A note on language: while mainstream medicine and media typically refer to UF as a “women’s health issue” at PbK we acknowledge and affirm that gender is not defined by genitals. Anyone with a uterus, regardless of their gender identity, can have UF. Therefore, throughout this article on fibroids and sex, we refer to UF as a reproductive health issue that affects people with uteruses or uterus-havers.
I learned about uterine fibroids (UF) earlier than most—middle school, to be exact. My mom always had them but was in the lucky subset of patients without symptoms, such as pelvic pain…until she wasn’t. Ultimately, her symptoms weren’t caused by UF. Since they have a genetic component, and my periods were heavy, I was told to let my future healthcare providers know about my family history, and that was that.
If not for this early knowledge, I would know nothing about fibroids—never mind their relationship to sex or pleasure. They weren’t discussed in either my public health program or my sex ed certification programs. Yet the impact of fibroids on sex is rather far-reaching. In this article, we’ll cover what fibroids are, who they impact, and how they affect your sex life.
Fibroids are muscular growths in the wall of the uterus (womb)
Also called leiomyomas or myomas, they are typically noncancerous and extremely common. The exact number of people living with UF varies widely, depending on both a study’s population and the diagnostic methods used. The Office of Women’s Health places it between 20-80% of people with uteruses.
Implicit bias and the nature of fibroids impact the ability to diagnose‑and therefore, treat—them and their associated symptoms
If the wide range confuses you that’s normal and there are many reasons for it. First, it’s well established that people with uteruses—particularly those who are Black, fat, disabled, not cis, not straight, don’t speak English, are poor, with lower education, and/or who carry any other marginalized identities—have a harder time receiving a diagnosis, being correctly diagnosed, and being believed about their symptoms, especially pain which is often present in fibroids. This goes for a wide variety of physical and mental health conditions (just google “diagnostic gender bias”), and especially for still poorly misunderstood conditions related to uteruses and the menstrual cycle.
There’s also the fact that fibroids themselves vary a lot. They can range in size from an apple seed to a grapefruit (or larger). Some people have a single fibroid, others have dozens.
Lastly, many people with UF have no symptoms and would only be found if a healthcare provider felt irregularities in the shape of your uterus. This means many people can be living with fibroids but not know it unless they are large and/or causing symptoms. This varies by race, as Black uterus-havers are more likely to experience UF symptoms, which may also contribute to increased rates of diagnosis in this population.
Age and race play a role in who develops UF
Fibroids are most common in uterus-havers in their 40s and 50s. Black people with uteruses have a three times higher risk for UF than their white counterparts. They also are more likely to develop them at a younger age, have bigger fibroids, have more fibroids, have more symptoms, and be hospitalized for them. (Source)
Though the exact reasons for this remain unknown, some of the other risk factors for UF are also higher amongst Black uterus-havers. These include low Vitamin D levels, hypertension, food additive consumption, and family history. While these biological factors may play a role, they are likely influenced by and intersect with psychosocial ones such as reduced access to healthcare and lower socioeconomic status. And, together, all of these can be connected to inherited racialized trauma, especially from the medical field, and ongoing anti-Blackness which creates additional stress in Black bodies that leads to overall more and worse health outcomes.
Fibroids and Sex
Painful sex is a common symptom of uterine fibroids
Though many people with UF remain asymptomatic, when symptoms are present they can be hard to live with.
Symptoms include but are not limited to:
- Heavy bleeding
- Long periods
- Painful periods
- Anemia (from the bleeding)
- Bloating in the lower belly
- Frequent peeing
- Pelvic pain
- Painful sex
- Lower back pain
- Complications during pregnancy and labor
While painful sex is only one symptom of UF, the other symptoms—as well as the stress of living with a chronic condition—can impact your sex life. That’s because sex impacts, and is impacted by, every other part of your life. Especially your health.
The impacts of fibroids on sex go beyond pelvic pain
When talking about the sexual impacts of…well, anything, really…it can help to look at them from three levels:
- Direct physical: physical symptoms and/or side effects that directly impact your sexual functioning (e.g. painful sex)
- Indirect physical: physical symptoms that make having and/or enjoying sex harder (e.g. lower back pain, frequent peeing, long periods)
- Psychosocial: the mental, emotional, and energetic fallout from dealing with the above symptoms that impact how you feel about yourself, your desire levels, your energy level, how your partner interacts with you, etc. (e.g. dinging your self-esteem)
In many ways, addressing painful sex from fibroids is the simple (though not easy) part
There are a variety of established approaches to managing pelvic pain from fibroids. They include:
- slowing down and savoring sensual play (aka foreplay) for longer to allow the body to be more thoroughly physically aroused
- using a long-lasting, “cushiony” lube that is body-safe and doesn’t irritate the vagina (we recommend this or this if you use condoms and this if you don’t)
- trying OhNut, a wearable sex tool that reduces pain with deep penetration
- focusing on non-penetrative sex, be it oral sex, sensation play, mutual masturbation, kink, or something else entirely. Read more: Healing Myself Through Mindful Masturbation
- incorporating mindfulness into both your self-pleasure and partner sex
- working with a pelvic floor physical therapist who can give you personalized mind-body practices, tools, and recommendations to support your body and sex life. Supporting your pelvic floor may also help manage other symptoms including lower back pain, constipation, and frequent urination.
Unraveling the non-physical impacts of fibroids on your sex life can be more complex
These are the less tangible impacts, one you can’t quite measure in any quantifiable way and which often results from living with the above list of physical symptoms. Things like:
- not feeling confident and sexy
- feeling betrayed by your body
- hating, disliking, and/or disconnecting from your body
- internalizing harmful messages—from family, religion, school, society, and more—about what it means for YOU, with all your varied identities, to have fibroids/a chronic condition. These messages are very individual—a Black trans man with fibroids will have a different set of messages to unlearn and heal than a white Latinx cis woman.
- stress over accessing empathetic and affirming care and navigating the bureaucracy of health systems
- and there are many more
All of these feelings don’t magically disappear when you start to get it on (if/when they create that device, I’ll take 10 please!). You carry them with you into sexy times and they can easily hit your sexual brake.
Furthermore, for each of these, there’s less individual control. There’s a lot you can do (more on that below), but you still have to live in a world where these systems of oppression are baked into every part of our society.
Sexual and psychosocial symptoms are more likely to be dismissed and/or ignored
This is especially true for non-white folx and those carrying multiple marginalized identities, for whom even finding affirming mental health care to address these symptoms can be a challenge.
Thankfully, this is changing. As mainstream medicine acknowledges the important role psychosocial factors play in overall health, it’s becoming less hard to find healthcare providers who help you thrive, not just survive, with a chronic condition like uterine fibroids.
If you have UF and want more intimate, exciting, and fulfilling sex, don’t focus only on the physical
Because sex is so much more than physical, finding freedom in pleasure with fibroids and sex means seeking solutions go beyond the physical.
Incorporating mindfulness; noticing, reframing, and healing harmful thoughts and internalized racism, sexism, ableism, etc; learning how to resource yourself; asking for help; communicating what you want and need; setting and upholding boundaries; taking action to boost your confidence; and more will not only help you navigate life with UF but also bring more fun and satisfaction to sex as well.
Are fibroids more than physical for you?
- Are they getting in the way of the relationship you have with yourself and/or a partner?
- Do they make it difficult to enjoy sex and pleasure?
- Do you want to put the spark back into your sex life, no matter what life throws your way?
Finding a team of specialist healthcare providers, experienced in the complexity of managing and treating fibroids, is essential.
This is where PbK counseling and sex coaching can help. We’ve helped dozens of couples and individuals dealing with a chronic illness to live, love…and thrive. And you can too!
Learn more and book your FREE consultation today to take the first step in finding freedom in pleasure–even with fibroids.