Sex, intimacy and relationships with urogynaecological conditions

This section covers:

  • Sex and intimacy
  • Changing roles in relationships
  • Understanding and support in relationships
  • Dating and new relationships

In this section we use the terms:
Pelvic organ prolapse (prolapse) is a condition in which pelvic organs, like the bladder and uterus (sometimes called the womb), move down or slip out of place and may bulge into the vagina.

Urinary incontinence is the unintentional loss of wee/urine. There are other bladder symptoms that do not involve incontinence, such as needing to urinate a lot, getting up at night a lot for a wee, or difficulties emptying the bladder.

UTIs (Urinary Tract Infections) are when bacteria infect the system that stores urine (such as the bladder). There are other types of conditions that can involve bladder irritation and pain, such as interstitial cystitis (also called bladder pain syndrome).

Dr. Matthew Izett-Kay, a consultant urogynaecologist, discusses the impact of urogynaecological conditions on people’s sex lives – a topic which healthcare professionals may ask about.

View profile

Bladder symptoms, prolapse, vaginal or bowel symptoms are obviously an intimate part of the body and when we’re talking about in, intimate parts of your health that then translates through to sex. Sex is of course a highly individualised process, so there’ll be patients that I see that aren’t sexually active, and have no interest in being sexually active, and it’s a very quick discussion and we move on. But of course for a lot of people sex is a really important part of day-day living, their interpersonal relationships, their self-identity, body image, and a lot of their pelvic floor disorders are tied into their sexual function. It’s a complicated area because having a satisfying sex life looks very different for different people. So one of my jobs is to explore with you what your sex life ideally would be like for you, and what it’s like at the moment.

They [urogynaecologists] may ask some quite difficult questions and if you don’t feel comfortable that’s fine, but the purpose of those quite intimate and personal questions is to try and identify where in the sort of sexual cycle your problems are lying, so that they can help signpost you and target your treatment towards a suitable professional or support service and to try and improve your wellbeing.

So through treating bladder symptoms, prolapse and bowel symptoms you may have some chats about sex, and sex life. So it might be that for example sexual intercourse is flaring up cystitis, or causing pain to worsen, so it might be that you come to an agreement with your clinician that that’s something that you pause for a while until you get on top of your symptoms. Sex maybe uncomfortable with your prolapse. Sex isn’t generally a risk factor or damaging to prolapse, incontinence or bladder and of course having satisfying sexual, your sex life is important for your wellbeing, so it’s very rare that we would say don’t have sex. Sex is generally safe with these problems. A lot of people ask about pessaries and sex and actually there’s some great research that shows that for most women with who have had a ring pessary that actually sex lives have improved with the pessary than they are without. So it’s absolutely fine to have sex with a ring pessary in situ, and some other forms of pessaries, but there will be certain types of pessaries where you can’t have intercourse because of the way they sit in the vagina. And so your clinician should discuss with you whether you’re sexually active and whether that pessary is suitable for you. There’ll be a group of patients that self-manage their pessaries, take them in and out and it maybe that you take your pessary in and out for intercourse because that feels right for you and your partner.

Embed Print Transcript

Sex and intimacy

Sex, intimacy and romantic relationships had been deeply affected by the experience of a urogynaecological condition for the people we interviewed. Jo, Jasmine, and Vickie felt physically different, which changed how they related to their bodies sexually. Jasmine worries that her vagina feels different or is “too big” now that she has given birth vaginally, which she fears may get worse if she has a second baby. Jane sympathises with young women struggling with problems with UTIs who may be unable to enjoy casual sex in the same way as others their age.

The impact could also be emotional, as it was for Sophie and Elly, who felt their confidence had been knocked. Eve felt less attractive, and Sophie thought the spontaneity had gone from her relationship with her partner. Clare found sexual intercourse painful and, although her husband was supportive and understanding, she was very worried about the effect that this would have on their relationship.

When Jeannie first had a ring pessary (a plastic or silicone device inserted into the vagina to support the tissues), she had bleeding and discharge which she says “doesn’t make you feel very sexy at all”.

And I think when I was first-, you know, when I was first diagnosed and I was first using the ring pessary, from that time, for about five years we didn’t have sex at all. And that was partly because, I think after the menopause I just wasn’t that interested anyway, partly that. I think, with the ring pessary, I didn’t know that you could get a lot of discharge from I think just having a foreign body inside, and also, I had some bleeding from abrasions caused by the ring so then I was using creams to stop the bleeding, like hormone creams. But none of that stuff makes you feel really like having sex, you know, it doesn’t make you feel very sexy at all.

 

Embed Print Transcript

Being told by a doctor that it was “all disgusting down there” contributed to Cynthia feeling like she didn’t want any intimacy, and she still feels that way.

Yeah, I mean, I guess in terms of intimacy I think it probably has had a really significant effect. I mean again, it’s difficult isn’t it to sort of disentangle like so many things that go on when you have small children, y'know, sex life is not necessarily easy or desirable when you’re exhausted and juggling small kids and busy at work and but I definitely think those early kind of contacts with the gynae team where they said it was all disgusting down there, sort of make, has really, has like had a psychological effect on me in that way like I just don’t feel at all don’t know again I kind of almost just don’t want to think about it. I sort of just switched off my desire for anyone to you know, look at me, touch me or anything and yeah, it’s very difficult to know how much of that is my, this specific set of experiences, but I think quite a lot of it probably is. And I don’t, I wouldn’t say that I’ve recovered in that sense like I still feel like that.

 

Embed Print Transcript

Those who were injured from mesh surgery said that this had a significant negative impact on their sex lives. Sian, Penny, Fran, and others explained how their sexual relationships had been badly affected by pain or, as Katy explained, worry about urine leaks and smells. Elisabeth explained that to “take someone who has had a sexually active life to nothing and no foreseeable sexual activity is very difficult, very difficult”.

For Katy, mesh surgery badly affected her sex life. She says she is embarrassed to have sex with her husband and it has completely changed her.

I just feel that, you know, every time you go to the doctors, they’re not, they don’t actually listen to what you’re saying to them. You know, when you’re saying, yeah, but I’ve got pain around my pelvis. It’s really hurting. It feels like someone’s kicking me. Sex is, you know, I can’t have sex. I’m embarrassed to have sex with my husband. And I used to have a really high sex drive. The TVT operation was sold to me as in you know, it’ll stop the, I had a tiny amount of stress incontinence and it was sold to me that fact that it would stop that stress incontinence and it would improve your love life, and you know, you’ll never have to worry about things like that again. And it completely did the opposite.
 
I worry about that quite a lot, especially from having quite a lot of time where my sex life was, even still, my sex life isn’t great because I worry. When I first met him, obviously, oh I don't know, it was just yeah, I worry about him all the time. I sometimes, you know, I have said to him on more than one occasion, you know, I wouldn't blame you to go off and just leave me and be with somebody else. You’d be happier. I don't know, yeah. It’s, he’s a, luckily for me he’s a lovely, lovely guy. But yeah, I would, I’ve tried to sabotage our marriage in ways like, you know, trying to sort of get him to leave. Picking arguments for the sake of arguments. So that, you know, when he’s, when he’s I suppose a bit horny and he comes up and puts his arm round me, I’ll sort of make excuses. But [sighs] I’ve tried now, I try now to be honest with him and open about how I’m feeling, rather than just sort of pushing him away or but even like now, I won’t, it’s weird, ‘cos before I’d’ve just got undressed in front of him and jumped in bed or whatever. And now, I’ll go into the bathroom and get undressed because I don’t want him to sort of think either, oh gosh, look at her or I’m a bit horny because I don’t want him to feel like that from getting into bed because I just wanna get into get into bed. I wanna curl up and go to sleep [laughs]. But the thing is, I feel that if I told the doctor that, the doctor would turn round and say, well it’s because you’re getting older [laughs]. You know, because older women don’t have sex lives, you know, which I don’t feel like I’m 50 by the way, mentally I’m very, very much younger [laughs].
 

 

Embed Print Transcript

Carole feels a “sense of bereavement” for her sex life which ended after mesh surgery. She feels “lucky” that her husband stayed by her side.

As far as any sexual contact that ended more or less, very shortly after I had the operation in 2007. I’m very lucky that I’ve got a partner who is the most patient man and very kind man that I’d ever wish to meet. And he’s stayed by my side, whereas a lot of people that’s their relationships ruined and their, their partners have gone. I still feel a sense of bereavement if you like, if I let myself think too deeply about it I get very, very upset. And of course, you know I know it, I’m, I can’t get back what I had, so you know I more or less have to give myself a poke and say, “You know, get, take control of yourself. Crying about it is not going to bring it back.” You know you can’t replace something like that really. But we, I’m lucky, I’m lucky that we’ve got a very, very good relationship, my partner and I, and we have lots of fun together, but basically we are just like brother and sister, and that’s not how we were before the operation.

 

Embed Print Transcript

Losing interest or being uncomfortable having sex could take a toll on people’s relationships. For those who felt that sex was a trigger for a UTI, like Jasmine and Leah, avoiding sex could make it difficult to feel connected with their partner. Jane also struggled with urinary tract infections (UTIs) after sex but found this could be improved by being careful about washing, staying hydrated, and being strategic with sex positions.

Julie, who experiences incontinence, felt that the condition had contributed to her sex life and marriage breaking down. Catherine and Gwen sought out counselling to help heal their relationships. Catherine found it helpful to “break those barriers down” about sex life.

Leah thinks that sex is a trigger for her UTIs. She finds that having problems with UTIs puts a “massive strain on your relationship”, even when your partner is supportive.

Obviously even at the start when I was having the recurrent UTIs, sex was always a bit of a worrisome thing because I’d have to take the prophylactic low dose antibiotic so there was always a little bit of anxiety around it. And then once I got it chronic, really, God for the first, how long, so February 2019 and then so February 2019 and then it was January 2021 where we first were able to have sex without an immediate flare and without an immediate exacerbation of symptoms. So, two years of being really scared to have sex. If we did have sex, being in pain after. My partner feeling incredibly guilty because he didn’t want to bring on pain. And it was often him that would say, “No, no, let’s not, let’s not, you know, let’s not, I don’t wanna make things worse for you.” I’m very lucky like, well, no lucky, I’m, rightly so I’ve never felt any pressure but I am lucky to have a boyfriend that has supported me in that.

 

Embed Print Transcript

Catherine feels that going to counselling has helped her relationship with her husband reach a “better place”.

It’s definitely helped it’s definitely got me to kind of understand why I kind of feel that way and I think without my husband kind of needed to do, needed to do his part as well, it’s like I don’t know, I don’t know whether it was kind of from a male, he didn’t quite know what to do or how to kind of react to it and obviously he just thought that I just wasn’t kind of talking to him and I didn’t talk to him after every session either because I think sometimes you just need time to reflect on your sessions and kind of just work out what you, what you need, what you need to do and this is what I found the hardest really is like he needed to kind of meet me halfway where I felt I was doing my part and he kind of needed to kind of do his I suppose. You know, he never really asked about, sometimes I didn’t tell him when I was going because he never really asked about or showed an interest so that kind of annoyed me and I was like I’m going through this and I feel like I’m going through it on my own. But we are in a better place now, that’s, you know, that’s for sure.

 

Embed Print Transcript

Some people told us that their urogynaecological condition had little impact on their sex life. Chelsea, who has UTIs, and Jessy, who has urinary incontinence, said that their condition had little impact on their sexual relationship.

Other health issues or concerns, or attitudes in relationships, sometimes meant sex was less prominent. Gwen and her husband reached the mutual conclusion that sex “wasn’t the most important part of our relationship”, allowing them to “move forward” together.

Understanding and support

Many felt that their partners had been supportive and described them as “kind”, “understanding” and “patient”. Jenny’s partner came with her to her first pessary fitting appointment. Fiona’s current partner is supportive and “very understanding” about her UTIs and “looks after her,” but she told us that her first husband was not the same.

Chelsea explains how chronic UTIs became “part of our relationship” and never caused any problems between her and her husband who “accepts it and helps me through it”.

I mean he’s always been very understanding, I think it’s just that he is aware of it and that that, it’s one of these daft things, but it is part of our lives together I mean we’ve mean married for 21 and a half years and I’ve had this condition for 19 years, so ultimately, well obviously without knowing what it was half the time but ultimately it is, I think it’s hard to say but it’s part of our relationship it, it’s there and it’s, it’s everyday life. And so it’s never caused any problems between us, he just accepts it and helps me through it.
 
It doesn’t [affect my intimate relationship with my husband]. I mean occasionally if I’m having a really aching phase it means that we don’t have sex for a couple of days because I’m just not comfortable about it, but in general it doesn’t it’s, it’s great when it doesn’t actually affect that side of things most of the time.

 

Embed Print Transcript

Several of the people that we talked to said that it could be difficult for partners to understand their condition and its impact. Anna’s husband, who she says rarely has any health problems, doesn’t always understand how her UTIs “can be such a constant thing” in her life. Jeannie, who has prolapse, said that her partner is “a little bit squeamish about things and doesn’t really want to know”, but he “listens and he cares”. Georgina explained that her partner was “sympathetic” but found medical things difficult to talk about. Jessy prefers to talk to her female friends about her health as she feels men don’t “get it”.

For Mary Y there had been a negative impact on her marriage. At times, she feels let down because her husband does not provide enough emotional support, and she gets the feeling that he thinks she’s “making a lot of it up”.

Sabrina’s partner used to make comments about her incontinence, but he now knows how much it bothers her and tries to be supportive.

My partner, he doesn’t, he just doesn’t even really bat an eyelid anymore. At the start it was kind of like, “Again.” Like “Come on,” like “Again.” And we joked that we’d have to put a lining on the sofa cos when my little one was so small it happened a lot, but now because he knows how much it does bother me, he doesn’t, nothing’s really said unless he’s trying to be supportive.

 

When it happened when we were out, and I got really, really upset, I think it dawned on him just how much it bothers me. And so he always tries to kind of, especially with his family, he, he always kind of be like, “Oh she’s been, she’s been really busy today, like it’s nice for her to have a sit down.” Just to kind of deflect the fact that I’m not joining in.

Embed Print Transcript

Changing dynamics and roles

Changes to people’s sense of self and their physical abilities had knock-on effects to their relationship dynamics. Elly feels like her husband “understands what I’m going through”, but that her urogynaecological issues “might contribute to more arguments”.

When Laura’s UTI didn’t get better, she felt she was no longer the same person that she had been in her relationship.

I couldn’t go out. I couldn’t go for a drink. I couldn’t go even for a walk with my partner. We, we went from having a fairly normal life to, I literally couldn’t do anything. I’d gone from playing sport with her, cycling, whatever and then I couldn’t. And I just felt like a- yeah, from someone who was sort of out and about and go getting and working and ambitious and all these things to suddenly being someone that was sick in bed, moaning all the time that they needed a wee that was, you feel very, very small and quite on the back foot in your relationship, for sure.

 

Embed Print Transcript

Living with urogynaecological issues could also require changes to roles and activities at home. This was the case for Amy and Vickie, who had prolapse after childbirth. To accommodate their physical limitations, their partners took on more caring roles, including lifting and caring for the children.

Eve and her partner have adapted how they care for their baby to accommodate her prolapse symptoms, though the emotional side of coping is still difficult.

So, yeah and the relationship with my partner, I mean he’s been amazing you know, I came back from private physio and I was like, “She’s told me not to lift anything” which I’ve been trying to, which I’m supposed to not really do any, I knew that before she told me on Friday but um, you know, he’s been like picking up the baby and carrying him ‘round for me and stuff which is nice but I’m sure like and this is no criticism of him but I’m sure after a while, he’ll forget because I look normal and I’ll probably just pick up the baby because it’s just what I’m used to doing and he’ll see me doing it and then it will just slip our minds and you know but, he has been like very understanding about it all because, you know, it does affect like me emotionally. I’ve been, I’m like very up and down emotionally and, you know, it affects how I feel about how I view myself, like, you know, what I was saying earlier about feeling a bit broken and just feeling like sometimes you feel like ugly and like unattractive so like, you know, obviously for us it affects things a bit romantically and, you know, he’s very understanding about all of that which is good.

 

Embed Print Transcript

Amy’s partner has taken on more household and childcare tasks, which she thinks he finds “a bit of a struggle”.

Obviously my partner has to do more as well, so he has to carry my-, cos I live on, we live on the top flat, so he has to carry my son up and down the stairs and stuff, and help, like if we go out the house, I need help getting out, I can’t get out of the house. I can get back in, cos he can walk up the stairs, but we can’t get out. And I can’t get out-, I can’t, the pushchair, I can’t get the pushchair out and, you know, I can’t, I need somebody to like constantly do things for me. And I think my partner finds that a bit of a struggle. ‘Cos he has to do stuff, but I can’t do it. And it’s like, no, there’s no way ‘round it, it’s just how it is. And I think it’s, I think my partner just feels sad for me really. I think that’s, I don’t think it’s caused a rift or anything, it’s just like he feels sad for me.

 

Embed Print Transcript

Some people we talked to had had surgery for their urogynaecological conditions. Partners, as well as wider family members, often also helped out more in the first few weeks and months whilst the person was recovering.

For some with serious mesh complications following this surgery, partners became long-term carers. This was the case for Susan, whose severe pain from mesh complications meant she needed help getting into the shower.

Sian’s relationship has changed as she’s been unable to have sex and her husband takes on a caring role. She appreciates that he has been kind and supportive.

The sexual relationship has, well its disastrous [laughs]. It’s been a state. We’ve had to forego a sexual relationship really with the ones you love most. He’s really tired most of the time. He’s coming home, he works full-time, comes home from work and he cooks the food and takes the dog out, washes the dishes sometimes if I’ve had an accident. I’m not allowed in the shower on my own, ‘cos I’ve got epilepsy. I gotta sing. You gotta make sure he’s listening to me sing. ‘Cos obviously, I still want a bit of privacy as well. Do you know what I mean? So, you know, it’s like coping strategies that we put into place in the home. But he’s having to care when he comes home from work. So, it’s difficult for him, but he’s one of the kindest men, a total contrast to my ex-husband.

 

Embed Print Transcript

Dating and new relationships

Starting a new relationship could be intimidating when living with a urogynaecological condition. Freia is single and would like to be in a relationship but feels she doesn’t know how she could start one with her urinary incontinence.

Deciding when to tell a new partner about a urogynaecological condition was also a concern. Parminder has urinary incontinence and felt it important that her partner knew about it. When planning dates out they look at where the toilets are.

Since her divorce, Julie has felt it’s “easier to stay single” than explain about her mesh surgery and other health conditions.

I’ve had a couple of relationships since you know, the divorce and that. But they only lasted a couple of years. I think I’ve got too set in my own ways and because of the problems I’ve got it doesn’t make me such a catch, you see what I’m, a lot of health problems and trying to explain that to someone, it’s like, it’s sort of like, no, it it’s easier to stay single. It would be nice. But it’s easier to stay single.

 

Embed Print Transcript

Melanie has urinary tract infections (UTIs) and vaginal atrophy. Vaginal atrophy is thinning, drying and inflammation of the vaginal area that may occur with low oestrogen levels and most often occurs around the menopause.

Melanie experiences UTIs and has vaginal atrophy. She is starting a new relationship after menopause, but says “I don’t know even know how to begin to have that conversation”.

I’m sort of might be starting a relationship, well I’m seeing somebody. It’s very, very early days and I don’t know even know how to begin to have that conversation with them and say I’d like, I love the idea of starting it with, “Well you see the landscape’s changed” [laughs]. You know, you’ve got to feel, you’ve got to feel quite a level of trust and understanding and kindness. I mean I’m in my fifties, he’s in his fifties so it may well be that maybe his landscapes changed, you know, men have difficulties too but, you know, but I think back to my youth and you know how spontaneous and fun and yeah I think we all took our bodies for granted and just do whatever and now I’m having to almost negotiate with my body and oh I don’t know, it’s much harder now.

 

Embed Print Transcript