What’s Up Down There?

Incontinence, Pelvic Organ Prolapse, and Pain During Sex

Author: Stefanie Teng, M.D., Internal Medicine, Kelsey-Seybold Clinic – Katy

Keeping ourselves healthy as we age is the most important thing we can do for our overall quality of life – so it’s important to listen to all the signals our bodies send us, even when the signals that something is wrong

are coming from “down there.” From pain and discomfort to incontinence, symptoms and conditions within the pelvic region can diminish quality of life, inhibit your feeling of freedom, and hinder intimacy. Here are some common problems you should watch for.


Urinary incontinence, or the inability to control urination, is a real medical condition that creates real-world problems for women who suffer from it. Incontinence can range from mild to severe and is categorized into one of three main types:

  • Stress incontinence, which happens during times of physical exertion and even laughing, sneezing,             and coughing.
  • Urge incontinence, which is a weakened ability to prevent the flow of urine when there is an

urge to urinate.

  • Mixed incontinence, which is a combination of stress and urge incontinence.

Incontinence becomes more common with age. Many issues can cause it, including pregnancy, childbirth, and menopause, as well as genetics and hormonal status.

Some women (and men) are embarrassed by incontinence and, as a result, don’t seek treatment for it. Forget the stigma and talk to your doctor if you feel that your incontinence negatively affects your quality of life.

Your doctor can talk with you about treatment options that include:

  • Nonsurgical approaches with behavioral management for stress or urge incontinence.
  • Medicines to help with urge incontinence.
  • Nonsurgical, or in-office treatments for urge and stress incontinence.
  • Surgical treatments for stress incontinence.

Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP) is a usually progressive condition in which some internal organs move or drop because of weakened muscles, ligaments, and connective tissue in the pelvic area. A common women’s health concern, POP affects an estimated 24 percent of women in the United States – though the incidence may be higher, as many women may not seek treatment.

The five most common symptoms of POP are pain or a feeling of fullness in the pelvic area, urinary incontinence, chronic constipation, back or abdominal pain, and the unnerving sensation that your insides are “falling out.”

POP comes as the result of many causes, including vaginal childbirth, especially with large birth-weight babies, multiple childbirths, or difficult deliveries; pelvic floor muscle deterioration, often due to a drop in hormone levels at menopause; a family history of the condition; and even chronic coughing. Chronic constipation is not just a symptom; it also can be a cause of POP as well.

While some women may not need treatment for POP, others with more troublesome symptoms may opt for non-surgical treatments – like exercises or pessaries – or for one of several surgical options available, including noninvasive, robotic surgical approaches.

Pain During Intercourse

Nearly 3 in 4 women have pain during sexual intercourse at one time or another, according to the American College of Obstetricians and Gynecologists. The specific area where women feel pain with intercourse depends on the cause of the pain but can occur anywhere from the genitals to the abdomen and back.

With such a high prevalence, it’s no surprise that the pain has many causes. Sometimes the cause is a passing issue, like emotional tension or recent childbirth. Other times the cause of the pain is longer lasting. Such causes range from ovarian cysts to gynecologic conditions like endometriosis and vaginal inflammation. Arthritis, diabetes, cancer, thyroid conditions, and some cancers can also make intercourse painful.

When pain comes with sexual intercourse, many women fail to seek help, due to the seemingly private or intimate nature of the pain. However, because pain during intercourse can signal a greater problem, it’s important to seek the advice of a doctor if your pain persists or is severe. Your doctor can speak with you about any pain that affects your quality of life and recommend a treatment plan with the cause of your pain in mind.

If your pain isn’t severe, you may be able to take measures at home to help, including use of a lubricant, taking warm baths or pain relievers before intercourse, and experimenting with activities that help you and your partner connect emotionally.

If you are experiencing symptoms, schedule an exam with your obstetrician, gynecologist, or primary care physician today. Call our 24/7 Contact Center at 713-442-0000.