Uterine fibroids are common, non-cancerous growths that develop within the uterus. While many individuals with fibroids experience no symptoms, these growths can sometimes lead to significant discomfort, including pain during sexual intercourse. This condition, known as dyspareunia, can impact quality of life and intimacy.
How Fibroids Cause Pain During Sex
Fibroids can cause pain during sexual intercourse through several mechanisms, depending on their size, location, and number. When fibroids are situated near the cervix, deep penetration can place direct pressure on these growths, leading to discomfort or sharp pain. Fibroids located within the uterine wall (intramural) or bulging into the uterine cavity (submucosal) can also contribute to pain, especially with deeper movements.
Pressure on surrounding pelvic organs and nerves is another common cause of discomfort. As fibroids grow, they can press against the bladder, rectum, or other pelvic structures, which can be exacerbated during sexual activity. Inflammation in the tissues surrounding the fibroids can also increase sensitivity and contribute to pain. In some cases, rapid growth or degeneration of a fibroid, where it outgrows its blood supply, can cause acute pain that is worsened by physical activity, including sex. Specific positions during intercourse can also intensify pain due to varying pressure on the uterus and fibroids.
Other Common Fibroid Symptoms
Beyond painful intercourse, fibroids often manifest through a range of other symptoms. Heavy menstrual bleeding, medically termed menorrhagia, is a frequent symptom, often accompanied by prolonged periods and the passage of blood clots. This excessive bleeding can sometimes lead to anemia, causing fatigue and weakness.
Individuals with fibroids may also experience pelvic pressure or fullness. Fibroids can lead to increased urinary frequency or difficulty emptying the bladder if they press on it. Constipation can occur when fibroids exert pressure on the rectum. Lower back pain or leg pains can result from fibroids pressing on nerves in the pelvic region.
When to Seek Medical Advice
If you experience persistent or worsening pain during sexual intercourse, it is advisable to consult a healthcare professional. Pain that interferes with your quality of life, relationships, or daily activities warrants medical evaluation. New or increasing pelvic pain or pressure, or changes in menstrual bleeding patterns such as heavy or prolonged periods, are also important indicators that medical attention may be needed.
A healthcare provider can conduct a pelvic exam to check for irregularities in the uterus. Diagnostic imaging, such as an ultrasound, is often the first step to confirm fibroids and determine their size and location. MRI or hysteroscopy may also be used to provide more detailed information for diagnosis and treatment planning.
Treatment and Management Options
Managing fibroids that cause painful sex involves various approaches, tailored to the individual’s symptoms, fibroid characteristics, and desire for future pregnancy. Conservative management often begins with pain relievers, such as over-the-counter anti-inflammatory medications, to alleviate discomfort. Lifestyle adjustments and open communication with partners about comfortable positions can also help manage symptoms.
Medical management options include hormonal therapies designed to regulate menstrual cycles and potentially reduce fibroid size. Gonadotropin-releasing hormone (GnRH) agonists can induce a temporary menopause-like state, leading to fibroid shrinkage and symptom improvement. Birth control pills and other hormonal contraceptives can help manage heavy bleeding and menstrual pain associated with fibroids.
Minimally invasive procedures offer alternatives to traditional surgery. Uterine Fibroid Embolization (UFE) involves blocking the blood supply to the fibroids, causing them to shrink and symptoms to improve. Radiofrequency ablation uses heat to destroy fibroid tissue while preserving the uterus.
Surgical options include myomectomy, which removes fibroids while leaving the uterus intact, a suitable choice for those desiring future pregnancy. Hysterectomy, the removal of the uterus, is considered for severe cases, particularly when other treatments have not been effective and future pregnancy is not a concern.