Pelvic organ prolapse, sex & pain
Can you have good sex with prolapse? Heck yes! You can have GREAT sex! Considering how common prolapse is, could you imagine if everyone with prolapse could no longer experience great pleasure? No way!
Tap the questions below to read my responses to these very common questions:
Why does sex hurt? What can I do? (including 6 rules to minimize painful sex)
Psst: If you haven’t checked out my Complete Guide to Pelvic Organ Prolapse, click to read my Blog - Pelvic Organ Prolapse: Your Top 10 Questions Answered.
Does prolapse affect sexual intimacy and intercourse?
Prolapse itself may not directly cause intimacy issues, but it can be a contributing factor. Many people with prolapse hold fear, anxiety and shame around the prolapse. They feel guilty like they somehow caused it (reminder: you didn’t cause your prolapse!) or that their body is broken (reminder: your body is not broken!). Not only can stress and anxiety kill your libido, it can also cause inadvertent clenching and tensing of your pelvic floor, which can then increase pain and discomfort during arousal and intercourse!
It’s been shown that people with prolapse who also experience urinary incontinence, can experience difficulty achieving orgasm, decreased libido and decreased sexual excitement.¹
5 ways prolapse indirectly impacts intimacy: B-R-I-S-M
Body image: concerns about what things look or feel like down there, feeling like you no longer deserve pleasure
Relationship changes: lack of communication, feeling judged by your partner for body changes, not receiving the care or touch you seek, feeling resentful about what you’ve had to go through.
Intercourse-focus: assuming that sex can only mean intercourse, feeling like sex is a failure if intercourse hasn’t happened or if you haven’t orgasmed
Stress: lack of rest, lack of sleep, a new baby to care for, less time to yourself, low libido
Mental health: Mental and emotional trauma or distress from a birth that didn’t go as planned, anxiety about the future
Is it safe to have sex with prolapse?
Yes! Sexual intercourse is actually beneficial for people with prolapse! More blood flow down there is good for healing. Not to mention, orgasms can do a world of good for your cortisol and stress levels! Orgasms also help to strengthen the pelvic floor, which is a great thing! A 2022 study shows that orgasms, through solo or partnered play, can improve postpartum pelvic floor strength when compared to doing Kegels alone.²
Remember too, if you’re feeling discomfort, pain or aren’t ready for penetrative sex, there is a world of sexual play and pleasure that doesn’t involve intercourse.
I’m worried my partner(s) will feel my prolapse
Unless your partner(s) is a pelvic physiotherapist or a gynecologist, they probably won’t even notice! Their finger, penis or a toy will just push the prolapsing soft tissues out of the way. Of course there are ways to prepare your body to receive pleasure, and this can include warm-up exercises, stretches and mobility exercises, as well as intentional positioning.
Grab the replay of my Reclaim your Pleasure workshop to learn the exact moves and tips to relax your tense pelvic floor, improve your arousal and have pleasurable sex and penetration!
Why does sex hurt? What can I do?
Many folks subconsciously contract their pelvic floors in an attempt to prevent further descent of their pelvic organs. Clenching your pelvic floor all the time doesn’t actually prevent anything from slipping out (don’t worry, your organs won’t end up on the floor!). If anything, the constant clenching actually increases symptoms of heaviness, and can cause the development of trigger points and pain in the pelvic floor. It’s often not the prolapse itself that’s painful, but it’s the tight, tense, and hyperactive pelvic floor muscles that cause pain.
People with prolapse may also have scars from episiotomies, tearing during birth and/or surgeries, which can also cause pain. Intercourse may be painful for people with prolapse for these reasons.
6 rules to minimize painful sex after prolapse:
Redefine sex. Sex doesn’t have to be intercourse. Sex can be cuddling, oral sex, manual stimulation or use of a toy. Take the pressure off and redefine what “successful sex” means to you. It doesn’t have to mean intercourse! Focus on a pleasure-full experience rather than just a penetrative experience.
Ensure that you feel ready. Communicate with your partner(s) on your needs. Let them know if something feels uncomfortable and what you need to make it feel better, e.g., less penetration, more oral?
Ensure adequate foreplay - aim for at least 30 minutes, and this can include a full body massage, kissing, snuggling, a bath together, rubbing oil over each other. Avoid touching the pelvic area until you’re thoroughly aroused.
Use lube! When you’re postpartum, fatigued, sleep-deprived or dehydrated, you may feel extra dry down there. When breastfeeding or chestfeeding, the lower levels of estrogen may also contribute to more dryness and vaginal thinning and atrophy. This is also common as we age and get closer to menopause. Use plenty of lube and make sure to adhere to the foreplay rule above.
Choose positions that don’t hurt! (see below!)
Seek assistance from a pelvic floor physiotherapist! We can help you mobilize, stretch and strengthen your pelvic floor and body so that sex feels more pleasurable! Orgasms strengthen your pelvic floor, and a strong pelvic floor also helps with better orgasms. Before you rush into doing all the Kegels (this may make your prolapse symptoms worse!), work with me one-on-one or try one of my workshops below:
Buy Reclaim your Pleasure workshop recording to boost pleasure, release tension and shame.
Buy Pelvic Strength workshop recording to improve sexual stamina and strengthen pelvic floor beyond Kegels.
What sex positions are best for prolapse?
Short answer: whatever feels good for you. Always try different positions to see which feels the best and most pleasurable. Avoid trying just one position and then giving up because it hurts. Your postpartum body may feel different and you may be lacking core and glute (butt) strength that is necessary for certain sex positions. So don’t just go off what felt good before you had kids, go by what feels good for your body right now.
While there is no magical position that will feel good for everyone, in general, positions that are anti-gravity may feel worse. So you may want to avoid cowgirl and reverse cowgirl to start with since they require you to be more upright and they require more exertion in general (not so easy when you’re still recovering postpartum!).
These sex positions may feel great for anyone with prolapse, pelvic pain or recovering postpartum:
missionary or modified missionary: placing a small pillow or folded towel underneath your hips to elevate your pelvis. This can reduce stress on your prolapse.
side-lying: this can give you great control over depth, and provide support for your body and pelvis. If one side doesn’t feel good, don’t forget to try the other side. Depending on where you’re holding tension in your pelvic floor, one side may feel better than the other.
doggy style or hands and knees: support your body with pillows and have that butt up high in the air, with your head down. This inversion can be helpful for those with prolapse, and can also help you create more relaxation in the pelvic floor muscles. This may not feel as good for those with a rectocele.³
How can I fix my prolapse?
Rather than looking to “fix” your prolapse itself (which may not be possible with conservative management), focus on reducing symptoms, and improving your strength, flexibility and mobility. Though the grading of prolapse may not change a lot, we want the prolapse itself to impact you less. You want to be able to have the sex you want, jump on the trampoline with your kids if you want, and go running if you want.
If you want support improving your prolapse symptoms, getting active and gaining strength, reserve your virtual pelvic physiotherapy session below.
Resources:
Purchase the replay to my Reclaim your Pleasure workshop to release excess tension, shame and welcome in more pleasure!
Purchase the replay to my Pelvic Strength workshop to learn how to strengthen your pelvic floor for better sex, intimacy and stamina.
Want 1:1 support? Click here to book with Surabhi
Click to read Blog: Prolapse: Your Top 10 Questions Answered
References:
Ozel et al. (2006) The impact of pelvic organ prolapse on sexual function in women with urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. doi: 10.1007/s00192-005-1327-0. Epub 2005 Jun 22. Accessed from: https://pubmed.ncbi.nlm.nih.gov/15971004/
Bhat GS, Shastry A. Sexually Induced Orgasm to Improve Postpartum Pelvic Floor Muscle Strength and Sexual Function in Primiparous Women After Vaginal Delivery: A Prospective Randomized Two-Arm Study. J Sex Med. 2022 Nov;19(11):1634-1643. doi: 10.1016/j.jsxm.2022.08.189. Epub 2022 Sep 25. PMID: 36167664.
Toronto Pessary Clinic: https://torontopessaryclinic.com/sex-and-pop/
