Sexual Dysfunction and Pelvic Floor Disorders
Sexual dysfunction & pelvic floor disorders at a glance
- Women with disorders of the pelvic area may experience aspects of sexual dysfunction ranging from reluctance to engage in sexual intimacy to vaginal pain.
- Such sexual problems are generally caused by urinary control issues, the repositioning of pelvic organs or of tissue in the vagina, and loss of estrogen during menopause.
- Symptoms vary according to the cause, but fall into the areas of reduced sex drive, infrequent orgasm, decreased arousal, and pain from sexual intercourse.
- Treatments are aimed at the underlying pelvic disorder and may involve lifestyle changes, estrogen replacement therapy or surgery.
Causes & symptoms of sexual dysfunction from pelvic disorders
Female pelvic floor disorders include pelvic organ prolapse (POP) and urogenital atrophy (often associated with menopause), as well as other disorders that are often accompanied by urinary incontinence and fecal incontinence. Pelvic disorders and incontinence can cause some form of sexual dysfunction, either directly or indirectly due to physical changes.
It is important to note that mental health also plays a major role in a person’s sexuality and sexual drive. The awareness of problems in the pelvic area can affect a woman’s interest in having sex, as well as the physical satisfaction she derives from it.
Pelvic organ prolapse
POP occurs when a pelvic organ, such as the bladder or uterus, drops (prolapses) into the vaginal wall. This may result in:
- Widening of the vagina opening
- Bulging of the vagina
- Pressure in the vagina
- Increase in urinary tract infections
- The repositioning of tissue from the prolapsed organ into the vagina
- Tissue protruding from the vagina
Sexual dysfunction associated with pelvic organ prolapse can include distress and poor body image or confidence from these physical changes, decreasing a woman’s sexual drive, or libido.
The changes in the vagina may also result in diminished arousal, infrequent orgasm and pain during sexual intercourse (dyspareunia).
Urinary problems
Incomplete control of urinary function can be caused by pelvic floor disorders, pelvic organ prolapse, menopause, damage to the pelvic area or aging. Women who experience any form of urinary problems—such as stress incontinence, urge incontinence, or increased frequency—are naturally self-conscious when it comes to sex, because there is a chance they might urinate during intercourse. This can reduce libido, arousal and frequency of orgasm.
In one study, about 45 percent of women with urinary incontinence reported that it negatively affected their sexual activity. Those with overactive bladder were more likely to complain of vaginal pain during intercourse.
Fecal incontinence
Caused by pelvic floor disorders and other conditions, fecal incontinence is the diminished control of the bowels, resulting in the unintended release of stool, liquids or gas. As with urinary incontinence, such possibilities can negatively impact a woman’s enjoyment of sexual activity. Women who experience fecal incontinence are more likely to experience decreased libido and arousal, as well as have more difficulties with lubrication and orgasms, and pain during intercourse.
Urogenital atrophy
Urogenital atrophy is a wasting away of muscle mass and tissue in the vagina, vulva and urinary tract due to aging, menopause and its subsequent reduction of estrogen, or a combination of the two. Atrophy of the vagina and vulva can result in itching, dryness, bleeding and/or a narrowing or shrinkage of the vagina and vulva.
This can have a negative impact on a woman’s sex drive, arousal and ability to orgasm, as well as cause pain during intercourse. Urinary atrophy also results in various symptoms of urinary incontinence, which can add to problems with sexual function.
Treatments for pelvic disorder sexual dysfunction
Treatments are related to the cause of the particular pelvic disorder and range from exercises that strengthen pelvic floor muscles to surgery. It may be beneficial for a woman who is experiencing pelvic disorder symptoms to consult with a psychologist or other counseling professional to help minimize the negative effects that her health condition may have on her self-esteem and quality of life.
Pelvic organ prolapse treatments fall into five categories:
- Watchful waiting
- Physical therapy and behavior changes (exercises, diet, weight control)
- Insertion of a vaginal supporting device (pessary)
- Medications
- Surgery
Urinary incontinence and anal incontinence treatments include:
- Dietary changes
- Maintaining proper weight
- Exercises to increase pelvic floor muscle strength
- Bowel or bladder training
- Devices for the urethra and vagina to block or control urine flow
- Surgical treatments
Urogenital atrophy treatments include:
- Estrogen replacement therapy, primarily topical
- Exercises to increase pelvic floor muscle strength
- Bladder training