The word prolapse, for many women, conjures up terrifying images of their internal organs falling out.
And the thought of having sex with a prolapse can seem inconceivable. Can sex and prolapse go together?
While severe prolapse can involve the involved organ coming quite a distance out of the vagina, most cases of prolapse are much milder. Prolapse is the technical term used for any stage of the organ (whether bladder, uterus or rectum) moving out of its anatomical position. This is evaluated by a gynaecologist or pelvic floor physio. If you have a minor bulge of the bladder into the vagina, it is still technically a prolapse. And by this, the correct definition:
75% of women who’ve ever had a baby will have a prolapse – that’s a clear majority!
It is often very distressing for a woman to discover she has a prolapse. Aside from the fears for the future – will this get worse? Are things going to come out completely? – it is a more personal, and therefore potentially distressing, area to experience a problem – much more so than your elbow, for example. And due to the intimacy of sex, in no part of the body is a problem more of a shared problem than the vagina.
So the natural question is: can I still have sex? Is sex going to be different? Will it cause damage?
Well, the research does suggest that sex with a prolapse is different. Women with prolapse tend to score higher on sexual dysfunction scores. This may sound depressing – but keep in mind these scores are self-report questionnaires, which describe a woman’s take on her experience of sex. So women with prolapse don’t find sex as satisfying or problem-free. And interestingly, this doesn’t always depend on how bad the prolapse is, but rather, just depends on the existence of prolapse, full-stop.
That said, advanced prolapse (stage III or IV, which describe the organ coming out of the entrance of the vagina) tends to negatively affect sexual self-image, especially in elderly women. Surgery for prolapse has been shown to improve sexual function.
However, other research shows that this mainly has to do with two things: firstly, the woman’s body image, and secondly, how bothered she is by her prolapse in general. Both of these things are very subjective, so it’s likely that by changing the way you view the prolapse as a problem, and nourishing your self-image and in particular your sexual self-image, you have the power to change this.
And thankfully, there is no evidence that prolapse is more likely – or that existing prolapse worsens – with consensual sexual intercourse, if surgery has not recently occurred.
So if you have a prolapse and are feeling awkward about sex and prolapse – you’re not alone. But be assured there are ways of working around it – and it is not harmful in the least. There is no reason sex and prolapse can’t be good bedfellows!
See your pelvic floor physiotherapist for help.