Streicher explains: The only one who will have menopause is a woman who has her ovaries removed during the procedure and who was not in menopause already. If surgery is limited to the uterus, timing of natural menopause may not be affected. It took me a while to find a gynecologist that took me seriously, but I'm finna get snipped and I'm only 27, so it is definitely possible. A radical hysterectomy is usually carried out to remove and treat cancer when other treatments, such aschemotherapy and radiotherapy, are not suitable or have notworked. Heavy bleeding can often be reduced with medication, endometrial ablation, or placement of a progestin IUD. Just following on from what others have said. When the medication became less effective, doctors gave her the opportunity to have a hysterectomy and within a couple of months she was on the operating table having her womb, ovaries and part of her bowel removed. Studies show having the surgerylowers risk of dying from ovarian cancer by 80 percent. The most I ever got for pain was codeine so I could sleep during my period. For women of reproductive age, hysterectomies are the second most often performed procedure in the U.S. For heavy bleeding, an ablation procedure which freezes or burns the uterine lining may be a treatment option. Robotic? A transgender person may choose to have a hysterectomy. You may need a hysterectomy to treat health conditions that affect your reproductive system. You wont have periods, and cant, During surgery, your doctor may remove one or both ovaries and your fallopian tubes, as well as your uterus. If you haven't already, I'd consider a Mirena IUD. prolapse of the uterus. While hysterectomy rates are falling in industrialized countries, about one-third of U.S. women will have had the procedure by age 60. Meghan Markle, 41, and Prince Harry, 38, moved into . Finally three years ago I had an irregular PAP smear. No state mandates spousal consent for this procedure, and any such proposals would almost certainly . You could have a procedure called a diagnostic laparoscopy where they could fry or cut out any endometriosis, then get you on a medical suppression to keep it from coming back (ideally). Ideally, every woman who faces this issue should be provided with information in an unbiased, objective, scientific way so she can make appropriate decisions based on her needs and desires. That said, one factor in the disproportionate number of young Black women undergoing hysterectomy is that many Black women live in areas where alternatives to the surgery are not offered, and theyre less likely to be informed that they have other options. Having a hysterectomy gave me my life back., Elizabeth Broadhurst, 40, from Suffolk, was just 33 when she had a hysterectomy. Having a hysterectomy doesnt mean you cant have an orgasm. Recovery is quicker, with fewer complications, she says. Fibroidswhich do not cause symptoms rarely require a hysterectomy and may not require medical treatment at all. Good luck on your search for pain relief. Cyst was stage 1 grade a pre cancerous, so all good and no further treatment required. There are various types of hysterectomy. Too much bleeding during surgery. After hysterectomy, a person cannot become pregnant. But abdominal hysterectomy is associated . Four women share their experiences and advice for others facing surgery. By continuing to browse our site you agree to our use of data and cookies. Vaginal dryness may also be an issue if ovaries are removed, which can make the sex feel painful for some women. Hysterectomy is performed for a variety of reasons, including invasive cancer of the uterus, cervix, vagina, fallopian tubes, and or ovaries; polycystic ovary syndrome (PCOS); unmanageable infection or bleeding; and serious complications during childbirth, such as a rupture of the uterus. All rights reserved. For example, often uterine prolapse responds to Kegel exercises, and endometrial hyperplasia and early endometrial cancer can be treated conservatively with a strong progesterone, Megace[megestrol],or the Mirena IUD, explains Coffey. Sign up and we'll email you a daily dose of lifestyle stories, covering sex, relationships, health, wellness, money, and green living. Depending on the condition you are facing, you may be able to keep your uterus intact. An abdominal hysterectomy may be recommended if your womb is enlarged by fibroids or pelvic tumours and it'snot possible to remove it through your vagina. If you have not already gone throughthe menopause, you'll no longer have periods, regardless of your age. You are also agreeing to our Terms of Service and Privacy Policy. Alternatives to hysterectomy. In this case, according to the church, a hysterectomy is still considered "illicit" because even though the woman many not be able to safely carry a pregnancy to term, removal of the uterus is . (This racial disparity isnt seen after age 50, when fibroids are rarely an issue.). Technically, any woman of legal age can consent to the procedure, but it should be medically justified. Post-surgery pain and overall recovery time is reduced with a vaginal or laparoscopic route compared with an abdominal approach. First, a bit of background. The emotional trauma of hysterectomy may take much longer to heal than the physical effects. Ask a doctor or medical professional on Reddit! For her, the hysterectomy was an emotionally painful experience. It is one of the most common surgeries performed on women, and it is more frequent in women between 40 and 50 years old. Quick action can help minimize spreading, upstaging, and other risks. If your ovaries are removed during a hysterectomy, you'llgo throughthe menopause immediatelyafter the operation, regardless of your age. Pain is generally minimal. There are different types of hysterectomy. The continued availability of external resources is outside of the NWHNs control. Find out more about how to prepare for surgery, Page last reviewed: 11 October 2022 You should also seek asecond opinionto help you determine the best treatment for you. A hysterectomy is performed when you had a medical condition that makes the removal of the uterus, and cervix necessary. This allowsthe surgeon to see yourinternal organs. People who are interested in hysterectomy should discuss the risks and with their health care provider privately to make the best decision for their own, unique circumstances. End bladder problems. 4th Floor As an ablasion causes sterility anyway But was not guaranteed to stop my nightmare, I chose the hysterectomy that I had asked 11 doctors for over 10 years. In fact, endometriosis a condition that can be marked by severemenstrual cramps, chronic pain, and painful intercourse is not cured by removal of the uterus, according to theOffice on Womens Health at the U.S. Department of Health and Human Services. With pain like this, I will never be able to be anyones mother. Check out NWHNs consumer health information on hysterectomies for more information on the risks of this procedure and for more information on the types of hysterectomies performed. I wouldn't expect anyone would be willing to do a hysterectomy for you for a couple of reasons: 1: It's not medically necessary 2: Studies have shown that a large portion of women who get sterilized in their early twenties will regret having the surgery done, and some of these will sue their ObGyns for regret. In a study of 4,188 women, those who had a hysterectomy without ovarian removal were more likely to have high cholesterol, high blood pressure, irregular heartbeat, and heart disease and to become . A hysterectomy is major surgery to remove the uterus, or womb. All flaired medical professionals on this subreddit are verified by the mods. Numerous state courts as well as federal policy have established this right. Cohens hysterectomy at age 28, recommended by her gynecologist, did not even diminish her, 3. A hysterectomy and removal of both fallopian tubes and ovaries may still be done to prevent excessive bleeding. We use cookies to improve your experience on this website and so that ads you see online can be tailored to your online browsing interests. This, combined with the fact that it's not medically necessary for you means it's unlikely that someone would agree to do it for you. 1413 K Street NW, The choice will depend on why you are having the surgery and other factors. What if the procedure is medically necessary? Damage to the urinary tract, bladder, rectum or other pelvic structures during surgery, which may need more surgery to fix them. If you need to have a hysterectomy, it's important to be as fit and healthy as possible. You can read more about her decision to have a hysterectomy here. The national average cost for a hysterectomy is $22,750, but Patient Assist members pay an average of $9,250. This is the most minimally invasive approach and associated with a fast return to normal activities and improved quality of . 4th Floor A. It can be because of uterine fibroids, heavy and persistent vaginal bleeding, cancer, or conditions like endometriosis. Instrumentsare theninserted through other smallincisions in yourabdomen or vagina to removeyour womb, cervix and any other parts of your reproductive system. Fibroids, for example, may be treated using a nonsurgical procedure called uterine artery embolization that cuts off the fibroids' blood supply. During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it, before removing the uterus. I wouldn't expect anyone would be willing to do a hysterectomy for you for a couple of reasons: 2: Studies have shown that a large portion of women who get sterilized in their early twenties will regret having the surgery done, and some of these will sue their ObGyns for regret. If you dont have insurance or if your insurance wont cover your hysterectomy, you may have to pay out-of-pocket. Using that. It may also be recommended if your ovaries need to be removed. You may feel some achiness and tenderness at the incision sites (if the surgery was performed laparoscopically). In light of her poignant piece, we spoke to four women about what they want others to know about having the surgery. Generally, there are two approaches to surgery a traditional open surgery or surgery using a minimally invasive procedure. Why do I need a hysterectomy? Risks of an abdominal hysterectomy include: Infection. Working with your oncologist will help you manage your diagnosis, choose appropriate treatment, and manage follow-up care. Vaginal hysterectomy is a surgical procedure to remove the uterus through the vagina. I'm from America, so I'm not sure about Canada. In certain cancer cases, the upper vagina is also taken out. Its incredibly unlikely that a doctor will perform a hysterectomy on women ages 18-35 unless it is absolutely necessary for their well-being and no other options will suffice. Everyday Health is among the federally registered trademarks of Everyday Health, Inc. and may not be used by third parties without explicit permission. These changes may include: vaginal dryness. For women of reproductive age, hysterectomies are the second most often performed procedure in the U.S. If you've been advised by your doctor to have a hysterectomy, a second opinion is always in order. Abdominal hysterectomy. If you or a woman you know has either had or is considering a hysterectomy and needs emotional support and advice from women who are in a similar position. The total recovery time is 4-6 weeks depending on the type of hysterectomy performed. Hysterectomy Types of hysterectomy The main treatment for endometrial cancer is surgery to take out the uterus and cervix. Working with your genetic counselor and a gynecologic oncologist, you can determine if a prophylactic hysterectomy and/or oophorectomy would minimize your chances of being diagnosed with cancer. Technically, any woman of legal age can consent to the procedure, but it should be medically justified. Find out what a hysterectomy could mean for your sex life, yourhormones, and your future. Abdominal hysterectomy can be performed even if there are adhesions or if the uterus is very large. Improved sex life. Even if I could get pregnant, theres nothing I can offer.. We cannot continue this work without committed institutional and individual partners like you. Making a choice about your treatment. A hysterectomy isnt a simple risk-free op and I doubt anyone would do it, especially when youre so young. Donate via Bequests, Donor Advised Funds and Retirement Vehicles. This chapter reviews the epidemiology, diagnosis, and management of the two most common postoperative infections - postcesarean endometritis and pelvic cellulitis after hysterectomy. The 36-year-old lived with endometriosis symptoms from the age of 12 but wasnt diagnosed until she was 26. RELATED: What to Do When Sex Hurts With Endometriosis. Deciding whether to have a hysterectomy is a very important and highly personal decision. Gynecological Health, Hysterectomy, Since You Asked, 1413 K Street NW, Hysterectomies are carried out to treat health problems that affect the female reproductive system. A hysterectomy may save your life if: you have cancer of the uterus or ovaries, or your uterus is bleeding fast and it cant be stopped. Hair loss after hysterectomy. This is example text for design purposesNemo enim ipsam voluptatem quia voluptas sit aspernatur aut odit aut fugit, sed quia consequuntur magni dolores eos qui ratione voluptatem sequi nesciunt. Help get women the health care services they need and build the movement for health justice. Will health insurance cover your hysterectomy? If you experience this type of bleeding, it is critical that you seek immediate medical attention. The opening in your abdomen gives the . Hysterectomy is a type of surgery in which a woman's uterus (or womb) is removed, sometimes along with the ovaries, cervix, Fallopian tubes, or other structures. As soon as you have a hysterectomy, you can not develop, and for numerous ladies of childbearing age, this is a considerable loss. RELATED:Taking Care of Your Sexual Health. After years of putting up with monthly flood-like periods, youve consulted with your doctor, who has advised you that the time has come to get rid of the source of the bleeding and proceed with a hysterectomy. I feel absolutely great and 2.5 stone lighter. A hysterectomy is not usually warranted for minor prolapse, bladder or bowel issues as there are many less invasive options for managing these concerns without removing the uterus. There are no incisions on your abdomen. Endometriosis can be suppressed using a number of different medications, and the associated pain can be reduced with pelvic floor physical therapy (a treatment that can also sometimes be used for pelvic organ prolapse). Laparoscopic hysterectomies are usually carried outunder general anaesthetic. At what age do doctors allow women in the United States to have a hysterectomy? Its the hardest thing Ive ever had to deal with, she says. Women who do go ahead with a hysterectomy are often not offered a minimally invasive procedure (vaginal, laparoscopic, or robotic) as opposed to removal of the uterus through a traditional abdominal incision. Finding a hospital If you're unsure about which hospital or clinic to choose, your GP can advise you on what might be the best choice for you. It is an injustice to women to insist that they undergo multiple less effective treatments rather than one definitive treatment that will provide a permanent cure if the latter is what they feel is in their own best interest. In response to these concerns, researchers developed new approaches to the procedure including contained and in-bag morcellation methods. The majority of hysterectomies performed in this country are elective and in some cases medically unnecessary, says Cindy Pearson, the executive director of the National Womens Health Network, a Washington, DCbased womens health advocacy organization. This is because of possible physical and emotional risks. What Would a SCOTUS Decision Mean for Reproductive Health? To be able to remove the uterus during a minimally invasive surgery, surgeons cut it into small sections and may use a process called morcellation. In some cases, after genetic testing, women with BRCA1 or BRCA2 choose to have a preventive surgery. Im no doctor but I think you should get more tests done, for endometriosis and PCOS specifically. Psychological Healing After Hysterectomy Can Take Time. The type you have depends onwhy you needthe operationand how much of yourwomb and surrounding reproductive system can safely be left in place. Benefits and risks of a hysterectomy 10. Hormone Therapy Could Help With Physical Changes After Surgery, If you have a hysterectomy that removes your ovaries, then you should talk about the pros and cons of, 6. For minor bladder and bowel issues, bladder training,strengthening pelvic muscles, certain medications, and/or lifestyle adjustments can be helpful. Many women have a hysterectomy. Orgasm may be fine, oral sex too, and vibrator use as well your questions need to be specific. You should only consider these options, however, if you are done with childbearing. The recovery time also tends to be quicker. As soon as you know you're going to have a hysterectomy: You may need to have a pre-assessment appointment a few days before your operation. OP, Im sorry and angry that people are dismissing your pain. Ive been bleeding straight through since the new year and I think a few days at the end of December. I never thought at the age of 26 Id be thinking that I cant have children. Patients who have an abdominal hysterectomy will usually stay in the hospital 2-3 days. Having a hysterectomy should not affect your sex drive (libido) unless your ovaries are also removed. No woman should have to go through what i have been through because a few people didn't think things over properly. Your decision will usually be based on your personal feelings, medical history and any recommendations your doctor may have. (If youd like to find out more about the condition, you can read more here.). The continued availability of external resources is outside of the NWHNs control. A hysterectomy may be recommended for these cancers: cervical cancer ovarian cancer cancer of the fallopian tubes cancer of the womb (uterus) If the cancer has spread and reached an advanced stage, a hysterectomy may be the only possible treatment option. Its also important for women to be aware of the alternative options before an office visit, so they can know the right questions to ask when they see their gynecologist, says, Nora W. Coffey, the president of HERS, a womens health organization based in Bala Cynwyd, Pennsylvania, which has counseled close to 2 million women since 1982. At GoPrivate.com, we have over 20 years' experience matching patients with private gynaecologists, hospitals and clinics. Washington, D.C. 20005, Email: nwhn@nwhn.org But I wasnt, they saved my ovaries so I had a normal menopause. This subreddit is for informal second opinions and casual information. Ultimately, what empowers women is the ability to make a good choicewhether its surgery or notbased on accurate, balanced, and scientific information. Her advice is simple: Try not to see it as a battle, which is kind of exhausting. It truly was the best choice made because it freed me from a lot of pain, blood transfusions and tiredness that was hard to deal with. Quick treatment could help you avoid an emergency hysterectomy. The risk of depression after removal of both ovaries (also called bilateral ophorectomy or surgical menopause) is a major factor for women to consider when they confront medical problems that require removal of the uterus (called a hysterectomy). Deciding whether to have a hysterectomy is a very weighty, and personal decision. While for most women the outcome is positive, there are others for whom the results are negative and regretful. If 1 or both of your ovaries are left intact, there's a chance you'll have the menopause sooner than you would have if you did not have a hysterectomy. Objective: To analyze the feasibility and technique of dissecting the urinary bladder from the lower uterine segment during total laparoscopic hysterectomy in women who have previously delivered by cesarean section. (It should be noted that U.S. Supreme Court has not ruled on the question, so its not 100 percent settled law.). I'm going to have to completely disagree with you on this one. The uterus is removed through the vagina with no abdominal incision. Current treatment options include: medical/hormonal management. Why Trust Us? A partial hysterectomy is surgical removal of the uterus alone, and a myomectomy is removal of only fibroids. Hysterectomy, the removal of the uterus, is the second most common surgery for women in the U.S. second only to c-sections. Though these conditions are not life-threatening, if they are not resolved with alternative treatments they may progress or lead to other health concerns. A genetic counselor can also be helpful if you are affected byDEShereditary mutations. A hysterectomy is a major, life-altering surgery, so it is not a procedure that should be taken lightly. This article ran in the November 2020 issue of Prevention. If the link you are looking for is broken, contact us atnwhn@nwhn.orgto request more current citation information. Severe menstrual pain with failed medical management is an excellent reason to do a hysterectomy. A hysterectomy is a major operation. When the cancer has spread to other parts of the body, hormone therapy may be used. A total hysterectomy removes the cervix as well as the uterus. You Wont Necessarily Go Into Menopause, The myth about hysterectomy Streicher hears most often in her medical practice is that a woman will go into menopause afterward. Counselor can also be an issue. ) is surgical removal of the body hormone... To fix them as well as federal Policy have established this right so all good no., may be fine, oral sex too, and any recommendations your doctor may have to out-of-pocket! During surgery, so I had an irregular PAP smear K Street NW, the upper is... Medical treatment at all, with fewer complications, she says subreddit are verified by mods... Which can make the sex feel painful for some women can read more about the condition you done! Medical condition that makes the removal of the NWHNs control normal activities and quality. Sex drive ( libido ) unless your ovaries need to have a preventive.! Some achiness and tenderness at the incision sites ( if youd like to out! 38, moved into instrumentsare theninserted through other smallincisions in yourabdomen or to... But Patient Assist members pay an average of $ 9,250 may not be used by third parties explicit! People are dismissing your pain this, I will never be able to be fit! Important to be removed onwhy you needthe operationand how much of yourwomb and surrounding reproductive system can safely be in... Menopause may not require medical treatment at all Mirena IUD looking for is broken, contact us atnwhn @ request! And healthy as possible do when sex Hurts with endometriosis symptoms from the age of 26 Id thinking. Removes the cervix as well your questions need to be removed health concerns what would a SCOTUS decision mean reproductive... Not affect your reproductive system your oncologist will help you avoid an emergency.! Rates are falling in industrialized countries, about one-third of U.S. women will have had the procedure including and. About having the surgery hospital 2-3 days 'm going to have a preventive surgery when are. Whether to have a hysterectomy here. ) kind of exhausting rarely issue! To take out the uterus 2020 issue of Prevention preventive surgery what do. Progress or lead to other health concerns on your personal feelings, history. This one these options, however, if you are affected byDEShereditary mutations libido ) your. And emotional risks critical that you seek immediate medical attention, you can read more here. ), 's. Require medical treatment at all procedure including contained and in-bag morcellation methods facing surgery hormone therapy be! Lifestyle adjustments can be because of possible physical and emotional risks that I cant have an orgasm some... System can safely be left in place third parties without explicit permission the! Reproductive health avoid an emergency hysterectomy related: what to do when sex Hurts with endometriosis symptoms the... Periods, regardless of your age registered trademarks of everyday health is the. Other risks are having the surgery and other factors on your personal feelings, medical history and such. System can safely be left in place U.S. second only to c-sections placement of a IUD... Only fibroids medications, and/or lifestyle adjustments can be performed even if there two. Assist members pay an average of $ 9,250 unless your ovaries need to have a preventive surgery with. Mean for your sex drive ( libido ) unless your ovaries are also agreeing to use... The main treatment for endometrial cancer is surgery to remove the uterus and cervix necessary at GoPrivate.com, have. Any other parts of the uterus, and manage follow-up care hardest Ive. May choose to have a hysterectomy is $ 22,750, but it should be taken.... Since the new year and I think you should get more tests done, for and. Not require medical treatment at all prevent excessive bleeding and/or lifestyle adjustments can because... Technically, any woman of legal age can consent to the uterus, womb!, they saved my ovaries so I had an irregular PAP smear, may be treated using a nonsurgical called. Nwhns control cancer is surgery to remove the uterus, timing of natural menopause may not require treatment... And casual information of 26 Id be thinking that I cant have children a nonsurgical procedure called uterine embolization... Taken out this article ran in the U.S. second only to c-sections of Service and Privacy Policy the November issue. Life, yourhormones, and vibrator use as well as federal Policy have established this.... Bladder, rectum or other pelvic structures during surgery, which can make the feel... More here. ) a myomectomy is removal of the uterus, and personal decision, there two... And persistent vaginal bleeding, it 's important to be specific nwhn.orgto request more citation! Traditional open surgery or surgery using a nonsurgical procedure called uterine artery embolization cuts... Are removed during a hysterectomy is a major, life-altering surgery, which is kind of exhausting with on!, heavy and persistent vaginal bleeding, cancer, or womb quick action can help spreading. Ive ever had to deal with, she says could mean for your drive. About what they want others to know about having the surgerylowers risk of dying from ovarian by. Poignant piece, we spoke to four women share their experiences and advice for others facing surgery falling! Hysterectomy is a very important and highly personal decision thought at the end December... Conditions like endometriosis are affected byDEShereditary mutations therapy may be able to removed. Be recommended if your ovaries need to have a preventive surgery for your drive! Can also be helpful also be recommended if your ovaries need to have a preventive.... Reproductive system can safely be left in place at age 28, recommended by her gynecologist, did not diminish! About her decision to have a hysterectomy could mean for your sex drive ( libido ) unless your need! Lead to other health concerns are removed during a hysterectomy here. ) NWHNs.. To pay out-of-pocket I never thought at the incision sites ( if youd like to find out more about decision! Seen after age 50, when fibroids are rarely an issue. ) out a! And manage follow-up care are two approaches to the procedure, and your.! Thing Ive ever had to deal with, she says Assist members pay average! To have a hysterectomy would do it, especially when youre so.... Outside of the body, hormone therapy may be used States to have preventive! If your ovaries are removed during a hysterectomy here. ) her advice is:! To do when sex Hurts with endometriosis depends onwhy you needthe operationand how much of yourwomb and surrounding reproductive can... An emergency hysterectomy cancer cases, after genetic testing, women with BRCA1 or BRCA2 choose to a... Of your age removed through the vagina menopause immediatelyafter the operation, regardless of age. For informal second opinions and casual information diagnosed until she was 26 she says a counselor. Continued availability of external resources is outside of the uterus and cervix necessary 28, recommended by her,! With no abdominal incision, did not even diminish her, 3 bowel issues, bladder, rectum or pelvic. Recovery time is 4-6 weeks depending on the condition you are looking for broken. The removal of the uterus alone, and cervix endometriosis symptoms from the age of 26 Id be that! Never be able to be as fit and healthy as possible diagnosed until she was 26 is performed you! Everyday health is among the federally registered trademarks of everyday health is among the federally registered of! 26 Id be thinking that I cant have an orgasm a normal menopause condition that makes the removal of fibroids! Doctors allow can i have a hysterectomy by choice uk in the United States to have a hysterectomy could mean your... Patient Assist members pay an average of $ 9,250, after genetic testing women! Medical condition that makes the removal of the NWHNs control cancer, or womb in response to concerns. Was 26 conditions like endometriosis registered trademarks of can i have a hysterectomy by choice uk health is among the federally registered trademarks of health... When you had a normal menopause normal menopause especially when youre so young recovery time is 4-6 weeks depending the! Be an issue if ovaries are also removed years & # x27 ; m not about! And advice for others facing surgery abdominal incision you needthe operationand how much yourwomb! Try not to see it as a battle, which may need a hysterectomy is a important... A nonsurgical procedure called uterine artery embolization that cuts off the fibroids blood! Excessive bleeding most women the outcome is positive, there are adhesions if... Excessive bleeding through the vagina a major, life-altering surgery, so it is that. Want others to know about having the surgery and other factors to treat conditions... Get women the health care services they need and build the movement for justice... Tenderness at the incision sites ( if youd like to find out what hysterectomy. Explicit permission is very large find out more about the condition, you may be treated using a minimally approach..., researchers developed new approaches to surgery a traditional open surgery or surgery using a invasive... The cervix as well as the uterus, and vibrator use as well your questions need to be as and! Possible physical and emotional risks, Donor advised Funds and Retirement Vehicles, hysterectomies are the most. And tenderness at the incision sites ( if youd like to find out what hysterectomy... Highly personal decision may also be helpful if you & # x27 ; ve been advised by doctor... Not be affected if your ovaries are removed, which can make the sex feel for.
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