Fibroids are the most common, noncancerous growth affecting people with uteruses*, with up to 80 percent developing fibroids in their lifetime. They are more common in Black uterus-havers as well as people in their 30s-50s.  Like all health issues, and especially those affecting the sexual and reproductive organs, fibroids can have big impacts on your sex life. Unfortunately, most conversations about fibroids don’t go there. We chatted with two sexual and reproductive health providers to get the information about fibroids and your sex life.

Fibroids vary a lot

“Fibroids are a little tricky because they can vary so much” says pelvic floor physical therapist Dr. Marqui Rennalls, PT, DPT. She’s referring to differences in location, size, and symptoms. “[Fibroids] can grow inside, outside, and/or within the walls of the uterus. If that’s not enough, their size also varies,” ranging from the size of your nail to a grapefruit or larger.  

Only about 25% of people with fibroids experience symptoms

According to gynecologist Dr. Temeka Zore, symptoms also are highly variable from one person to another and can depend on size, location, and numbers of fibroids. “Most [people] with uterine fibroids are asymptomatic, meaning they have no symptoms related to the presence of their fibroids.”

Abnormal bleeding is one of the most common symptoms of fibroids

 “Periods spanning weeks don’t leave much room for sexy time,” says Dr. Rennalls. “If that’s not enough, the major loss of blood from those periods can result in anemia and therefore make sex a strenuous and exhausting experience. Add a little dizziness, nausea, and a headache or three on top of that from the anemia and sex just might not be at the top of your to-do list.”

Beyond that, fibroids can also throw off progesterone and estrogen, two hormones that plan a big role in sexual desire

Pelvis pain and pressure are also common symptoms that can cause sexual problems and low sex drive

“People with larger fibroids or who have fibroids located toward the top of their uterus (known as the fundus) may experience more issues with sexual dysfunction compared to fibroids in other locations of the uterus,” says Dr. Zore. 

Meanwhile, Dr. Rennalls flags those that arise near the cervix as leading to painful sex. “[…] depending on the size- the friction and pressure during penetrative sex can cause anything from mild to severe pain.” That pain can be accompanied by some blood too, which may or may not fit into your definition of sexy.

Treatment for fibroids focuses on reducing size and symptoms

“Treatment options will largely depend on where the fibroids are located as well as future childbearing wishes,” says Dr. Zore, “These options should be discussed with your gynecologist to determine which may be best based on your individual history and goals for therapy. “ 

Treatments range from medications that affect your hormones to surgeries. Concerns about these treatments, as well as the actual experiences of them, may further impact one’s sexual desire. 

Just like with diagnosis, there’s racism in the treatment of fibroids. Dr. Zore elaborates:

“[…] one study noted that black [uterus-havers] were almost 4x as likely to have a hysterectomy for any medical diagnosis (not just fibroids) compared to [their white counterparts]. This may speak to a larger issue as to whether black [people with uteruses] are being counseled adequately about alternative options to hysterectomy for their medical diagnoses or whether they are presenting later for care and hysterectomy becomes one of the only options that will be of benefit.” 

Pelvic floor physical therapy is one way to treat the symptoms of uterine fibroids

Because fibroids take up space in the pelvic region, they increase the pressure in the area. Beyond painful sex, this can lead to difficulty having bowel movements, frequent urination, and pain in the low back, hips, tailbone, stomach, or other local areas.

Pelvic floor muscles are responsible for [all these function] and the ease in which you are able to perform these daily tasks. Pelvic floor physical therapists are specially trained to treat myofascial pain and the pelvic floor muscles. We use internal and external manipulations of the muscles to alleviate pain and encourage optimal function.”

You can take steps to manage fibroids and their symptoms at home

These include things like:

Diet and environmental exposure may also play a role in the development of fibroids. “Phthalates are one emerging area of study as these have been shown in numerous studies to be endocrine disruptors and may mimic reproductive hormones like estrogens and androgens and interrupt the normal endocrine balance. One study noted that higher exposure to certain phthalates, such as those found in plastics, may increase fibroid volume. Additionally, another study noted fibroids were more common in [uterus-havers] who ingested more trans-fatty acids in their diets” says Dr. Zore. While this research is new, taking steps to avoid exposure are additional steps you can take on your own to support your reproductive health.

It’s important to check for fibroids

“I wish women realized how common uterine fibroids were and also that if they are noticing a change in their bodies, whether it is their menstrual cycles, their sexual function/desire or pelvic pain or pressure to speak up and let their OB-GYN know,” says Dr. Zore.

Dr. Rennalls agrees, wishing that all people with a uterus—and especially Black uterus-havers—knew to check for fibroids. This is especially true since asymptomatic fibroids can still cause problems with your pelvic floor. It’s worth checking for them to monitor and for the opportunity to optimize function—and increase your pleasure! 

You know your body best—and that makes you your best advocate

“No [uterus-haver] should have to suffer with pain and all deserve to have their voices heard regarding their bodies and concerns they have” stresses Dr. Zore.

We couldn’t agree more. 

*While mainstream medicine and media typically refer to UF as a “women’s health issue” 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.

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