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Help! Fibroids Are Making Intimacy Painful
For some women, fibroids can mean heavy bleeding and uncomfortable sex
Kiersten Essenpreis
Here’s a surprising fact I just learned: Most women will develop uterine fibroids by the time they’re 70. Who knew this was a thing?
For most of us, fibroids aren’t usually a big deal and “no reason to freak out,” says ob-gyn Ana Cepin. Not so for this week’s questioner, who says it’s affecting her sex life. Our medical experts weigh in.
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How do I handle sex with uterine fibroids? It’s painful.
First, some context. Seventy percent of women will develop uterine fibroids by the time they’re 70, according to ob-gyn Ying X. Liu, who specializes in minimally invasive gynecologic surgery at GW Medical Faculty Associates in Washington, D.C. The figure is even higher for African Americans — 80 percent.
“A lot of women won’t know they have [fibroids] because they do not always cause symptoms,” Liu says.
But 25 percent of women with fibroids, like our “In the Mood” reader, will develop signs due to the size of the fibroid and its location in the uterus.
Liu says symptoms can include pain with sex, heavy bleeding during menstruation, constipation, a need to urinate more frequently, pelvic pressure and, less commonly, infertility.
What exactly are uterine fibroids? Fibroids are benign tumors made of smooth muscle cells that develop in the uterus, Liu says. They can be as small as 1 centimeter — the size of a pea — or as large as 10 to 20 centimeters — the size of an orange or a small cantaloupe.
Fibroids are affected by the hormones estrogen and progesterone, which mostly go unnoticed when they are at normal levels. Liu adds that typically in menopause, when those hormone levels are low, fibroids will decrease in size or stay stable, but will never go away.
Detection methods. Ob-gyn Maureen Slattery, who is associated with Rochester Regional Health in New York, says most uterine fibroids are found “incidentally” when a woman is examined by ultrasound for some other reason, like heavy vaginal bleeding. MRIs and CAT scans can also be used, she says, but the go-to diagnostic tool is ultrasound.
About that pain during sex… If the fibroids are large and in the back of the uterus, closer to the cervix or vagina, penetrative sex can be painful due to the friction and motion created by the penis during intercourse, says Liu, an associate professor at the George Washington School of Medicine & Health Sciences.
Change up sex positions. One possible remedy is to try different positions to see if the pain diminishes, says Boston Medical Center ob-gyn Matilde V. Hoffman, who is also an assistant professor of obstetrics and gynecology at Boston University. “Figure out: Is there one position that’s more uncomfortable than another?”
Hoffman says to communicate with your partner and help them understand exactly where it hurts — and to make adjustments accordingly. The questions you might discuss include: Is it painful at entry? With deep penetration? With foreplay — meaning any stimulation of the clitoris, labia, vulva or perineum? And what about pain when you use a vibrator?
One other tip: Use lubrication. “An important aspect of feeling more comfortable with sex can include the use of lubrication so that there’s less friction with the movement of the penis,” Hoffman says.
Consult a health care provider. Anyone experiencing painful intercourse — with fibroids or not — should consult a gynecologist who has sexual health or pelvic pain expertise, Slattery says.
“Our intimate life, with or without a partner, is important to discuss,” adds Hoffman.
A doctor can also rule out any other issues that could be contributing to your pain. “Pelvic pain is very complex and nuanced,” Hoffman says — noting that it could result from fibroids, endometriosis, age-related or menopausal changes, or gynecological lesions.
Study up on hysterectomies. Removing the uterus is the top option for postmenopausal women and women who don’t want a future pregnancy if the fibroids are large and intrusive (smaller fibroids don't usually require any intervention). That’s a better option than removing the fibroids individually, which can be a more significant surgery, says Cepin, an assistant professor of obstetrics and gynecology at Columbia University in New York City.
Depending on the size of the uterus and your surgical history, the procedure can be performed in a minimally invasive manner — either through laparoscopy or with robotic assistance — removing the uterus through small incisions in the abdomen, says Cepin, who also practices at Columbia University Irving Medical Center. And the recovery, she adds, is “fairly easy.”
Options for premenopausal women. For premenopausal women who may suffer from heavy vaginal bleeding or pain with sex, Liu says, there are three other interventions to consider:
- Radiofrequency ablation: a minor surgical procedure that can be done vaginally or abdominally. It uses ultrasound and a device that projects small needles that heat up the fibroid to destroy fibroid tissues, resulting in shrinkage.
- Uterine artery embolization: performed by an interventional radiologist who injects tiny particles called embolic agents into the blood vessels that supply the uterus. This blockage reduces blood flow to most of the uterus, alleviating heavy bleeding and shrinking fibroids.
- Myomectomy: surgery to remove the fibroids, recommended for women who desire future pregnancy. This can be done via the vagina or abdomen.
Become your best advocate. Physicians don’t get a lot of training in sexual health, but it’s important for patients to talk about intimacy issues with them, Hoffman says.
“The bottom line is, as a patient, you know yourself better than we ever will. You are your own advocate — so advocate,” Hoffman says. In other words, be very clear and precise with your doctor about how your body is feeling. “The best we can do is listen and then come up with a workup and treatment tailored to you.”
Do you have questions about sex or relationships as a 50-plus adult? Send them to sexafter50@aarp.org.
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