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How to navigate intimacy with pelvic organ prolapse

How to navigate intimacy with pelvic organ prolapse

In Australia, it’s estimated that at least half of women who have had more than one child experience pelvic organ prolapse (POP). Pelvic organ prolapse is where one of the pelvic organs sags and may bulge or protrude into the vagina. There are several types and grades of prolapse and many women are asymptomatic. Others report vaginal pressure or heaviness, a vaginal bulge that can be seen or felt, irritation, sexual problems or incontinence. 

Sexual health has important positive impacts on our wellbeing, physical and mental health. But what happens when sex seems impossible?

The 2 biggest concerns in navigating intimacy with prolapse

Sexual self-image

Body image and sexual self-image are the biggest causes of a reduced sex life. Women with pelvic organ prolapse feel undesirable, embarrassed, ashamed and insecure. 

They are also concerned about what their partner may see or feel during sex because they may not want to see or feel their own genitals. 


54% of mothers aren’t confident to discuss sex-related problems. Women with POP find it difficult to speak to their partner about:

  • Sexual pain/discomfort
  • Incontinence during sex
  • Different sexual activities such as oral sex. Is it a yes or a no-go?
  • Fear of the unknown or unrealistic fears. Will sex make the prolapse worse? 
  • Pessary use during sex

Is intimacy with prolapse possible?


Sex includes a plethora of activities, toys included. There are many ways to remain intimate and sexually active in your relationship with prolapse.

26% of your body’s surface is erogenous zones. Working out what your body best responds to is going to make genital play and penetration more comfortable. 

How to communicate and navigate intimacy with a partner

If it’s been a while since you’ve been intimate or you’re experiencing intimacy with POP for the first time, you probably feel nervous and stressed. It’s time to take the stress and nerves away with:

Partner Communication - Expectations

There’s no avoiding this potentially awkward conversation if you want to move forward. It’ll be one of the most important conversations you ever have. Grab a drink, sit down with your partner and talk about:

    • How you see yourself as a sexual person
    • How important intimacy and sex are to you
    • What your biggest concerns are when it comes to having sex 
    • What your boundaries are, what you are willing to do and try and what you don’t want to do

This conversation is going to reduce your anxiety because you’ve developed a solution-focused game plan. 

Pessary use during sex

If you wear a pessary you’ll need to decide whether you’re going to leave it in or take it out during sex. Only some pessaries are removable so if intimacy is important to you and your relationship, where possible, request a removable pessary. 

In one study of sexually active pessary users, 70% removed their pessary for sexual intercourse, often due to partner preference. Several studies have found the partner’s opinion on sex with a pessary was highly influential. Often it’s removed because the partner can feel it or is concerned that it will hurt the woman. 

Whether you want to remove the pessary or not is up to you considering pain reduction, pleasure enhancement and comfort.

Back to Basics - Touch Techniques

Touch is important for connection and increasing sexual desire. Use various touch techniques of differing pressure, vibration, temperature and location.

Non-genital touch sessions are great to start with by taking the pressure off a session heading too far or in a direction you aren’t ready for.

Genital touch doesn’t need to be skin-to-skin. Keep your underwear on until you feel comfortable removing them.

Intercourse Plan

Try lots of different positions until you find the ones that work best for you. Missionary is often thought of as male-dominant because they are on top, but you can take control from the bottom. For example, telling your partner to straighten their legs and support themselves on their elbows will automatically limit movement. Consider positions where gravity is working with you, NOT against you. 

Important tools of the trade

  1. Lubricant: grab a good lubricant that’s going to last. Silicone-based are thicker and longer lasting than water-based. Finding the right lube is all about personal choice and trial, so don’t be shy to shop around.
  2. Ohnut: a set of rings that act as a buffer and are used to stop penetrative pain. It’s great for easing back into penetrative intercourse. If you find a pessary during intercourse more comfortable but your partner can feel it, the Ohnut may be enough to prevent them touching it so you can both enjoy the same level of comfort.

Confidently get back in the saddle and enjoy your sexual health and all its benefits.

Contact Vanessa directly for any questions or download her Sex and Prolapse Fact Sheet for more information.

Written for Bubba Bump by 

Vanessa Tarfon, Mmed(HSSH) - Sex Therapist and Founder

IG - @authenticawareness

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