Q: Can I revive my sex drive and orgasm after a hysterectomy?

There are a number of pieces to this puzzle--we women are complicated! First, because your hysterectomy was "complete," you no longer have ovaries, which are a major source of testosterone (up to 50 percent) for women. Losing that testosterone can be a major hit to women's desire, arousal, and orgasm. Some women benefit from adding back testosterone, but it's not FDA-approved in the U.S. and not all practitioners are familiar or comfortable with prescribing it for women. If you're taking oral estrogen, some complicated biochemistry is at play that can further decrease your testosterone. Replacing estrogen by a means other than oral--skin patch, spray, gel--is important. If you're not taking estrogen, orally or otherwise, that may be a contributing factor, too. Losing estrogen leads to less blood supply to the genitals, which makes arousal and orgasm more difficult.  Localized vaginal estrogen works for many women, and it's not absorbed system-wide. Beyond the hormonal pieces of this puzzle, I often recommend warming lubricants or arousal oils, which use a stimulant to bring more blood supply to the genitals. Using a vibrator can also help; the more intense stimulation can make a difference. And I encourage women to explore self-stimulation: What you require now may be different from what it was, and the better you understand yourself, the more you can help your partner meet your needs. Best of luck! It will be worth the time and effort to revive this part of yourself!

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