Pelvic organ prolapse and sexuality

I see many women with newly discovered vaginal prolapse who report they are afraid to have sex because they fear it will cause damage or worsen their prolapse.  Alternatively, they may feel that the bulge makes them unattractive and for that reason become reluctant to have sex.  Certainly a vaginal bulge may be an unpleasant surprise, however, it is not typically an indication of danger.  An evaluation is appropriate, but unless accompanied by a worrisome sign like bleeding or pain, it is not a medical emergency.  Because prolapse is a result of the loss of support of the pelvic organs through any of a number of means (childbirth, menopause, inherited tendency/family history, prolonged cortisone use, smoking, chronic constipation, prolonged/frequent straining) it is often gradual at first, followed by a relative “sudden” increase in the severity of the prolapse.  Many women are completely unaware of it as it is not a painful condition, and typically symptoms only really begin when the ability to empty the bladder or bowel is affected or the tissue is hanging out far enough to become irritated.  Sometimes, pain can accompany prolapse due to urinary tract infections or a sensation of pressure, but the prolapse itself is only one component of that problem.

Sexuality is normal and healthy.  Although many medical conditions may make it more challenging to have sex, there are often workarounds that can help individuals and couples successfully enjoy sexuality.  I will post another blog later regarding sexuality and disability.

There are many misconceptions about prolapse and sexuality; this article is designed to help clear some of them up and perhaps get a dialog started on the subject.

First, intercourse does not cause prolapse, nor will it damage anything to have intercourse when uterine or vaginal wall prolapse is present.  As orgasm brings more blood flow to the area, it may help strengthen the tissues and encourage better and stronger collagen growth around the vagina.  That doesn’t mean it will cure prolapse, but it certainly won’t hurt!
Second, prolapse does not always worsen.  While progression of prolapse is common, it is also quite common to have it remain relatively unchanged for many years.
Third, having a pessary placed to treat prolapse does not automatically end the ability to have intercourse. While some pessaries may make intercourse difficult or impossible, there are several that are quite compatible with penetrative sex, notably the ring or dish types.  Since these are the most common pessaries used and are very similar to the diaphragm used for contraception, it is often possible to be able to continue to enjoy intercourse while the pessary remains in place.

Finally, as long as sex is not painful, is mutually enjoyable and comfortable, it can be enjoyed despite the presence of prolapse.  When there is a lack of desire, it should be addressed appropriately regardless of other medical conditions.  Furthermore, all medical conditions should be taken into account when reviewing both treatment of prolapse and issues with sexuality.  Please feel free to discuss this with your doctor.  If you are uncomfortable, please find a doctor with whom you feel comfortable discussing your concerns.  There is definitely help available!

Copyright Linda Kiley, MD, 2016

Author
Linda Kiley, MD Dr. Kiley is a Board Certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery, and is also Board Certified in general Obstetrics and Gynecology.

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