"Is it safe to have sex with a prolapse?"
Short Answer: heck yeah!

"Does sex cause a prolapse?"
Short answer: nope

"How can I make sex with a prolapse more comfortable?"
Short answer: breath, position and connection

A little bit ago we talked ALL about postpartum sex and a few people reached out asking about sex with a prolapse. So….here we go! (Previous blogs here and here)

First, let's address some common fears around both sex with a prolapse. This is an important step because when you have the capacity to acknowledge your fears you can take the next steps to overcome them.

Can sex cause a prolapse?

The main organs that can prolapse are the vagina, uterus and cervix, bladder and rectum. These organs are muscular and they can move, grow, squish and shrink. Usually when you have sex these parts will simply move out of the way to create more space so you can have sex! Great news here, sex will NOT cause a prolapse. In fact, sex will not damage any of the organs so your bladder, uterus and rectum are safe! Furthermore, sex will NOT cause these organs to fall out.

Will sex cause my prolapse to worsen?

Having sex usually does not cause the a prolapse grade to worsen! Unfortunately there are two "catches" here where you may notice increased symptoms.

The first catch is that some people notice a change in symptoms... increased pressure or heaviness like there's a tampon stuck between their legs. In these cases, the changes you notice are usually related to two things- your breathing and/or position. If this is you, these are addressed later on in more detail!

Now, here's the second "catch" so I want to make sure we address this as well. This is the case if you have a prolapse AND a decrease in estrogen (signs of this include vulvar and vaginal dryness, thinning, pale or shiny color, discharge and pain around the opening…this often can cause itchiness as well) or vulvar lichen (which appears like patches of white skin that's thickened and crinkly). In these instances, there is an increased risk of irritation in general. It doesn't inherently mean your prolapse is worse but you may experience more pain and discomfort. 

Benefits of sex with a prolapse

The benefits of sex with a prolapse include the benefits of an orgasm…which are actually quite abundant! Orgasms naturally increase blood flow to the pelvic region. When you have an orgasm you are not only increasing blood flow but also increasing oxygen and a bunch of amazing hormones to the tissue which is an important part of healing! 

Orgasms also help release a cascade of feel-good hormones. This includes oxytocin, or the love hormone, which helps you feel attachment and love. Dopamine is also released which helps you feel pleasure, reward and desire. Endorphins are released to naturally increase your pain relief and decrease your stress. Serotonin is also relaxed to help your mood, appetite and sleep. Finally, Prolactin is released which helps boost your bonding and satisfaction with sex and orgasm. All of this to say that the hormones released during an orgasm can help you physically and emotionally feel better, decrease pain, feel more rested and help you feel more connected to your partner and self. If you’re looking for the sex-education on female orgasms you wish you received (because knowledge is power), then the people over at School Of Squirt are what you are looking for as they are a wonderful resource on all things female orgasm.

Risks of sex with a prolapse

These were addressed earlier on, but the risk of having sex with a prolapse is nominal. That risk increases if your tissues need more estrogen or if there are other conditions in addition to the prolapse (lichen plants, lichen sclerosus).

3 ways to Improve Sex with a Prolapse

Are certain positions better for sex with a prolapse?

If you Google "best positions for sex with a prolapse" you'll find a dozen different answers. That's because each of us are a different human and we experience prolapse differently. One key I hope you remember is that your organs are squishy and can move to make room for sex so your prolapse may feel more comfortable in certain positions than someone elses because your tissues and organs squish differently. Also, if you're not used to exploring other sex positions, this is a great guide to help you learn by Vanessa Marin, a sex therapist.

The following are a few guidelines you can consider when having sex with a prolapse:

• Sex in the upright position may be a little uncomfortable as gravity pulls the organs downward and can increase awareness to the prolapse. If that's the case, simply try a different position where gravity isn't going straight down (missionary, doggy, side-lying).

• If you have an anterior prolapse (cystocele or uterine prolapse) you may notice an increase in symptoms any time you are on your back. Positions that may be more comfortable for an anterior prolapse are doggy style, pretzel dip, flatiron, leap frog

• If you have a posterior prolapse (rectocele) you may notice increased pressure if you are face-down thanks to gravity. You may enjoy missionary, corkscrew, 69, G-whiz

• It's pretty common (and normal) for a prolapse to be more noticeable at the end of the day due to fatigue and endurance. If this is you, don't hesitate to try and have sex earlier in the day! Remember, sex can happen at any time!

• If you feel like during sex your pelvic floor gets tired or prolapse symptoms become more noticeable, you can prop your butt up with a pillow to help gravity gently pull the organs to their homes by reducing the prolapse. This can include propping up in missionary, leap frog, or flatiron

Prolapse, Breath and Sex

If you notice an increase in symptoms after having sex it may be because you are bearing down during sex. Think of a time you were really constipated and just wanted to poop. Do you remember pushing, trying to get the poop to come out so you could feel better? That forceful straining or pushing is called "bearing down" and happens when you use the breath to push downward into the pelvic floor. While it's not uncommon to occasionally need to bear down, it can increase prolapse symptoms if it becomes a regular habit. 

One way you can help this is to practice your 360 degree breathing. Take a deep breath in and allow your lower ribs to move down and out your abdomen go out outward, your pelvic floor gently move downward and your low back to expand with air. This 360 degree breathing is a great way to decrease the downward pressure caused by bearing down. If you're not sure if you are bearing down you can schedule a consult with a pelvic floor rehab provider or check out "What's Going on Down There" and find out for yourself.

De-Stress during Sex 

This one looks different for everyone but my hope is that you can connect with your partner physically, emotionally and mentally. On the physical side, if you are stressed during sex you probably notice increased symptoms afterwards. This can be because the muscles of your pelvic floor (and possibly even your inner thighs, butt or abdomen) were working overtime. If your muscles are working too hard they can become "tight" or "hypertonic" which can cause prolapse symptoms to increase. 

On the other hand, if you're struggling to connect emotionally/mentally, I highly recommend working with a sex counselor from AASECT. Sometimes there are other emotional barrier barriers that prevent you from being able to connect with your partner and a sex counselor can help you navigate those so you can reconnect and enjoy having intercourse.

If you're ready to take back control of your pelvic floor and life, I'd love for you to join me for a discovery call for Rediscover Down Under- a program to help you reconnect, nourish and grow with a prolapse.