Some people are completely unaware of their prolapse and have no problems with intimacy. In contrast, others with POP can experience a significant impact on intimate relationships with a partner or potential partner.
The physical symptoms of POP, such as pain and incontinence, may impact sexual activity or sexual desire. This in turn can impact one's emotional wellbeing, self-confidence, and connection with their partner.
Having open conversations with a partner can allow them to understand your symptoms, needs and boundaries when it comes to intimacy and reduces any frustration, shame and miscommunication that may be experienced.
It’s okay to feel overwhelmed or unsure where to start these conversations with a partner, particularly if you have a new sexual partner.
Ways to explore the topic with your partner
Partners may feel reluctant to engage in sex due to fear of causing you pain or discomfort.
Most people who have anterior vaginal wall prolapse (bladder) or posterior vaginal wall prolapse (bowel) do not experience any pain with intercourse and are not bothered by their symptoms. Letting your partner know which symptoms you have and which positions are comfortable for you can alleviate these concerns.
You may be concerned that your partner can “feel” the prolapse during intercourse.
The vaginal wall is flexible and mobile, meaning that a mild to moderate protrusion can be easily moved with penetration and isn’t felt by a partner’s penis. This can be an important thing for both partner’s to discuss, as it can reassure each other if there is no discomfort or change in sensation felt.
Letting your partner know that vaginal intercourse is very unlikely to worsen vaginal prolapse
It can again reduce fear and hesitancy around intimacy and intercourse.
Be honest and open with your partner about steps you may need to take to reduce your risk of leaking.
Some people may experience urinary or fecal incontinence as a result of their prolapse. This can create fear of leaking during sex and reduce sexual function. Be honest and share the steps to avoid it - such as emptying your bladder or bowels before sex (including use of splinting). If both partners are prepared and aware of the likelihood of coital incontinence occurring, it can be easily managed and lead to being more relaxed and comfortable with intimacy.
Be open with your partner about what feels good or improves sensation.
As with any aspect of sexual intimacy, being open can help to improve the experience for both partners.
Tips that may improve sexual function with POP
Lubrication. Good lubrication can reduce physical discomfort and help promote pleasurable sensations. Prolapse is associated with thinning of the vaginal walls so lubrication can improve comfort as well as arousal. Use the best lubricant ingredients for your vaginal health (oil and petroleum-based lubricants can contribute to vaginal infection).
Preparing for intercourse/foreplay. Consider your own needs and enjoyment, not only those of your partner. Try to stay in the moment by focusing your attention on foreplay, physical sensations and/or closeness rather than negative self-talk where possible. Slow deep breathing can help you relax your body including your pelvic floor muscles.
Non-Penetrative sex. As most POP does not protrude outside of the vagina, there is no change to external or clitoral sensation with POP. Communicate with your partner about what other forms of sex or touch may feel best for you.
Positioning for sex. Particularly with uterine prolapse (descent of the uterus and cervix down into the vaginal canal), some positions may be uncomfortable. Side lying positions may be more comfortable for penetrative sex, but ultimately communicating with your partner about which positions are comfortable and pleasurable for you is the best way to reduce stress and discomfort around sex.
Note: If you have had gynaecological repair surgery, check with your surgeon as to when you can have intercourse. Due to pain and discomfort after major surgery, there is often a reluctance (from both partners) to resume intercourse. It can take up to 8 weeks for the pain to disappear. If there is ongoing chronic pain you should see a specialist.
It is helpful to remember you are not alone in your POP journey. Reach out to online support groups of other women with POP, or seek professional help if you feel it is impacting your relationship or wellbeing. Finding someone you trust and feel able to talk to about this topic can often be the first step to getting help. In our experience a good women’s health physiotherapist can often be the starting point. However, further help from a couples counsellor or sex therapist may be useful.