Pelvic organ prolapse and sex

Prolapse can be an issue for women at any life stage, but often begins after pregnancy and birth.

As women move into menopause and lose oestrogen and androgens in the tissues supporting their pelvic organs, they can find the prolapse becomes more of a problem.

The changes that lead to prolapse also affect sexuality, and we know that women with pelvic organ prolapses can have changes in their sex lives for a number of reasons – some functional (bladder leaks, loss of sensation, weaker orgasm, for example) and some due to the impact of prolapse on their body confidence, self esteem, and ability to stay in the moment during sex. There are also relational impacts.

In short, prolapse is (another) biopsychosocial issue!

What is a Pelvic Organ Prolapse?

The bladder, bowel, and womb – can move from their usual position in the pelvis and into the vaginal space.

Prolapses vary in severity, from mild to severe. Women may have bulges of the front or back wall of the vagina, or the cervix and womb can descend towards the vaginal opening.

In the most severe prolapses, the pelvic organs can be visible beyond the vaginal opening.

How does this affect sexuality?

The evidence suggests pelvic organ prolapse has a significant impact.

Pelvic organ prolapse reduces sexual satisfaction

Women may experience decreased sexual arousal, infrequent orgasm and pain with sex.

Women also report an impact on body image, leading to reduced initiation of sex and lower self esteem and sexual satisfaction.

Confidence can be affected

In a 2022 qualitative study, women reported reduced confidence in body shape and genital attractiveness

“I don’t like my body & I don’t like my husband to see me naked”

Pain and urine leakage can be an issue

Emptying the bladder before intimacy can help.

Position changes can improve sexual pain.

Prolapse repair surgery improves sexual function

A review of the evidence shows surgical repair improves sexual function scores.

Pelvic floor exercise is important in the prevention of prolapse, and improving bladder leak and orgasm quality.

Prevention of prolapse is important

Maintaining and exercising your pelvic floor muscles is key: especially after pregnancy and at menopause.

Local vaginal oestrogen at menopause is important in protecting pelvic tissues, bladder and sexual health and function!

Prevention is key, and we take a proactive approach at Spiced Pear at every life stage. We also work with the expert womens health physios at @TenHealthFitness to support women in optimising their pelvic floor function.

If you are affected by any of the issues in this post, please get in touch for support and treatment.