Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop from the muscle tissue of the uterus. These growths vary widely in size, from tiny seedlings to bulky masses that change the shape of the uterus. Fibroids can cause pain during and after sexual intercourse, a condition medically termed dyspareunia. This symptom is a direct consequence of the fibroids’ physical presence and their interaction with surrounding pelvic structures.
How Fibroids Cause Pain During and After Intercourse
The pain associated with sexual activity due to fibroids is typically deep dyspareunia, meaning the discomfort is felt deep within the pelvis rather than at the vaginal opening. This deep pain is primarily a result of mechanical pressure exerted on the uterus and the fibroid itself during penetration. Fibroids located on the posterior wall of the uterus, or those near the cervix, are particularly likely to be compressed during deep thrusting.
Larger fibroids increase the bulk of the uterus, limiting the space available for normal movement and creating significant discomfort when the uterus is moved during intercourse. This mechanical interference can lead to a sharp or aching pain that often persists after sexual activity has ceased. Fibroids can also cause the uterus to become tender or inflamed, making it hypersensitive to pressure. In some cases, the mass of the fibroid displaces the uterus into an abnormal position, and the resulting strain on surrounding ligaments contributes directly to deep pelvic pain.
The discomfort experienced is not always immediate or sharp; it can manifest as cramping or a dull, throbbing ache in the lower abdomen or pelvis following intercourse. This lingering pain may be due to the continued irritation of the pelvic nerves and the uterine wall after the physical pressure has been relieved. For some individuals, the pain may also be exacerbated by the natural uterine contractions that occur during orgasm.
Other Symptoms Associated with Fibroids
While painful intercourse is a significant concern, fibroids commonly cause a range of other symptoms related to their size and bulk within the pelvic cavity. One of the most frequently reported issues is heavy or prolonged menstrual bleeding, known as menorrhagia, which can sometimes lead to anemia due to chronic blood loss. Some women also experience bleeding between cycles.
The physical size of fibroids can lead to pressure symptoms as they push against adjacent organs. This often manifests as a feeling of pelvic fullness or a consistent, dull pressure in the lower abdomen. When fibroids press on the bladder, it can cause a frequent need to urinate, or even difficulty emptying the bladder completely.
If the growths press on the bowel or rectum, they can contribute to symptoms like constipation or discomfort during bowel movements. Additionally, fibroids, particularly those growing on the back of the uterus, may press on nerves in the lower back, resulting in chronic back pain. These bulk-related symptoms often occur alongside or independently of pain during sexual activity.
The Process of Diagnosis
The diagnostic process typically begins with a thorough medical history review and a standard pelvic examination performed by a healthcare provider. During the physical exam, the provider may be able to feel irregularities in the shape or size of the uterus, suggesting the presence of fibroids. This initial assessment helps determine the need for further imaging studies.
The primary diagnostic tool used to confirm fibroids is transvaginal and abdominal ultrasound, which uses sound waves to create images of the uterus and ovaries. Ultrasound is quick, non-invasive, and effective for mapping and measuring fibroids. If the ultrasound does not provide sufficient detail, or if the fibroids are numerous or large, a Magnetic Resonance Imaging (MRI) scan may be ordered.
MRI provides a more detailed view of the number, size, and exact location of all fibroids, which is crucial for planning surgical interventions. The provider must then correlate the location and size of the tumors with the patient’s specific symptoms, such as deep dyspareunia, to confirm the fibroids are the source of the pain.
Management and Treatment Options
Treatment for fibroid-related pain focuses on managing symptoms and reducing the size or eliminating the growths. For mild symptoms, initial management often involves over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs). Hormonal therapies, including birth control pills or IUDs, can help control heavy bleeding and reduce overall pelvic pain, though they typically do not shrink the fibroids themselves.
For more significant symptoms, Gonadotropin-releasing hormone (GnRH) agonists or antagonists may be prescribed to temporarily reduce estrogen levels, causing fibroids to shrink. These medications are generally used for a limited time because fibroids can regrow once the treatment is stopped. This medical shrinkage can provide temporary relief from pressure and pain symptoms.
Minimally invasive procedures offer options that preserve the uterus, such as Uterine Fibroid Embolization (UFE). In this procedure, small particles are injected into the arteries supplying the fibroids, blocking their blood flow and causing them to shrink over time. Focused Ultrasound Surgery (FUS) is another non-invasive option that uses high-intensity ultrasound waves guided by MRI to heat and destroy the fibroid tissue.
Surgical intervention provides the most definitive treatment for fibroid-related symptoms. A myomectomy surgically removes the fibroids while leaving the uterus intact, which is important for individuals who wish to retain fertility. For those who have completed childbearing or have severe, persistent symptoms, a hysterectomy (removal of the entire uterus) offers a permanent cure for fibroids and all associated symptoms.