How to Keep Fibroids From Affecting Intimacy
The hard facts: Most women develop uterine fibroids at some point in their lives. Many will never experience any pain or symptoms from these non-cancerous growths that evolve from the muscle tissue of the uterus. But if uterine fibroids are making your sex life painful, you’re hardly alone. Because the fibroids can occur in different shapes and sizes, some may be more painful than others, especially during sex. What to do? We tapped OB/GYNs and a physical therapist for advice on everything from positioning to products to talking to your partner, to help you enjoy intimacy with UF.
“For those who experience pain, often it’s because fibroids are making the uterus bulky,” says Rachel Pope, M.D., an obstetrician and gynecologist at University Hospital Cleveland Medical Center in Ohio. Uterine fibroids can also move the uterus into a more retroverted position, she says, and the jostling associated with deep thrusting during sex can cause pain. Contractions of the uterus during orgasm may also cause pain in women with UF, says Los Angeles-based Sherry Ross, M.D., an OB/GYN and author of she-ology. “And if you know something’s going to be painful, it can decrease libido.”
The first step to more comfortable sex? Good communication. Start by bringing your partner to your next doc appointment. “So many patients come in on their own, but it’s really important to clue your partner in,” says Dr. Pope. “If it’s simply positioning during intercourse, the partner can make a big difference.” Open communication will help everyone realize that no one is at fault for the pain and encourage couples to find alternate positions that are more comfortable, agrees physical therapist Karen Connor, a certified pelvic rehabilitation practitioner at the University Hospital Cleveland Medical Center.
Nail the Timing
Fibroids can also make women’s menstrual flow especially heavy, and that, too, can lead to feelings of self-consciousness around intimacy. If you are having long, heavy periods and avoiding sex because of it, the amount of time each month when you feel OK about having sex is limited, Dr. Pope points out. In those situations, she often recommends birth control pills or an IUD, which should alleviate the bleeding. You can take birth control pills for three months with one week of placebo, limiting periods to four times per year, she says.
There are as many ways to have sex as there are pages in a book (thank you, Kama Sutra), so if one position is painful, try another. For instance, if you have a grapefruit-sized fibroid on top of the uterus that’s pushing on the bladder, the traditional missionary position with the woman on the bottom could be uncomfortable, Dr. Pope says. Having the partner with fibroids on top is often better because she can be in control of the speed and pace, she adds.
Too much body fat can boost estrogen levels, which makes it easier for fibroids to grow. Constipation can also make UF feel worse: “There’s only so much real estate there, so constipation when you have uterine fibroids can be a recipe for pain,” says Connor. In both cases, the discomfort can transfer over to sex. Your Rx? Eating a plant-based diet may help, Connor says, as can drinking plenty of water, stretching your hip flexor muscles, and propping your legs up on a stool when using the toilet.
A few simple tools can help women with uterine fibroids enjoy sex. For starters, use lube. If you’re feeling anxious about sex or anticipating pain, your body probably won’t create lubrication, says Dr. Pope, who recommends one that is simple silicone-based (or water-based if you’re using sex toys are having sex in the shower or tub). Another top tip? Try a pelvic wand—the device can ease muscle tightness and pain, Connor says. Another option: a penis buffer: “The male partner could put one on his penis so thrusting isn’t as deep,” Connor says.
After you’ve talked to your health care provider and your partner, record the details associated with any discomfort. “Keep track of when the pain is occurring with sex, what position it’s occurring in, whether it happens with orgasm, whether there’s bleeding after sex and how long it continues,” Ross advises. After three to six months, bring your journal to your appointment and talk to your doctor about patterns.
Since your pelvic floor works with the rest of your body, physical therapists experienced in this area may be able to help by showing you how to strengthen areas of weakness. “We can do internal work on patients, the same way we would do if you got a knot in your neck,” Connor says. A PT may also be able to guide you through deep breathing exercises that can help relax muscles that tend to clench in pain, Connor says. (Be sure to look for someone certified in pelvic rehabilitation.)
If adjustments to positions and trying new techniques isn’t providing pain relief, don’t give up. Medications and various procedures can shrink the fibroids or a hysterectomy can be performed to remove the uterus entirely. While surgery is usually the last resort for treatment of uterine fibroids, it does mean you’ll be able to return to a more comfortable sex life—or just life! “If it’s disruptive for sex, it’s probably disrupting other things, too,” Ross says. Talk with your doctor about options to consider.