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Are you avoiding sexual activity because of fear of wetting yourself or your partner? Or because your doctor told you that your bladder or uterus is falling? Incontinence (involuntary loss of urine) and pelvic organ prolapse (pelvic organs “falling” into the vagina) are common conditions, usually the result of childbirth, and are not barriers to a satisfying sex life.

A lot of women have told us that they avoid sex because of these conditions. The advice we give is to get the condition treated if it is negatively impacting your life. If treatment isn’t possible or a woman just isn’t ready for treatment, then she is given tips on how to enjoy sex despite prolapse and incontinence:

If you have incontinence:

· Empty your bladder before sexual activity—if your bladder is empty it’s unlikely you will leak.

· Let gravity work for you, not against you. When you are on your back, you will have much less chance of leaking while if you are upright (i.e. on top) you will have a higher chance of leaking.

· Consider moving the action to the shower or tub.

If you have prolapse:

· Think of prolapse as a hernia and use gravity in your favor. When you are upright, the prolapse may bulge down and when you are on your back the prolapse will fall back inside. Regardless of position, anything that enters the vagina will simply push the prolapse back in and will not harm you or make the prolapse worse.

· Don’t worry about your prolapse getting worse with sex. It is quite the opposite as having regular sex and orgasm actually improves your pelvic floor muscles.

Your clitoris is the key player in the orgasm game. Pelvic organ prolapse or incontinence should not physically impact your ability to have an orgasm although these conditions might mentally affect orgasm. Many women are so worried that they might leak or their partner will feel their prolapse that orgasm is inhibited, but you should know that you can still experience satisfying sexual activity with incontinence and prolapse. Your focus should be on enjoying the intimacy and finding what works for you. It may help to experiment on your own first—being able to achieve orgasm on your own will give you confidence when you are with your partner.

The bottom line is that common conditions like incontinence and prolapse should not be a barrier to a satisfying sex life. And if you feel that they are, these conditions can be treated which is why we are here for you.

Dr. Dubinskaya is an ob-gyn who is currently completing a fellowship in Female Pelvic Medicine and Reconstructive Surgery at Cedars-Sinai.


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