• Bladder and Pelvic Health
• Menopause
• Uniquely Female

Your Sex Life When Things Change “Down There”

Pelvic floor disorders and their link to sexual function continues to be a hot topic for researchers. For every study that finds a link, another study sheds uncertainty. What’s a woman to do?

Pelvic floor disorders are caused by a weakening of pelvic floor muscles and tissue, causing pelvic organs — including the uterus, bladder and rectum — to drop and put pressure on the vaginal walls. Urinary incontinence (leaking of urine) and title=pelvic organ prolapse;healthinfo=Pelvic Organ Prolapse (the dropping of female pelvic organs) can result.

Medical literature, while varied, does produce general agreement on the following:

• Surgery can correct physical symptoms, which in turn, may improve a woman’s body image, attitudes on sex and comfort levels surrounding sexual activity.
• A kaleidoscope of non-physical factors can contribute to overall sexual function and attitudes, such as age, menopause, body image, stress, relationships and general desire.
• The physical aspects of pelvic floor disorders themselves generally do not prevent sexual activity or orgasm.

How Do Pelvic Floor Disorders Impact Sex?

Technically, pelvic floor disorders do not prevent sexual activity, explains William Rush, MD, female pelvic medicine specialist with Lifestages-Samaritan Centers for Women, in Dayton, Ohio.

“Regular sexual activity can actually help alleviate symptoms by increasing core and pelvic strength,” although it will not improve the prolapse.

Most of Dr. Rush’s patients with pelvic floor disorders voice fears of hurting something or making a prolapse worse, and they often stop having sex or have it much less frequently. Dr. Rush alleviates these worries.

“It’s okay to remain sexually active. You’re not going to make it worse. You’re not going to harm anything. The tissues may appear to be in the way, but they should move out of the way in most situations.”

He continues, “Regular sexual activity can actually help alleviate symptoms by increasing core and pelvic strength,” although it will not improve the prolapse.

Still, the simple feeling that “things down there” don’t feel or work the way they used to can be sufficient cause for an impact on sexual function. The degree of impact can be affected by the severity of the pelvic floor issue and on personal attitudes and emotions surrounding sexual health, relationships and overall self-esteem.

A pelvic prolapse may impact a woman’s overall self-esteem and if unchecked, it can become her true self-image, explains Beth Esposito, MS, LPCC-S, LSW, chief of clinical operations with Samaritan Behavioral Health in Dayton, Ohio,

Restoring Intimacy and Sexual Satisfaction

If your pelvic floor disorder is affecting your sexual function, you might benefit from either surgical or non-surgical treatments. Often, the initial approach is to start with the least invasive treatment, which involves strengthening the pelvic floor muscles, possibly in combination with behavioral modification.

Esposito also offers these tips:  

• Share with your partner your view of self and any feelings of being undesirable. This can help reduce barriers to sexual intimacy.
• Allow vulnerability and honesty in conversations regarding sexual performance and self-perception.
• Share all your concerns – perceived or real – with your doctor or health care provider. This will help you develop a complete understanding that physically, you’re able to have sexual intimacy and that you can provide sexual gratification.
• Share your feelings with a trusted support person.
• Exercise. Feelings have to come out emotionally or physically, so providing any kind of outlet is vital to healing.
• If the above strategies don’t help, consider seeking brief therapy with a cognitive behavior therapist. Your thought patterns could be impacting your self-esteem and overall view of self.

Source: International Society for Sexual Medicine; Medscape; U.S. National Library of Medicine, National Institutes of Health; William Rush, MD, Lifestages-Samaritan Centers for Women; Beth Esposito, MS, LPCC-S, LSW, Samaritan Behavioral Health, Premier H

William J. Rush, MD

Lifestages Centers for Women

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Beth Esposito, MS, LPCC-S, LSW

President, Samaritan Behavioral Health