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.

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”.

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.

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.

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.

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.

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

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”.

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.

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.

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.

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

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.

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.

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”.