Sex With PCOS: How to Maintain Intimacy in Your Relationship
An often silent threat best known for its impact on fertility, polycystic ovary syndrome (PCOS) can also invade people's sex lives.
PCOS triggers a wide range of symptoms that rarely look identical in people with the condition. Some women will experience little to no symptoms, while others will be plagued by infrequent periods, ovarian pain, excessive hair growth, fatigue and more.
PCOS affects between 6 percent and 12 percent of reproductive-age women in the United States, according to the Centers for Disease Control and Prevention (CDC). Across the world, 1 in every 10 women will be diagnosed with PCOS in their lifetime, as reported in the Journal of Human Reproductive Studies.
Rebuilding self-esteem brick by brick can prevent you from bringing insecurities into the bedroom.
PCOS can take a long time to diagnose, with a 2017 study published in the Journal of Clinical Endocrinology and Metabolism revealing that more than one-third of women reported diagnosis taking more than two years and requiring visits to more than three different health professionals.
As a result, its impact on sexuality is under-researched and solutions equally underfunded. Despite its best efforts, PCOS does not and should not have the power to snuff out anyone's sexual satisfaction entirely. Figuring out how best to manage it and maintain your sex life requires practice and patience, but it is certainly possible.
What is PCOS?
"PCOS is the most common endocrine disease in reproductive-age females," said Corey R. Babb, D.O., an OB-GYN with Haven Center in Tulsa, Oklahoma. "It is an amalgamation of symptoms that typically manifest with abnormal periods, signs of excessive testosterone and multiple cysts on the ovaries."
The condition is caused by the ovaries producing an abnormal amount of androgen—the male sex hormone usually only present in women in small amounts. The name PCOS is derived from the numerous small cysts on the ovaries.
More than half of women with PCOS do not have symptoms, according to the United Kingdom's National Health Service. However, potential symptoms include sleep apnea, weight gain, thinning hair and hair loss, acne and difficulty getting pregnant.
Symptoms of PCOS typically manifest during a person's late teens or early 20s. There is no singular test to diagnose PCOS, but a physician will likely order blood tests to evaluate hormone levels and study the ovaries using an ultrasound.
"There is no known cure for PCOS, though the symptoms can be managed," said Charlotte Cremers, G.P., a U.K.-based general practitioner and relationship expert. "This condition is treated depending on the type of symptoms. Symptoms such as hair loss and excessive hair growth can be managed using the combined oral contraceptive pill or eflornithine for facial hair. Anti-androgens like spironolactone, flutamide, cyproterone acetate or finasteride can also control excessive body hair."
Explaining to your sexual partner about your PCOS condition can be challenging but also relieving if your partner understands your ordeal.
If your symptoms indicate PCOS, do not be afraid to advocate for yourself. This condition often takes a long time to diagnose and patient self-advocacy is key to improving diagnosis rates. You know your body better than anyone else, so speak up.
Other management methods include making dietary changes to introduce more whole foods, fruits and vegetables and getting regular cardio exercise. However, there is no linear treatment plan for PCOS; it depends on the symptoms and the impact on the individual.
"It honestly varies from month to month, so there's nothing specific," Babb said. "Some patients find that if they're on oral birth control or other hormonal medications they will have less noticeable symptoms."
As there is no cure for PCOS, treatment is largely reliant on lifestyle changes and individuals identifying the best management techniques for them. For people who encounter fertility difficulties, doctors can prescribe medications to assist or provide insight into IVF treatment.
Can you still have sex with PCOS?
"PCOS affects sexual functioning and satisfaction and the sexual response cycle," Cremers said. "Women with PCOS have significantly reduced orgasms. A study showed that women with normal-level testosterone are at a higher risk of sexual dysfunction."
Women with PCOS have a significantly lower orgasm completion rate compared to women without PCOS, according to a 2013 study published by The Journal of Sexual Medicine. Although it did not discover any other significant differences in sexual dysfunction between women with and without PCOS, another study had different results.
A 2014 report published in the Iranian Journal of Reproductive Medicine reported that desire and arousal were affected in 99.2 percent and 98.5 percent of cases, respectively. Reliable research into the impact of PCOS on sexual function is sparse, and determining the full scope of its impact on sexuality is impossible without further research.
However, existing studies and anecdotal evidence point to a broad range of effects, including lower libido and difficulty climaxing. A lesser-discussed symptom is the impact on penetration, according to Babb.
"Some patients may have pain with deep penetration secondary to enlarged ovaries, although this is not always the case," he said.
Overall, PCOS has a broad-ranging impact on a patient's well-being, with people with the condition being more likely to experience anxiety and depression. The physical side effects can interfere with sexual self-esteem, too.
"The symptoms of PCOS, such as belly fat, acne and too much body and facial hair, impact sex drive because women must deal with dissatisfaction with their appearance," Cremers said. "They also suffer perceived reduced femininity and feelings of less sexual attractiveness."
Navigating sex with PCOS
"Explaining to your sexual partner about your PCOS condition can be challenging but also relieving if your partner understands your ordeal," Cremers said. "The best move is to book a medical appointment together to make your partner understands the condition and its symptoms. This will allow your partner to find ways of helping and supporting you."
Communication is your most powerful tool for reigniting your sex life with PCOS. Be honest about the impact on your sexuality and work together to build an intimate connection that accommodates your needs and satisfies you and your partner.
"For many women with this condition, sex becomes painful to the extent that interest gradually diminishes," Cremers said. "Exercise patience and never allow the condition to define your sexuality."
Take your time while you figure out how PCOS has changed your sex life and how you can manage it. There is no need to rush—formulating a satisfying sex life takes time.
If penetration is uncomfortable, let it go for a while and focus on other sexual exploits. It will alleviate your pain and expand your sex life beyond the standard penis-in-vagina encounters.
For people with lowered libido, rebuild slowly by focusing on self-pleasure first. Try seducing yourself by setting aside a few hours to explore your body. Light some candles, create a playlist of your favorite sexy songs and identify things that arouse you. Plus, self-pleasure is a powerful pain-relieving tool, so it can help make those painful periods more manageable.
Managing the psychological effects of PCOS
The first step in dealing with the psychological impact of PCOS is identifying areas of vulnerability. Ask yourself how PCOS has changed your body and how you feel about each of these changes.
Try writing them down and adding solutions next to each issue. There are physical solutions to excessive hair growth and thinning hair, but the focus should be on creating mental strength by building a foundation of self-love.
Remember, physicality is just a small part of the sum of who you are. However, of course, that is far easier to say than to truly believe. So try standing in front of a mirror once a day, choose one thing you like about yourself, and say it out loud.
At first, this may feel excruciatingly difficult, but it should become easier with consistency.
Rebuilding self-esteem brick by brick can prevent you from bringing insecurities into the bedroom. If the effects of PCOS on your mental well-being feel too heavy to manage alone, reach out to support groups or seek a therapist to help manage the impact.