Pelvic Organ Prolapse: No One Talks About This Physical and Sexual Dysfunction Affecting Millions of Women—And Others—Worldwide

Pelvic organ prolapses (POP) aren’t sexy, but it’s vital to talk about these pelvic floor disorders as they affect the sexual health and enjoyment of countless human beings. POP and its symptoms can affect a person’s body image and confidence, sexual behavior and response, sexual comfort and function. Many people, and their partners, suffer as a result.

Cis-gender women constitute the largest population suffering  from uterine (uterus), cystocele (bladder), and/or rectocele (rectal) prolapses (though people of other genders can also experience organ prolapses). (There are five kinds of prolapse in all.) Those who suffer from such changes in anatomy often feel baffled, uncomfortable and ashamed of their bodies; thus becoming reluctant to engage in sexual intercourse because of pelvic pain or embarrassment. Prolapses will eventually present as bulges in or around the entrance to the vagina as the pelvic floor support weakens, and most sexuality professionals know that body image issues can inhibit sexual enjoyment. To make matters worse, urinary stress incontinence and fecal incontinence are among the other distressing symptoms affecting people with POP. Such symptoms increase the difficulty of talking about pelvic organ prolapses, even with a long-term partner or a doctor. A severely prolapsed uterus, one that is leaving the vagina almost entirely, can be a life-threatening medical emergency, but POP patients seldom receive this warning. 

According to a study published in the British Medical Journal (Barber, 2016), the common risk factors are “vaginal childbirth, advancing age, increasing body mass index,  and prior hysterectomy.” Trans women who have had a vaginoplasty are also at risk, as are trans men who have had hysterectomies. Many POP patients are over the age of fifty, and some are quite elderly. It’s common knowledge that women and the elderly, as well as transgender people, often get short shrift from the medical profession, especially when it comes addressing quality of life concerns such as sexual health and enjoyment.

The same British Medical Journal study estimated that between 30-70% of “women presenting for routine gynecological care” and about “1 in 12 women” living in the UK are afflicted with pelvic organ prolapses (Barber, 2016). Studies from other countries also show high incidence. So while I claimed that “no one” talks about pelvic organ prolapse, I should clarify that there is a lot of conversation taking place in medical and surgical journals, and among medical and surgical professionals, particularly urogynecologists and pelvic floor therapists. I’ve personally downloaded and collected over a hundred English-language studies and abstracts—just a fraction of what’s out there. However, these studies and their results are seldom published in human sexuality and sex therapy journals. Therefore, few sex therapists and sex counselors and educators have much awareness or knowledge of POP and how it can affect a person’s sex life. 

Treatment for the varieties of POP range from pelvic floor therapy, pessary use, and various forms of surgery.  Surgeries, however, can cause nerve damage and a decrease in sexual sensation and pleasure. Surgical recovery often ranges from six to eight weeks, at best. Mothers with young children have a particularly rough time recovering from POP surgery, as lifting over 5-10 lbs. is prohibited during recovery. Post-surgical effects can also be troublesome (or not). Some surgeries need to be repeated in a few years. Plus, the artificial mesh used in many POP surgeries has now been recalled by the U.S. Food and Drug Administration. As for pessaries, which are inserted into the vagina to hold organs in place, they work very well for some people as an alternative or precursor to surgery, but they can cause lesions in the vagina and other side effects. All pessary use should be medically monitored. On the bright side, pelvic floor therapy can be wonderfully effective for many and should be a first treatment consideration whenever possible. (Go to https://pelvicguru.com - a wonderful website!)

Obviously, this short article cannot cover all the pertinent issues regarding POP treatments, so please do some additional research.

What Human Sexuality Counselors, Sexologists, and Sex Therapists DON’T Know about Pelvic Organ Prolapses

I am sorry to say this, but human sexuality professionals–myself included–have neglected this topic, probably because their (my) own education did not include much, if anything, about it. I can also make this claim after scouring all my relevant human sexuality books for mentions of anything that could be related to POP, especially its impact on sexuality. From Kinsey’s research into Sexual Behavior in the Human Female (1953) to much more recent sex therapy and sexual self-help books and websites, there isn’t much at all. What there is, is piecemeal. And I’ve been amused by what makes it into such books instead.

For example, Albert Kinsey’s 1953 book, Sexual Behavior in the Human Female, doesn’t mention prolapses, urinary incontinence, or painful intercourse, but it does contain a reference to the ancient Roman poet, Catullus (in a footnote to do with “petting”). The eleventh edition of Our Sexuality, a college textbook by Robert Crooks and Karla Baur (2011) doesn’t mention prolapses per se, though it does mention intercourse pain due to torn “ligaments that hold the uterus in the pelvic cavity.” Though other references to POP are absent, Our Sexuality does mention the necrophiliac formerly known as Jeffrey Dahmer but I’m not sure how this is helpful. Another textbook, Human Sexuality, authored by Masters, Johnson, and Kolodny (1995), doesn’t mention anything resembling a prolapse at all, but at least I can find entries for “shingles,” “Buddhism,” and “castration anxiety.” 

More up to date authors of books on human sexuality, including those which focus on “women’s sexuality” and “sex after fifty,” also neglect to mention pelvic organ prolapses though symptoms such as pain and incontinence may be addressed in passing. This means that POP patients, and their partners, cannot find much to assist them with their specific sexual function and relationship questions. 

Sex therapists, counselors, and educators could assist this underserved and very large group of potential clients by (1) including discussions of pelvic organ prolapses in subsequent editions of their books, revised websites, and workshops; (2) linking such topics as “sex without intercourse” (e.g. outercourse), suitable sex toys (e.g. clitoral stimulation vs. penetrative toys), sex positions and options, body image issues, pain, sexual communication, and other adult sex ed staples to POP, so that POP patients can easily find this topic in indexes, chapter headings, and website blogs and pages. This professional community can also communicate with organizations of medical professionals, such as the American Urogynecologic Society, to suggest and recommend sex-positive language in their informational handouts and to include sexuality professionals in their links for patients.

I am a POP patient myself, and even though I am a sexuality professional, this journey continues to be immensely frustrating. I have my own questions and concerns and I know from spending time in social media support groups that other POP patients also struggle with a lack of information and even basic respect for their concerns. Many have given up sex and cannot even tell their partners why. The need for good adult sex ed on this topic, including sexual communication and sexual strategies (including the option of moving away from intercourse-centric intimacy, if needed), is staggering. Partners of POP patients also need support and education. 

There is an immense amount to say on the topic of POP, and in future TickleLife articles I’ll cover more of the specifics. For more information about POP, please go to my webpage. I have a downloadable study list and links to handouts and websites. I add resources as I find them. Check in frequently.

If you have or suspect you have a pelvic floor disorder, if things have changed “down there” remember you are not alone. Millions of women and people of other genders are also suffering. The key to ending that suffering is to get the best possible information you can about your own condition, the exact extent and nature of your prolapses, the range of treatment options, and information about strategies that will enable you to continue to enjoy your sex life.

Photo by Alexander Grey on Unsplash