything wrong in the lowest few inches of the rectum. Also, most importantly, the doctor can use this technique to feel the prostate gland, and so assess its shape, size and firmness. What the doctor will do is to get you to lie on your left side, and then draw your knees up as far as you can. He will then put on a rubber glove, and squeeze some lubricant onto his fingertip. Finally, he will insert his finger into your bottom, and spend a few seconds in feeling forwards, backwards and sideways.

You enquire about pain. In fact, this examination is NOT really painful, but it is generally uncomfortable. However, the discomfort is gone in a few seconds. Finally, you ask the common question: 'Is there any danger that you might like it?' Men pose this question when they are concerned about issues of possible homosexuality. But in practice, I do not think that I have ever seen a patient who derived any pleasure from undergoing a rectal examination. So you have no need to fret.

Q. I am a female Gleaner reader in the USA, and recently I have been under much stress and sexual tension. I have been advised that I should take some kind of therapy called 'CBT'. Do you know what that is doc? And would I have to take any pills?

A The letters CBT stand for Cognitive Behavioural Therapy. This is a type of treatment which is widely used for stress, anxiety and some sexual problems. Basically, it involves talking with a therapist for periods of around an hour, at least once a week for a couple of months or more. She encourages you to completely alter the way you think, so that eventually you take a much more positive attitude to life. CBT has helped many people and there are no pills involved.

Q. I am a man, aged 35. I am a little worried by the fact that when I was younger, I masturbated a lot. Now my girlfriend has told me that there is a link between cancer of the prostate and masturbation. So does this mean that I will get it, doc?

A. Your girlfriend is right in saying that scientists have shown a link between masturbation and prostate cancer. But it is not what you think! In fact, the researchers found the rather surprising fact that men who have masturbated are LESS likely to develop prostate cancer. So you can quit fretting.

Q.  I am 28 and female. I have never had a vaginal examination before, but I am going to have to undergo one next week. My doctor's nurse told me that he will be putting a speculum inside me. What does this mean? Is it a really bad experience?

A. Well, a speculum is just a little device which enables the doctor to see inside the vagina, and get a good view of the cervix. It is made of either plastic or metal. It looks rather like a child's toy pistol. Putting one inside is NOT generally painful, unless the woman is very tense, so that her muscles contract. I must admit that occasionally a patient complains that a speculum examination pained her, especially if the doctor was inexperienced. But if you are consulting an experienced doctor, there should be no problem.

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