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-to-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.

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.

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].
 

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.

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.

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.

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.

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.

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.