Spring 2011: The Sex Files

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 Quite a few women with uterine fibroids suffer in silence, unaware of how common their condition actually is and not knowing where to turn for help and support.

Between 20 and 35 percent of women ages 25 to 50 have symptomatic uterine fibroids (leiomyomata). And African American women have an even higher chance of developing these benign (noncancerous) tumors and experiencing symptoms at an earlier age. Even more women have fibroids without knowing it. 

As far as sexuality is con-cerned, uterine fibroids typ-ically do not affect the ability to get aroused, lubricate or reach orgasm. But, those who exper-ience symptoms complain of feeling and looking bloated, pelvic pain and pressure, heavy and prolonged or irreg-ular menstrual bleeding, frequent urination, gastrointestinal problems and pain during intercourse. Some women with excessive menstrual bleeding become anemic and feel tired all the time. All of these symptoms can range from mild to severe—and any of them can make the woman feel not only uncomfortable, but less attractive, causing her to put the brakes on her sex life. 

Uterine fibroids also can interfere with fertility. A woman may have problems becoming pregnant or, if she’s already pregnant, she may experience a miscarriage or other complications. 

How do you find out if you have fibroids? If you are experiencing any of the above-men-tioned symptoms, you should ask your health provider. The diagnostic test comprises a pelvic exam, often combined with ultrasound, MRI or CT imaging of the uterus, and will show one or several tumors. Size-wise, these can range from looking like a raisin to a large grapefruit, and they can be located anywhere in the uterus wall or even grow as stalks from the uterus. The latter type can cause much pain if they become twisted. Uterine fibroids depend on estrogen for their growth and usually shrink or disappear following menopause.

Treatment options for fibroids range from lifestyle modifications, acupuncture, anti-inflammatory drugs, hormone therapy and birth control pills to surgery to remove the uterus. In fact, uterine fibroids are now the most common reason for hysterectomy. However, there are now alternative treatment options available, which let the woman retain the potential for fertility by leaving her uterus in place. These include:

Myomectomy: Instead of removing the entire uterus, only the fibroids are surgically removed. 

Uterine fibroid embolization (uterine artery embolization): The blood supply to the fibroid is blocked, thereby starving it and helping it shrink. During this procedure a fine tube is threaded through an artery in the groin and small pellets are introduced to block the circulation.

Magnetic resonance-guided focused ultrasound: This non-invasive, outpatient procedure can cause symptom relief with-in days of treatment, and fol-lowing it, fibroids shrink about 30 percent every six months. 

Currently, UVA has one of the few treatment centers world-wide that offers MR-guided focused ultrasound for uterine fibroids. The Focused Ultrasound Surgery Foundation (fusfoundation.org), located here in Charlottesville, helped to open the center in partnership with UVA, and has a patient support initiative, Fibroid Relief. Visit fibroidrelief.org or call 220-4859 for more information.

Charlottesville’s Annette Owens, MD, Ph.D., is certified by the American Association of Sexuality Educators, Counselors, and Therapists. She has co-edited the four-volume book, Sexual Health (Praeger).

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