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!
Dr. Barb DePree, M.D., has been a gynecologist and women’s health provider for almost 30 years and a menopause care specialist for the past ten.
2 comments
Women do lose their genitals….they do atrophy, and while estrogen can help minimize that, it won’t prevent it completely. Time is not our friend. Most women lose up to 80% of their genitals to atrophy. Some medications can impair orgasm, chronic health conditions (heart disease, for example) can get in the way of orgasm, but often it is aging. Trying a warming lubricant like Zestra may be of benefit for you. The estrogen directly to the clitoris won’t do anything in addition to the vaginal estrace that you are using. I don’t know what the intensity of the vibrator you are using, but the Emotional Bliss vibrators (Womolis, Femblossom and Isis) are the most intense, designed to help women with medical conditions that may impair orgasm. In my experience those have been the most successful.
I had a total hysterectomy 27 years ago. I’m now 68 and I’m having a terrible time having an orgasm. Sometimes I get 90% there and it never goes all the way. This has been for 3 yrs. now and nothing is working. I’m on bio-identical hormones with estrogen, progesterone and testosterone. I apply this close to the vaginal lips every night for 25 days as told, then stop for five. I use internal Estrace 3 times a week for athopy and dryness, not sure if it’s better as my husband has ED, but has a very high estrogen and testosterone count that they are trying to get an answer to. I’ve also noticed that my clitoris seems to have gotten smaller? I asked the doctor about it, he said that it did have some athopy and to put some of the HRT cream directly on it every day. It’s been 3 weeks but I don’t see it getting any larger. Can it shrink as we get older? I’ve tried the Trojan clitoral vibrator and it doesn’t help either. Any advice would be appreciated.