Cystic fibrosis (CS) comes with a set of issues that concern the vagina, sex, and fertility quite specifically. While CF is covered amply in other corners of the internet, this space is just for the vaginal, sexual and reproductive impacts of cystic fibrosis. It might not apply to children with CF right now, it’s good to know for the future.

Reproductive system impacts

Hormones

People with CF have normal hormone levels, which means that sexual desire, function and fertility remain intact, at least in theory.

Hormone clearance is poor, however, since the liver, bowel and kidneys don’t have sufficient flow to clear. That can result in hormone build-up, including oestrogens – oestrogen excess can result, which comes with its own problems including breast tenderness, body fat distribution changes, and PMS. It can also add to making you feel like crap, since the liver can’t process your metabolites properly. This is exacerbated when you add a lot of medicine on top of it.

There are only two ways to help this, and that is either reducing the liver’s load from the top end (your mouth), and then helping the liver along with medication to clear out mucous. Some herbal medicine can be really useful in supporting your channels of elimination (liver, kidney, skin, bowel), so talk to a herbalist, in conjunction with your doctor. Your herbalist or naturopath will be able to tell where your hormones are at generally by asking you some questions and looking at whether you are showing signs of oestrogen excess.

Sex life

CF doesn’t stop you wanting to have sex – libido can be healthy and normal, despite some of the physical, mental and emotional barriers that can crop up from time to time.

Sometimes it can be hard to imagine ever feeling good enough to have actual sex, but when you do, it can be problematic in several ways. First, you have the mucous to deal with. Second, you worry about or do get puffed. Third, take your pick of symptoms that make sex uncomfortable, from coughing up bloody phlegm to incontinence.

Ways to make sex easier and better

i) Don’t be around things that aggravate your symptoms. That might sound obvious, but lots of things that go with sexy are also bad for you. This includes perfumes, both yours and your partner’s, cigarette smoke, and anything else that smells strong or affects your lungs.

ii) Use a short-acting bronchodilator 20-30 minutes before having sex.

iii) Try to dislodge as much mucous as you can before your ‘date’ using your exercises.

iv) Have sex in positions that are not too strenuous for you – your partner may need to do more work. Avoid putting pressure on your chest, as it can cause you to cough.

v) Use birth control if you don’t want to become pregnant – it’s still possible! The Depo Provera shot is not recommended for women with CF, since it increases the risk of osteoporosis. Discuss birth control options that suit CF best, since some medication can interfere with birth control.

vi) Use a barrier method of contraception to protect you from sexually transmitted infections if required.

Common issues for women with CF

Fertility

In the vagina and cervix, secretions can be so thick and sticky that sperm can’t move into the uterus or fallopian tube to fertilise the egg, compromising fertility. Ovulation may be less frequent. It is important to speak to your healthcare provider about any desired pregnancies before the disease advances.

Additionally, CF can be passed on to your children, but so long as they don’t find a partner with the gene too, their offspring won’t have CF. CF needs both parents with the gene. Pregnancies are unaffected. Some options if you have trouble getting pregnant naturally are having the semen implanted into the uterus to try to facilitate movement into the fallopian tube, or more serious help with IVF or other assisted techniques to get a fertilised egg straight into the uterus.

Yeast infections 

Women with CF suffer yeast infections more than most, since antibiotics and corticosteroids disrupt vaginal acidity and microflora, resulting in frequent overgrowths. Any time you are on antibiotics or steroids (or just anytime), you can take a targeted probiotic that contains Saccharomyces boulardii, a known yeast fighter, to combat the yeast infection.

Avoid carbs – yeast loves carbs. Additionally, eat as many fermented foods as you possibly can – you can make these cheaply at home or buy them alive (important!). Sauerkraut, kimchi, tempeh, kombucha, milk and water kefir… Fermenting foods is an excellent way to help avoid infections in your whole body, and help keep pathogenic bacteria and yeasts at bay.

Antifungals are available over the counter at pharmacies.

Stress incontinence

Stress incontinence occurs when urine is expelled upon coughing or sneezing or heavy lifting. Exercises can really help with this – see the pelvic floor exercises list.

 

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