This narrative review aimed to summarize existing evidence on the impact of uterine fibroids on women's sexual health and to draw attention to an underreported aspect of clinical care. The authors conducted a literature-based narrative review focused on associations between fibroids and female sexual dysfunction and framed the topic as clinically important yet often marginalized in practice.
Uterine fibroids are identified as the most common benign uterine tumors. In symptomatic patients, several clinical manifestations directly or indirectly impair sexual function. Prominent among these are heavy menstrual bleeding and progressive anemia, which contribute to generalized fatigue and reduced sexual desire. Local pelvic symptoms reported in the literature include pelvic pressure and mechanical discomfort, and many women experience pain with intercourse, described as dyspareunia. These physical symptoms combine to lower quality of life and reduce interest in sexual activity.
The review describes multiple pathways by which fibroids can lead to sexual dysfunction. Mechanical effects of intramural or large subserosal/submucosal fibroids can create pelvic pressure and pain during penetration, limiting arousal and sexual activity. Pain during or after intercourse can produce anticipatory anxiety and avoidance behaviors, compromising both desire and arousal. Anemia from chronic heavy bleeding contributes via reduced energy and libido. The authors also emphasize psychological mechanisms, noting that fear of pain, reduced self-image, and emotional distress related to symptoms can impair arousal and orgasmic function.
Heavy menstrual bleeding and the resultant progressive anemia are highlighted as key systemic contributors to diminished sexual desire. Anemia-related fatigue and reduced overall well-being are described as lowering libido and the capacity for sexual activity. The review ties these systemic effects to broader detriments in quality of life and underscores that correcting bleeding and anemia may be an important component of restoring sexual desire.
Beyond physiological and mechanical factors, the review places emphasis on psychological contributors to sexual dysfunction in women with fibroids. Fear of experiencing pain during intercourse, concerns about bodily changes or appearance, and lower self-esteem arising from chronic symptoms can reduce sexual interest and interfere with both arousal and orgasm. The interplay between physical pain and psychological sequelae is presented as a reinforcing cycle that can sustain sexual dysfunction unless both domains are addressed.
Surgical interventions such as myomectomy and hysterectomy are reported to often improve sexual function by alleviating the physical symptoms that impair sexual activity. However, the review cautions that outcomes are variable: improvements depend on the specific surgical technique used and on the potential for perioperative or iatrogenic nerve injury, which can negatively affect sexual response. The literature summarized indicates that while many patients report better sexual function after symptom-relieving surgery, other patients may have unchanged or worsened sexual outcomes depending on surgical factors and individual circumstances.
A central recommendation from the authors is that clinicians treating women with fibroids should include routine assessment of sexual health using validated tools. Incorporating standardized sexual function questionnaires into clinical evaluations would help identify the scope and drivers of dysfunction—physical, hematologic, surgical, and psychological—and would support more comprehensive, patient-centered management plans. The review suggests that acknowledging and measuring sexual health as part of fibroid care can reduce marginalization of the problem and improve outcomes.
The review concludes that uterine fibroids significantly impact women's sexual health through a combination of heavy bleeding and anemia, mechanical pelvic symptoms including dyspareunia, and psychological distress that reduces desire, arousal, and orgasmic function. Surgical treatments that relieve symptoms often lead to improved sexual function, but variation in outcomes means clinicians must weigh risks and discuss expectations with patients. The authors call for routine use of validated sexual health assessments in fibroid management to deliver more holistic and patient-centered care. Specific measurement instruments and detailed protocol recommendations were not reported in the abstract of the source review.