Great Sex or Bad Blood? Expanding the Discussion of Sexuality After Hysterectomy

Abstract

What happens to women's sexual response after hysterectomy or oophorectomy remains a worthwhile question for an ongoing feminist analysis, and needs to go beyond the usual depiction of hysterectomy as a prime example of patriarchal violence that is most common in feminist critique of the medical profession. The widespread, and long standing practice of this surgical removal of the uterus and ovaries has continued mostly unabated, despite consistent reports that a certain percentage of women have always reported a less satisfactory sex life as a result of the operation, and the fact that the demographic group of young women who had previously understood hysterectomy to be a largely unnecessary operation have now entered the phase of life where menstrual difficulties are most likely to present themselves. Important new information is also emerging which suggests that even the "simple" removal of the uterus may be implicated in a subsequent ovarian failure for up to as many as forty percent of women (with its subsequent consequences for a woman's urogenital functioning, and the necessity of long term hormone replacement therapy (HRT) to mitigate some of these effects), and that the cervix, which has usually been depicted as unimportant to the orgasmic response in women, has important sexual, physiological and endocrinological roles to play in a woman's wellbeing. This information emphasises the importance of keeping feminist critiques of sexuality, with its avowed interest in women being able to accurately depict their bodies and desires, relevant to such issues as that of sexuality after hysterectomy. In this research project, I interview twenty-nine women about their hysterectomies, menstruation and changes to sexual response. I discuss how feminism, despite its early adoption of the exploration and enthusiastic dissemination of results of the scientific study of female sexuality, and its embracing of William Master's and Virginia Johnson's "Human Sexual Response Cycle" (HSRC) as a legitimate and hopefully emancipatory measure for the accurate depiction of a female sexuality analogous to that of males, quickly became confined by the parameters set by a politics of difference argument, which demonised male sexuality and thereby cast women yet again into the role of victim. I argue that more recent discussion centred around postmodernism supports my belief that if we continue to eschew the conceptual coinage of the HSRC it will be to our own disadvantage, and I use, as a tactical choice the metaphor of the human sexual response cycle to inform the question I asked women about their sexual responses after hysterectomy. Their answers show that for many women, there are changes, subtle and not so subtle, which support the latest research findings regarding female sexual functioning, and these descriptions enhance the ones more commonly found in scattered form throughout various lay, journalistic and sociological accounts, and a medical literature which relies on an even more structured form of questioning and analysis. I believe that leaving the analysis of female sexuality at the level of it being depicted as being totally defined by a male ideology and a patriarchal medical dominance not only presents the usual difficulties and consequences of non-commensurate studies, but also deprives ordinary women of a language with which they could legitimately discuss the possibility of sexual changes or harms subsequent to surgery. Accounts of a simply patriarchal medicine and harms done by doctors and surgeons alone (although holding essences of truth) also serve to disguise and leave unexplored the social and cultural practices around menstruation, and enforced by all men, which are just as likely to lead women to an almost inevitable acceptance of major surgery as a viable option to problematic bleeding (around seventy percent of New Zealand hysterectomies are performed for dysfunctional bleeding). Although menstruation has most often been studied in relation to young women entering menarche, I look at the strains that common customs around menstrual bleeding present to adult women operating in home and work places today. Detailed accounts by women demonstrate the difficulties that a menstrual etiquette presents for the effective functioning of an adult female who is expected, with the sole exception of her sexual partner, to conceal any evidence whatsoever of her menstrual cycling throughout the entirety of her fertile years. Even though this study argues that feminist researchers take a more pragmatic approach to the study of sexuality, in effect recommending joining in with the scientific conversation in order to be less harmed by it, and to enable more effective description of our sexuality, I believe it also supports a materialist feminist understanding that sexuality is not the sole basis of subordination of women. This is a definition that assumes instead that females do more servicing of males outside the bed sheets than between them, and it is supported by the description of women in this study who give detailed accounts of how heavy bleeding, although especially normal in midlife women, handicaps a woman, and her household to the extent that the surgical option (given there are no others which so effectively eliminate female bleeding) seems in many respects, even for self-avowed feminists, the "sensible" or only decision to make regarding their own bodies.