What is a vaginal cuff, also sometimes called a hysterectomy cuff? What will your vagina cuff feel like? Will you be able to have sex? In this quick guide to what to expect from a vaginal cuff after hysterectomy, we’ll discuss what a vaginal cuff is, how it may impact your sex life, and any potential complications to watch out for.
What Is a Vaginal Cuff?
Simply put, the vaginal cuff is the new end of the vaginal canal after a total hysterectomy.
Pre-hysterectomy, the vaginal canal ends in the cervix, the ring of tissue that acts as both barrier and passageway between the uterus and the vagina. In a total hysterectomy, both the uterus and the cervix are surgically removed. This leaves the vaginal canal as an open tube with no end.
To close the vaginal canal, the two sides of the vaginal wall are sewn together at the ends, creating the vaginal cuff. The two sides will heal together and the stitches will dissolve, creating an end for the vaginal canal much like the toe of a sock. The vaginal cuff is anchored to ligaments in the abdomen and pelvis to hold the vagina up and help prevent prolapse.
There are multiple kinds of hysterectomies, and not all involve a vagina cuff. A vaginal cuff is only necessary for a total hysterectomy. A partial hysterectomy, in which only the uterus is removed, leaves the cervix in place.
So what is the vaginal cuff? It’s a new end for your vaginal canal after a total hysterectomy, made of your own vaginal tissue.
Will a Vaginal Cuff End My Sex Life?
While a vaginal cuff (and hysterectomy more generally) will probably change your sex life, it doesn’t have to end it.
You will have to abstain from sexual intercourse (and potentially all sexual activity) for a certain number of weeks after your surgery, typically six to eight. It’s critical that you follow your doctor’s recommendations to minimize risk of vaginal cuff dehiscence (see section below on complications). After that, however, you will be free to resume sexual activity.
While there may be changes or difficulties at first, note that with time (and in some cases, treatment) most women are able to regain sexual function and continue sexually fulfilling relationships with their partners. In fact, if you were suffering from pain and sexual difficulty leading up to your hysterectomy, you may experience immediate improvement in sexual function.
Here are some changes you may encounter, and how to address them:
Feeling That the Vagina Is Shorter
In most cases, the vagina will not be considerably shorter after the creation of a vaginal cuff. (Some studies estimate a loss of about a quarter inch). However, the tissues of the vagina may be stiff after surgery and may not stretch quite as easily as they used to for the first few penetrative encounters, giving the impression of a “shorter” vagina. If this is a consistent issue, vaginal dilators can be used to help re-stretch the vagina to accommodate penetration.
Note that after a radical hysterectomy, in which part of the vagina is removed, the vagina may well be considerably shorter. In this case, moving towards non-penetrative sexual activities can be a good way to foster a pleasurable and rewarding sexual relationship.
Pain or Discomfort
You may feel some initial pain or discomfort with penetration the first few times you have penetrative sex after your hysterectomy. Your partner may be hitting tender scar tissue at the end of the vagina cuff. You may also have lower vaginal lubrication than usual, which can cause pain. Proceeding gently and gradually to stretch the vaginal tissues, using plenty of lube, and hormone therapy (if necessary) can all help foster a pain-free experience. Using sexual positions that allow you to control the depth of penetration can also help.
Even in cases where ovaries are left in place, you may experience a reduction in hormone levels after hysterectomy. Lower estrogen levels can reduce vaginal lubrication, creating discomfort during sexual intercourse. Using lube and locally applied or orally administered hormone replacement therapy can help address issues of vaginal atrophy and low lubrication. Discuss hormone replacement options with your doctor.
You may not have much sexual desire in the weeks and months following your surgery and the creation of your vagina cuff. It is pretty natural to experience low levels of sexual desire for a while after a major surgery on your sex organs! However, you may also be feeling lower desire because of lower hormone levels. Some combination of time and/or hormone therapy can help your sexual desire to gradually bounce back.
Many women find that their orgasms feel different after a hysterectomy. For some women, uterine contractions are a major part of their orgasm experience pre-hysterectomy. Post-hysterectomy, they will experience different sensations (not necessarily better or worse) during orgasm. Some women report initially feeling weaker orgasms but regaining orgasm intensity over time. Some experience stronger orgasms immediately after hysterectomy!
You may find that it is more difficult or takes more time to reach orgasm after your hysterectomy. This may change with time, or it may not.
Possible Complications of a Vagina Cuff
The surgical creation of a vaginal cuff after hysterectomy has many of the same complications as surgery more generally: there’s potential for damage to nerves and surrounding organs (e.g. bowel and bladder) during surgery and risk of infection after.
The main risk particular to getting a vagina cuff, however, is vaginal cuff dehiscence. This is when the closed end of the cuff partially or completely opens. This can pose a risk of serious infection, damage to the bowel and bladder, and, in extreme cases, total pelvic organ prolapse.
Though very serious, vaginal cuff dehiscence is rare, with an estimated incidence of .24-.31%. Risk may be slightly elevated after a laparoscopic hysterectomy. While having intercourse before the cuff is completely healed and straining during bowel movements can both increase your risk of vaginal cuff dehiscence, most cases happen spontaneously.
These are the signs of vaginal cuff dehiscence:
- Sudden abdominal or pelvic pain
- A feeling of pressure
- Bloody or watery vaginal discharge
- Nausea and/or vomiting
- Change in bowel habits
If left untreated, vaginal cuff dehiscence can be life-threatening. If you suspect that you are experiencing vaginal cuff dehiscence, seek medical attention immediately.
What Is a Vaginal Cuff? The Bottom Line
A vagina cuff is the new end of your vaginal canal after a total hysterectomy, made of vaginal tissue and shaped like the toe of a sock.
While you may experience some initial difficulties with intercourse after the creation of your vaginal cuff, you should regain sexual function with time and treatment as necessary.
The most serious complication of a vagina cuff is vaginal cuff dehiscence, when the cuff partially or completely opens at the end. This can be life-threatening if left untreated. Seek immediate medical attention if you think there is any chance you are experiencing vaginal cuff dehiscence.