How do fibroids affect sexual health?

Fibroids are a common condition amongst people assigned female at birth (AFAB); however, they are rarely spoken about, and even less so is the hidden impact of fibroids on sexual health and wellbeing. 

But what exactly are fibroids? They are non-cancerous muscle growths that develop in the uterus, which is the womb of people AFAB.¹ Individuals living with fibroids may experience symptoms such as lower abdominal pain, pain during sex, and abnormal uterine bleeding.^1,2 

The prevalence of fibroids varies by region and ethnicity, particularly affecting people of colour.¹ However, globally, fibroids affect up to 70% of people AFAB by the age of 50.¹ 

The aim is therefore to empower affected individuals with this knowledge, as well as offer solutions and support.

What physical symptoms of fibroids can affect sexual health?

Why do fibroids cause pain during sex?

The first area this article explores is how fibroids have an impact on sexual health, particularly on pain during or after sex (known as dyspareunia). This pain may occur because fibroids press on certain areas within the pelvis. This happens when fibroids grow and exert pressure on the uterus or surrounding structures, such as the cervix (opening of the womb).³ Pain during or after sex can be superficial or deep. In the case of fibroids, the pain is usually deep, meaning it occurs during penetration.⁴ The location of fibroids also affects where individuals experience pain. People with fibroids in the upper section of the uterus are more likely to experience pain during sex.⁵ Furthermore, back and leg pain may also affect sexual desire.⁵

Can fibroids cause bleeding during or after sex?

Abnormal menstrual bleeding caused by fibroids can also affect sexual intimacy. People with fibroids may experience unusually heavy periods, defined as “excessive menstrual bleeding that interferes with a person's physical, social, emotional or material quality of life".⁶ The cause of heavy bleeding from fibroids is still uncertain, but it may be related to increased blood vessels in the uterus.⁷ People with fibroids may also have irregular periods or vaginal discharge.⁷ These symptoms can affect sexual functioning, confidence, intimacy and psychological wellbeing.⁸

How do fatigue and heavy bleeding affect intimacy?

Fibroids can lead to low iron levels (anaemia), caused by heavy and frequent periods. Iron deficiency anaemia can cause fatigue, as the body has less oxygen available, which may reduce energy and sexual desire.⁹ Testing for iron deficiency is a simple and low-cost step that can be included in the assessment of people experiencing sexual dysfunction. Studies show that people with iron deficiency anaemia caused by heavy bleeding from fibroids report improved sexual function after treatment.¹⁰

How do fibroids affect body shape and physical function?

Fibroids can grow significantly, sometimes reaching the size of a full-term baby. This can lead to visible body size and proportion changes.¹¹ Made of muscle tissue, fibroids can bulge from within or outside the uterus.¹² While this can cause pain, it can also affect body image and confidence, which may interfere with sexual desire. A study by Borah et al. found that 37% of participants felt self-conscious about the size and shape of their abdomen, and 20% believed fibroids affected their relationships with partners.¹⁸ Another study found significant improvement in sexual and psychological wellbeing three months after surgical fibroid removal.⁸

Fibroids may also cause bladder and bowel issues due to increased abdominal pressure, which can impact sexual wellbeing and confidence.¹³

How do fibroids affect emotional and psychological wellbeing? 

Why might fibroids cause anxiety around intimacy

Individuals with fibroids are also at higher risk of depression and anxiety, self-directed violence and stress.^8,13 Glover et al.¹³ found that 35% of people AFAB scored in the borderline or clinical range for depression, and 61% for anxiety. The burden and distress that people with fibroids experience are comparable to those of other chronic diseases, and should therefore not be ignored.¹² Worrying about pain or bleeding during intimacy may also worsen these symptoms, leading to hesitation and reduced libido.⁸ Uterine fibroids are reported to be among the greatest psychological stressors for people assigned female at birth, adversely affecting their emotional and mental wellbeing.^1,2

How can fibroids affect self-esteem and body image?

The impact of unpredictable pain, heavy or irregular menstrual bleeding, and bleeding in public places associated with uterine fibroids on self-esteem should also be considered. Some people may feel "less feminine," unattractive, or "out of control” of their own body, which may lead to decreased desire for sexual intercourse. After surgery for fibroids, many report a significant improvement in sexual function and feelings of attractiveness, related to fewer menstrual bleeding issues.^14,15

What relationship challenges can arise from fibroid symptoms?

Similarly, the impact that fibroids and the resulting sexual dysfunction can have on relationships can be extremely straining. This may be due to misunderstandings and miscommunication around avoiding sexual intercourse because of pain. People with fibroids may feel frustrated that their condition affects not only their social lives, but their intimate lives as well. This may lead to feelings of fear of rejection anxiety or guilt related to avoiding intimacy.¹⁵ 

What can help people with fibroids feel better physically and emotionally?

What treatment options are available for fibroids?

Firstly, a doctor or other healthcare provider may ask about your symptoms and carry out an abdominal and pelvic exam if they suspect fibroids.¹² This may be because your uterus is enlarged, has an irregular shape, or you are experiencing pain during sex, irregular bleeding and prolonged periods.¹² 

If your fibroids are not bothersome, you may not need to opt for therapy. If your symptoms are interfering with your quality of life, the treatment options include observation, medication, or surgical treatment.¹² The best treatment depends on which symptoms are most bothersome to you. Medications may include iron supplements or a multivitamin if your iron levels are low. Nonsteroidal anti-inflammatory drugs such as ibuprofen can help reduce menstrual cramps and bleeding. These can be taken during your period.¹²

Hormonal birth control such as the pill, skin patch, vaginal ring, hormonal IUD and implant reduce bleeding and pain during the menstrual period, and can also correct anaemia.¹² However, it can take up to three months for results to show, and it may worsen bleeding symptoms initially.¹²

Other medications include tranexamic acid, which slows menstrual bleeding rapidly. However, side effects include headaches, muscle cramps or pain.¹² This medication should not be taken with birth control as it may increase the risk of blood clots.¹²

Minimally invasive procedures, such as uterine artery embolisation (UAE), can also be used. This treatment starves the fibroids of blood supply, causing them to shrink over weeks to months, and reduces symptoms such as abdominal pain and heavy bleeding. UAE is typically offered to individuals who do not plan to become pregnant after the procedure. However, it is still possible to get pregnant in the future. This needs to be discussed with the doctor before having the procedure.

Surgical options include a myomectomy (removal of just the fibroids) vs. hysterectomy (removal of the entire uterus).¹² Myomectomy reduces bleeding and size-related symptoms. Most people who undergo one can get pregnant thereafter.¹² Removal of the entire uterus is a permanent treatment that can relieve heavy menstrual bleeding and most of fibroid-related symptoms.¹² The ovaries and cervix may be left in place. However, pregnancy will not be possible after the procedure. Additionally, there may be a risk of heart disease later in life.¹²

How can sex be made more comfortable with fibroids?

In addition to medical and surgical treatments, attention should also be given to making sex more comfortable for people with fibroids. Experimenting with different sexual positions may help alleviate pain on penetration. Using pillows, cushions, and lubricant to reduce discomfort may also be effective. Some people also find that timing intimacy when symptoms are least severe (e.g., mid-cycle) helps make sex more comfortable.

Summary

In summary, fibroids are an extremely common condition, affecting up to 80% of women before the age of 50. However, the link between fibroids and sexual health is not often discussed. It is important to note that fibroids can significantly affect both physical and emotional aspects of sexual health and well-being. Symptoms include pain during sex, irregular bleeding, changes in body shape and difficulties with body image. With open communication, medical support, and access to information, a fulfilling sex life is absolutely within reach.