Everything You Need To Know About Having Sex With PCOS

It's estimated that one in every 10 to 15 women has polycystic ovarian syndrome, a.k.a. PCOS. But while the condition is fairly common, medical experts know surprisingly little about the causes of PCOS — and even less about its impact on women's sexual function.

PCOS involves a cluster of symptoms, which means that individual women can have vastly different experiences with the disorder. Some of them may not even have ovarian cysts, as the name would suggest. To be diagnosed with PCOS, a woman just needs to meet two of the three criteria: high levels of androgens (male sex hormones), lost or irregular periods, and polycystic ovaries.

According to Dr. Shannon Clark, the hallmark physical symptoms of PCOS include weight gain, excess body hair, acne, and loss of head hair. But that's not true for every PCOS case; some women don't have any of the common physical manifestations, yet still experience the internal aspects of the disorder. PCOS is also linked with infertility, and many women with PCOS simultaneously suffer from coexisting metabolic and cardiovascular conditions, like diabetes and hypertension.

"All of this rolled into one can directly affect a woman's sexual function," Dr. Clark said.

So how exactly does this confusing diagnosis impact women's sex lives? We spoke to Dr. Clark and other experts to break it down. Click ahead for the info.
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Women with PCOS don't always have a great time during sex.

PCOS patients have been found to "markedly suffer from sexual dysfunction." This is especially true in terms of orgasming. Doctors aren't sure exactly why this is the case, but Dr. Clark said that it might be tied to hormonal imbalances, since excess androgens can throw a woman's hormones out of whack, which can affect sexual function.

But it's not just about hormones. Many PCOS experts say that women with the disorder may have body image issues that can lead to a psychological block during sex. The physical symptoms of PCOS — such as weight gain, excess body hair, and acne — can make sufferers feel uncomfortable about their appearance, which Dr. Clark said can directly affect their ability to orgasm, as well as negatively impact their mental well-being. In fact, depression and anxiety have been found to be more common among women with PCOS.

Joann Paley Galst, PhD, a psychologist who specializes in reproductive health issues, said that she tries to encourage women with PCOS who are feeling self-conscious in their sex lives (and beyond) to connect with their bodies in a way that makes them feel attractive and comfortable, whether that means taking a dance class, an exercise class, or doing another movement-based activity. This, she said, has helped her patients.

"It's not necessarily with the goal to lose weight, but it's for them to see that their bodies can function beautifully," Dr. Galst said.
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Women with PCOS are more likely to struggle with fertility.

The most common cause of infertility is PCOS, since the condition can cause women to stop ovulating. But for women seeking to have children, this issue can create problems in their sex lives.

Dr. Galst said that, when women with PCOS are trying to have a baby, intimacy can go from "the joy of sex to the job of sex," since conceiving can often involve scheduling sex during the times they're most fertile. Women also might be taking fertility medication that can affect their libido.

If having children is important to you, anxiety about fertility can also serve as a reminder of "not succeeding in one of your life's important goals," Dr. Galst said. Many times, women struggling with fertility can feel a sense of "my body is failing me," which can make sex less enjoyable, according to Mindy Schiffman, PhD, a clinical psychologist and sex therapist.

"Anyone having problems with infertility, not only women with PCOS, can have problems with sexual function," Dr. Clark said.
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If they’re not on the pill, women with PCOS may have irregular periods.

Anyone who's ever lost a pair of underwear to the "period pile" knows what a pain irregular bleeding can be. Women with PCOS know this feeling all too well, since erratic periods are a common symptom. Menstrual cycles usually last about 28 days, but since many women with PCOS often have high levels of androgens and insulin, their cycles can be thrown off, which can lead to heavy or irregular bleeding. (But it can also lead to lighter or absent periods; like we said, PCOS is a mixed bag.)

"Having irregular bleeding while trying to have a healthy sex life can be stressful, because you never know when you’re going to have bleeding," Dr. Clark said.

To fix this, doctors prescribe birth control pills or Metformin, a medication commonly used to treat diabetes. Or if you'd rather go drug-free, learn to embrace period sex. It can be way more fun than you'd think.
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PCOS can affect women's sex drive in unexpected ways.

The women who opt for birth control to regulate their periods may experience a drop in sex drive; about 15% of women taking oral contraceptives report decreased libidos, whether or not they have PCOS.

But other medications women with PCOS may be taking can affect sex drive, too. Dr. Clark said that women should be aware of how medications they're taking for coexisting illnesses — like diabetes and hypertension — could be affecting their sex drives. She said that Metformin, a common medication for PCOS and diabetes, has actually been shown to increase sexual desire in women.

Sounds great, but even an upward change in libido can be hard on the psyche if you don't feel "normal," Dr. Galst says. That's why it's smart to get info from your doctor about all potential side effects of meds and conditions — having a logical explanation for symptoms can be really comforting.
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Bottom line: Women with PCOS shouldn't be afraid to seek help if they're having trouble with their sex lives.

Most women with PCOS only seek out medical or psychological help if they're trying to conceive, so it's not really clear how PCOS affects women who aren't actively trying to have children. Dr. Clark stressed the importance of talking to your physician if you're feeling at all concerned about your sex life — especially if you're not diagnosed and have a family history of PCOS.

"It's better to address it sooner rather than later," Dr. Clark said. "Don’t wait until you get to the point where you’re trying to have a baby and can’t; realize you can be assessed earlier."

Dr. Schiffman said that women with PCOS can talk to a psychologist, sex therapist, or physician, and they can even find a support group in person or online.

"Sex is an important part of most people’s lives," Dr. Schiffman said. "When sex isn’t good or you’re having doubts about yourself, it can affect you in ways that are far more subtle than you may think."

She added: "Knowing that you're not the only one can help."
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