Pelvic organ prolapse (POP) and urinary incontinence can have many sexual repercussions for women. Recently, a team of European researchers described these problems in detail in the Journal of Sexual Medicine.
POP occurs when female pelvic organs drop and put pressure on the vaginal walls. Urinary incontinence (UI) refers to the loss of bladder control and leaking of urine. Both conditions can make women anxious about sex.
The authors explained that healthcare providers often do not consider themselves fully trained to treat sexual issues associated with POP and UI. Also, much research has focused on the quantitative aspects of sexual function for these women. The goal of this study was to add “meaning and context” to the current literature.
Thirty-seven women between the ages of 31 and 64 participated. Each woman was about to have corrective surgery for POP, UI, or both POP and UI. All participants were sexually active except one, who avoided sex because of her condition, but wanted to start again after surgery.
Each woman was interviewed face-to-face, responding to open-ended questions about how POP and/or UI affected them sexually. Questions focused on desire, arousal, orgasm, pain, satisfaction, body image, partners, and intimacy. Because of a recording error, one interview could not be used. Therefore, results were based on interviews with thirty-six women.
Seventeen percent of the women said their sex lives were satisfactory, with no problems from POP or UI. Thirty-nine percent rated their sex lives negatively and 44% indicated that their sex lives were fine overall, but that certain aspects were negative.
Most Commonly Affected Sexual Areas
• Body image. Women with POP described their vaginas negatively, using descriptors like “ugly” and “not normal.” Those with UI were anxious about using incontinence pads and emitting urine odor. Many women felt embarrassed, depressed, unattractive, or undesirable. They were also concerned about their partner’s experience. For example, some women with POP worried that a partner could feel the prolapse.
• Desire. Many women found themselves less motivated to have sex because they feared pain and felt awkward. Some rushed through sex; others avoided sex altogether.
• Arousal. Distraction, fear of pain, and difficulty relaxing could all contribute to diminished arousal.
• Orgasm. Some women had trouble reaching orgasm because they couldn’t relax or “let go.” Others found their orgasm less intense. Some didn’t allow themselves to reach orgasm because they feared incontinence.
• Pain. Women with POP were more likely to report discomfort or pain, which were mainly due to sexual position, the prolapse itself, or the fullness of their bladder.
The authors acknowledged that other factors, aside from POP and/or UI, could play a role in the women’s sexual problems. A partner’s sexual issues, relationship conflict, stress, and menopause could all be involved. “Despite the profound effect of POP and/or UI, the confounding effect of these factors should not be overlooked when assessing female sexual function,” the authors wrote.
They also noted ways that healthcare providers can help women with POP and/or UI by addressing sexual problems. Letting patients know that these conditions are common may help them gain confidence.
Resources
Johns Hopkins Medicine
“Pelvic Organ Prolapse”
(September 24, 2008)
http://www.hopkinsmedicine.org/news/publications/johns_hopkins_health/Fall_2008/pelvic_organ_prolapse
The Journal of Sexual Medicine
Roos, Anne-Marie, MD, MSc, et al.
“Pelvic Floor Dysfunction: Women’s Sexual Concerns Unraveled”
(Full-text. First published online: January 24, 2013)
http://onlinelibrary.wiley.com/doi/10.1111/jsm.12070/full