Recent studies conducted in the United Kingdom show that 33% to 46% of women report decreased sexual response after hysterectomy-oophorectomy. The prevailing theory in the United States for over 30 years in counseling women is that such decreases are infrequent and, if they do occur, are psychogenic. The postulates of the psychogenesis theory were examined and found no longer tenable in the light of current physiologic knowledge of female sexuality, which suggests that when sexual response is diminished after this surgery, hormonal changes (including ovarian androgens) and anatomic changes (removal of the cervix-uterus as a trigger for orgasm in some women) may be etiologic factors. The newer knowledge may now be utilized in counseling the one of four women who reaches menopause through surgery. In cases of decreased response, women may be helped by hormone replacement therapy and/or conjoint sex therapy.