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Response to BMJ Article about Female Sexual Dysfunction

Far from being an invention of the pharmaceutical industry, as Ray Moynihan, the male journalist claims, sexual dysfunction is a disease suffered by a significant number of women and their partners. [1] It causes them great distress and can ruin their relationships and their lives. Most women are too embarrassed to seek help and those who do may be accused of being hysterical or depressed.

My own particular interest and research has focused on sexual dysfunction after hysterectomy for our patient group, FEmISA (Fibroid Embolisation Information, Support & Advice).

Approximately 75,000-100,000 [2],[3] women in the UK have hysterectomies each year and all will experience some form of sexual dysfunction. This is caused by the removal of organs involved with orgasm, hormonal changes and early menopause, and for psychological reasons.

The uterus and cervix are involved in the female orgasm and have rhythmic muscle contractions during it. Their removal and changes in pressure effects and orientation can result in a lessening of the sensation of an orgasm, which is quite noticeable in some women. The vagina is likely to become narrower and shorter after hysterectomy. This can make sex painful and full penetration difficult. Surgical damage of the nerves, particularly to the vagina can result in loss of sensation. Few studies have been carried out on this important issue but changes in climax have been noted in 33-35% of women. [4],[5],[6],[7]

Many studies put any loss of libido down to depression, or the psychological loss of femininity. [8],[9],[10] The reduction in testosterone levels after oophorectomy may lead to loss in frequency and desire for sex. 42% of women after hysterectomy but with conservation of at least one ovary had sexual intercourse less often, while 74% after removal of both their ovaries had less sex. [1],[7] Reduction in other sex hormones and early or immediate menopause can also result in other sexual dysfunction symptoms such as reduced lubrication in 38% of women. [1],[6]

It is estimated that 20% of women in the UK will have had a hysterectomy by the age of 55, making sexual dysfunction from this cause alone a significant problem. [2]

In the future less invasive alternatives to hysterectomies, as advocated by Maresh et al [3] will help to reduce medical / iatrogenic sexual dysfunction. Approximately 30% of hysterectomies are carried out for fibroids / leiomyomata and a significant number could be treated by uterine artery embolisation, which does not adversely affect sexual function. [11]

For those women who are already suffering sexual dysfunction it is hoped that Viagra or other similar drugs will be able to relieve symptoms in some.

If 17 million men can benefit from prescriptions for Viagra I sincerely hope that a similar number of women can also.

Mr Moynihan gives the impression from his article that he cares nothing for women's distress, but greatly enjoys pursuing a vendetta against the pharmaceutical industry.

Ginette Camps-Walsh

Fibroid Embolisation - Information, Support & Advice
An independent patient group

A full discussion on the article, with contributions from a wide range of opinions, can be found at:


  1. Meston CM, Frohlich PF - Update on female sexual function - Current Opinion in Urology 2001 Nov,11,6,603-9

  2. Vessey MP et al - The epidemiology of hysterectomy: findings in a large cohort study BJOG May '92 Vol 99 pp 402-7

  3. Maresh MJA et al - The VALUE national hysterectomy study: description of the patients and their surgery - British J Obstet & Gynae March 2002 Vol. 109 302-312

  4. Ennerstein L et al - Sexual response following hysterectomy and oophorecomy - Obstet Gynecol 1977 Jan;49(1):92-6

  5. Dicker RC, Greenspan JR, Strauss LT - Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. Am.J.Obstet.Gynecol 1982; 144:841-848

  6. Poad D, Arnold EP - Sexual Function After Pelvic Surgery - Aust NZ Obstet Gynaecol 1994; 34:4:471

  7. Farquhar CM, Sadler L, et al - A prospective Study of the Short-Term Outcomes of Hysterectomy with and without Oophorectomy - Aust NZ J Obstet Gynaecol 2002 42:2:197

  8. Bachmann GA - Psychosexual Aspects of Hysterectomy - Women's Health Issues 1990 Fall;1 (1): 41-49

  9. Carlson K J et al - The Maine Women's Health Study: Outcomes of hysterectomy Obstet Gynecol 1994 Apr;83(4):556-65

  10. Schofield M - Self-reported long-term outcomes of hysterectomy - Br J Obstet Gynaecol 1991 Nov;98 (11):1129-36

  11. Watkinson AF Babar SA Robertson F Magos A Torrie EP Holt E - Impact of uterine artery embolisation on sexual function - Radiology 2001: 221(P):30 Presented at Radiological
    Society of North America Chicago 2001