With nearly every theme discussed freely these days in media, most health issues land squarely out in the open. Conversations related to sexual energy are generally considered acceptable topics of conversation. Unfortunately, the stigmatized symptoms of pelvic organ prolapse (POP) hinder dialogue about this extremely common women’s health condition.
Thanks to the breast cancer campaigns of Komen and National Breast Cancer Foundation in the 1980's, breast cancer stigma came to a halt. Prior to that, few spoke about breast cancer out loud, the word breast was not allowed in printed publications such as newspapers or magazines, and breast conversations were considered “off the table”. We now recognize and freely talk about breast health. We created a comfort zone with awareness.
In 1998, few spoke about erectile dysfunction out loud prior to Pfizer providing a beacon of hope for men with the little blue pill. We now see ED pharaceutical commercials during prime time on a regular basis, men comfortably admit to using the little blue pill and women are perfectly comfortable with it, hundreds of thousands of men are treated for ED annually, and everyone speaks comfortably about ED. We created a comfort zone with awareness.
Thanks to the media and some savvy ad campaigns, the stigma has been removed from both breast cancer and ED. We need to get to the page where we speak freely about pelvic organ prolapse and ALL of its symptoms, including those that impact intimacy.
While women with pelvic organ prolapse navigate physical, emotional, social, sexual, fitness, and employment impact, intimacy is a zone that carries significant baggage. Generally we women talk about pretty much everything. We freely give up gory details about childbirth.
“They told me to push and then next thing you know, I pooped on the table.”
“My water broke in the middle of the mall; the guy walking next to me almost threw up”.
“The intern had his hand up inside of me b/4 he even introduced himself.”
You get the picture.
So how exactly does POP cause issues in the bedroom? Typically women with POP have numerous symptoms that may interfere with the intimacy they emotionally covet, but find physically unfeasible.
1. Vaginal tissue bulge. Without a doubt the most common symptom of POP, women who feel vaginal pressure or tissues bulging when they wipe after urinating may take a look with a mirror to see what is going on down below. Most often what appears to be a tumor coming out of your vagina prompts a visit to the gynecologist, after which POP may be diagnosed. From that point forward, women often feel their nether regions look unattractive to men and shut down the gates.
2. Vaginal pressure. Intercourse may feel like trying to stuff the toothpaste back in the tube, because tissues and the organs behind them bulge into the vagina, shrinking vaginal space.
3. Pain. Often women with POP experience vaginal, rectal, abdominal or back pain. For some, pain with intercourse prevents intimacy altogether, no matter what sexual position. Women try to explain to their partners what the pain is like, but it is extremely difficult to put words to pelvic discomfort related to POP. Women may not be believed by the men in their lives when expressing that pain holds them back. While what I experienced wasn’t pain, I used to say it felt like someone turned an electric potato masher on in my guts. Some women are able to distinguish POP pain as sharp, dull, an ache, pulling; others not. Since there are five types of POP, and four levels of severity with many combinations of POP types, pain is very individual.
4. Chronic constipation. Chronic constipation is the status quo when it comes to rectocele. Chronic constipation can lead to persistent bloat, that stuffed sausage sensation. Not the type of occasional irregularity that Activia talks about, more like I haven’t pooped more than raisin sized stool in a week and I’d hand over my first born child to have one-normal-bowel-movement type constipation. Discomfort ranges from mild to excruciating. Constipation once in a while is tolerable; on a daily basis it is enough to make an ogre out of an angel. All you want to do is have one good poop. And the last thing you want is more “stuff” inside of you-needless to say, adding a penis to the clutter causing pressure inside the pelvic cavity can be a bit distressing.
5. Urine retention. The flip side of incontinence is urine retention, which is what I experienced. No matter how badly I had to pee, urine simply was not coming out. Picture a garden hose crimped in half stopping the flow of water-that was my urethra. Now imagine a penis pushing into your full bladder over and over.
6. Coital incontinence. Yes it is exactly what it sounds like; during the physical engagement of intimacy, urine or stool leaks out of your body. It’s nearly impossible to share such personal information with a partner ahead of the curve. Loss of urine or stool in day to day activities is one thing, but how on earth do you handle leakage in the middle of an intimate act? Talk about a mood breaker…
7. Lack of intimate sensation. Women may experience a lack of clitoral sensation. Women who used to being able to orgasm relatively easily find it a bit disillusioning to lose sensation altogether. Women may feel they might as well get the dishes done if there is no physical satisfaction.
POP and intersecting women’s pelvic floor conditions are estimated to impact 50% of the female population, with medical documentation dating back nearly 4000 years. What will it take to break the silence? Pelvic health is health. Talking about POP and all the symptoms out loud will evolve awareness, diagnostics, support, and screening, pivotal to shift women’s pelvic health into the 21st century.