"Why do I think your column on sex after a hysterectomy will be the most popular ever?"

That's how one of the many dozens of letters I received began, and she was right. In the nine years I've been writing this column, my discussion of the effects of a hysterectomy on sex generated the most response I've ever received, and some of it the most impassioned.

I had asked readers who had had a hysterectomy, with or without removal of the ovaries, to tell me about the effects it had on their sex life. The following results are not statistically sound, meaning that you can't take the relatively small number of responses and apply them to all women who have a hysterectomy. But having said that, the results were pretty striking.

The most important factor seemed to be whether the ovaries were left in. Most women who had their uterus removed but who retained their ovaries reported either no change in their sex life or an improvement in it. Some women's sex lives actually improved because they had a previously painful or distressing condition cured by surgery or they were freed of the worries of becoming pregnant.

A couple of women experienced some problems with vaginal dryness or pain following a hysterectomy, which slightly decreased their enjoyment. In both cases, estrogen treatment and lubricants took care of the problem.

The results were quite different for the 18 women who had also had their ovaries removed. Only one woman felt that her sex life was better. Another woman felt it was better but attributed that situation to a new and better relationship. Another woman didn't notice much change.

By far, most women who had had their ovaries removed experienced a decrease in their libido (sex drive or interest), the quantity or quality of their orgasms, or both. Fifteen women fell into this category. Although estrogen hormone pills helped one woman, most did not find any change in their libido with estrogen therapy.

A couple of women had tried taking testosterone, the male sex hormone, which can increase libido. They felt that it helped, although the result wasn't the same as it used to be. One had no problems with side effects, although it took some experimenting to find the right dose. Another didn't have any problems until after using testosterone for five years, when she noticed a slight increase in facial hair.

I thought that one woman's story was particularly telling. After a hysterectomy, she experienced no change in her sex life. Then, she had one ovary removed for endometriosis, again with no change. But when she had the other ovary removed for endometriosis two years later, she noticed a definite decrease in her libido.

Other women had a lot to say, especially on the lack of counseling about surgery's possible effects on their sex life. Many of these comments came from women in stable, happy marriages who had had enjoyable sex lives before their ovaries were removed. In many cases, the ovaries were removed not because of any disease but as an incidental procedure to the hysterectomy in order to avoid the small risk of ovarian cancer in the future.

Here are samples of the comments I received:

* "I wonder if this lack of sexual desire might be studied more carefully by researchers if males were castrated as often as women. I think far too many doctors still think it's all in our minds! I pleaded with my surgeon not to remove my ovaries unless it was absolutely necessary (because I do enjoy sex and had heard about this possible loss of sex drive). I trusted her judgment completely. However, I'd give anything to have those ovaries back! I can still have an orgasm but not with the intensity that I had before the hysterectomy. Good luck with your informal survey. I have a suspicion that in about 20 years we'll look back and consider the removal of ovaries barbaric. Hopefully, there will be more information about hormonal treatment for women after hysterectomy."

* "Perhaps the loss of sexual response is not such a major thing for all women, but it was for me. What had been a vivid, frequent, reliable Technicolor sexual experience for me was now in black and white, and fast fading to gray."

* "No one told me about this {decrease in sexual pleasure} before the surgery! How can they do this? All of the pre-surgery literature suggests that after the hysterectomy, everything should be fine -- in fact, that sexual pleasure might increase. Or they suggest that any decrease in sexual pleasure is due to unresolved fears of being 'unwomanly' because of the loss of childbearing capacity. This leaves women like me to feel not only asexual, but crazy!"

* "I think that it is virtually criminal that women are not warned that this {decrease in sexual drive} is a possibility. Can you imagine not warning a man before prostate surgery that there may be a chance of loss of sexual function?"

* "Since my own experiences, I have talked with perhaps five or six women who have had hysterectomies with their ovaries removed, some married and some single. They all say the same thing: If we had to do it over again, we wouldn't have our ovaries removed. We have all had decreasing sex drives and lives because of the removal of our ovaries. We don't care what doctors think or relate to us; we know what we experience and they don't."

Personally, I believe that the argument for routinely removing the ovaries at the time of hysterectomy is not justified. At the least, women should make the decision after a discussion of the pros and cons, including possible effects on sexual function. The risk of future cancer is low, and the ovaries serve a useful purpose. Women with a family history of ovarian cancer fall into a different category, and they should discuss their options with their doctor.

For more information, contact the Hysterectomy Educational Resources and Services (HERS) Foundation, 422 Bryn Mawr Ave., Bala Cynwyd, Pa., 19004; 215-667-7757.

Jay Siwek, a family physician from Georgetown University, practices at the Fort Lincoln Family Medicine Center and Providence Hospital in Northeast Washington.

Consultation is a health education column and is not a substitute for medical advice from your physician.

Send questions to Consultation, Health Section, The Washington Post, 1150 15th St. NW, Washington, D.C. 20071. Questions cannot be answered individually.