Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop from the muscle tissue of the uterus. These growths are very common, affecting a large percentage of women by age 50, though many women do not experience symptoms. For most people, having intercourse with uterine fibroids is physically safe and poses no risk of injury or medical emergency. Adjustments are often necessary, however, because the size and location of the growths can significantly affect comfort and pleasure.
How Fibroids Cause Discomfort During Intercourse
The physical presence of fibroids can lead to pain during sexual activity. Deep penetration pain is frequently caused by large fibroids located on the outer wall of the uterus (subserosal) or within the uterine muscle wall (intramural). Deep thrusting can push against the cervix or the uterus itself, creating sharp or aching pelvic pain.
Fibroids situated near the cervix are particularly prone to causing discomfort due to direct pressure or friction during penetration. Larger fibroids can also cause generalized pelvic congestion, where increased blood flow during sexual arousal exacerbates a feeling of heaviness or pressure. Fibroids that bulge into the uterine cavity (submucosal) or shift the uterus’s position can also contribute to painful misalignment.
Safety Concerns and Managing Bleeding
A common worry is that sexual intercourse might injure the fibroids, cause them to rupture, or lead to excessive blood loss, but sex is generally safe. There is no evidence that sexual activity causes fibroids to grow or increases the risk of serious complications. The mechanical forces of intercourse do not typically cause a medical emergency.
Spotting or light bleeding after intercourse (post-coital bleeding) can occur because of fibroids, but it is usually not a sign of danger. This bleeding happens when friction irritates the enlarged uterine lining or fragile blood vessels near submucosal fibroids. Any new or unusual discharge, severe pain, or fever following intercourse should be monitored, as these could indicate an infection or other issue.
Practical Strategies for Pain-Free Intercourse
Adjusting positions minimizes deep penetration pain associated with fibroids. Positions that allow control over the depth and angle, such as being on top or side-lying (spooning), reduce direct pressure on the uterus and cervix. Experimenting with different angles and using pillows to support the hips can help find a comfortable configuration that avoids painful contact.
Extending foreplay ensures full arousal and natural lubrication, which reduces friction that might irritate the area. If natural lubrication is insufficient, using a water- or silicone-based lubricant can significantly ease discomfort during penetration. For some individuals, taking over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 30 to 60 minutes before sexual activity can help reduce inflammation and pain.
Open and honest discussion with a partner about pain levels, boundaries, and desired activities is necessary for a positive experience. Communicating immediately when a movement causes pain allows couples to pause, adjust, or switch to other forms of intimacy. Focusing on mutual pleasure and redefining intimacy beyond penetrative sex can alleviate anxiety and emotional strain for both partners.
When Sexual Symptoms Require Medical Intervention
If pain becomes severe, debilitating, or prevents sexual activity entirely, it signals a need for medical evaluation. Symptoms that cause significant emotional distress, relationship strain, or anxiety about intimacy also warrant professional help. Persistent or heavy bleeding after intercourse, particularly if it is more than light spotting, warrants a check-up to rule out other causes and assess fibroid involvement.
Signs of a possible infection, such as fever, unusual discharge, or rapidly increasing pelvic pain, require prompt medical attention. If conservative strategies do not provide sufficient relief, the solution is treating the fibroids themselves. Medical or procedural treatments, such as hormonal therapy, uterine fibroid embolization, or myomectomy, can shrink or remove the growths, which often resolves the sexual pain.