Cystic fibrosis and vaginas, sex, and fertility

Cystic Fibrosis and your vagina 65roses My Vagina

Cystic fibrosis (CF) comes with a set of issues that concern the vagina, sex, and fertility quite specifically.

Cystic fibrosis is covered amply in other corners of the internet, so this space is just for the vaginal, sexual and reproductive impacts of cystic fibrosis. It might not apply to children with CF right now, however it’s good to know for the future.

How cystic fibrosis affects your 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. This can result in hormone build-up, including oestrogens.​1​

Oestrogen excess can result, which comes with its own problems including breast tenderness, body fat distribution changes, and premenstrual syndrome (PMS) or premenstrual dysphoric disorder (PMDD).

Sluggish liver clearance can also add to making the day worse, since the liver can’t process your metabolites fast enough. This poor clearance is exacerbated when you add a lot of medicine on top of it.

There are only two ways to help this overload: either reducing the liver’s load from the top end (your mouth), and second, 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 or naturopath, 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.

How cystic fibrosis affects your 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. 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 when living with cystic fibrosis

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 negatively.

ii) Use a short-acting bronchodilator 20-30 minutes before having sex. iii) Try to dislodge as much mucous as you can before your hot 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 cystic fibrosis

Cystic fibrosis and (in)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 sooner rather than later.​2,3​

Additionally, CF can be passed on to your children, but so long as you don’t have a partner with the gene, 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.

Women with CF are understood to have lower ovarian reserve (less eggs stashed for release).​4​ Lowered levels of fertility are observed in women with CF overall, starting in adolescence due to malnutrition – late puberty, late starting periods, and/or a lack of periods is common. ​5​

Polycystic ovaries are also commonly found, in line with the hormone changes linked with polycystic ovarian syndrome (PCOS), which can also interfere with fertility.​6​

Cystic fibrosis and yeast infections

Women with CF suffer yeast infections more than most, since antibiotics and corticosteroids disrupt vaginal acidity and microflora, resulting in frequent overgrowths.​7​

Any time you are on antibiotics or steroids (or just anytime you need to), you can take a targeted probiotic that contains Saccharomyces boulardii, a known yeast fighter, to combat the yeast infection.

Check out our yeast infection page for more tips. 

Avoid carbs – yeast loves carbs. Additionally, eat fermented foods – you can make these cheaply at home or buy them alive (important!). Sauerkraut, kimchi, tempeh, kombucha, milk and water kefir all help keep the gut healthy and keep microbes in check.

Antifungals are available over the counter at pharmacies, however note that antifungals have just as high rates of drug resistance as antibiotics, and should be used sparingly.​8​

Cystic fibrosis and stress urinary incontinence

Stress urinary incontinence is when urine is expelled upon coughing, sneezing or heavy lifting – the ‘stress’ on your bladder and urinary tract.​9,10​ Pelvic floor exercises can really help with this form of incontinence – see the pelvic floor exercises list. It can also pay to see a pelvic physiotherapist for an assessment and proper exercises for your body.

You can do your kegels when you walk around, while you do the dishes or shower, keeping in mind that your breathing also impacts your pelvic floor, and relaxing your pelvic floor is just as important as strengthening it.​11​

Any time each day where you will remember to do your pelvic floor exercises is a good time, so pick the activity and make it a habit. The exercises are simple to do, and any ‘fitness level’ can do them.

It might start off hard, but as you practice each day, your muscles – like any muscle – will get stronger. Consistent, regular exercise brings results quite quickly.

If you already have stress urinary incontinence, these exercises are invaluable. If your pelvic floor exercises don’t work, then talk to your specialist for a referral to a pelvic physiotherapist, an osteopath who specialises in the pelvis, or another practitioner who can help you.​12​

References

  1. 1.
    Zeitlin PL. Cystic fibrosis and estrogens: a perfect storm. J Clin Invest. Published online November 20, 2008. doi:10.1172/jci37778
  2. 2.
    Jarzabek K, Zbucka M, Pepiński W, et al. Cystic fibrosis as a cause of infertility. Reprod Biol. 2004;4(2):119-129. https://www.ncbi.nlm.nih.gov/pubmed/15297887
  3. 3.
    Kazmerski TM, West NE, Jain R, et al. Family‐building and parenting considerations for people with cystic fibrosis. Pediatric Pulmonology. Published online August 18, 2021. doi:10.1002/ppul.25620
  4. 4.
    Schram CA, Stephenson AL, Hannam TG, Tullis E. Cystic fibrosis (cf) and ovarian reserve: A cross-sectional study examining serum anti-mullerian hormone (amh) in young women. Journal of Cystic Fibrosis. Published online May 2015:398-402. doi:10.1016/j.jcf.2014.09.008
  5. 5.
    Roe AH, Merjaneh L, Oxman R, Hughan KS. Gynecologic health care for females with cystic fibrosis. Journal of Clinical & Translational Endocrinology. Published online December 2021:100277. doi:10.1016/j.jcte.2021.100277
  6. 6.
    Hughan KS, Daley T, Rayas MS, Kelly A, Roe A. Female reproductive health in cystic fibrosis. Journal of Cystic Fibrosis. Published online October 2019:S95-S104. doi:10.1016/j.jcf.2019.08.024
  7. 7.
    Chotirmall SH, Greene CM, McElvaney NG. Candidaspecies in cystic fibrosis: A road less travelled. Med Mycol. Published online November 2010:S114-S124. doi:10.3109/13693786.2010.503320
  8. 8.
    Magee LC, Louis M, Khan V, Micalo L, Chaudary N. Managing Fungal Infections in Cystic Fibrosis Patients: Challenges in Clinical Practice. IDR. Published online March 2021:1141-1153. doi:10.2147/idr.s267219
  9. 9.
    Neemuchwala F, Ahmed F, Nasr SZ. Prevalence of Pelvic Incontinence in Patients With Cystic Fibrosis. Global Pediatric Health. Published online January 1, 2017:2333794X1774342. doi:10.1177/2333794×17743424
  10. 10.
    Dodd M, Langman H. Urinary incontinence in cystic fibrosis. J R Soc Med. 2005;98 Suppl 45(Suppl 45):28-36. https://www.ncbi.nlm.nih.gov/pubmed/16025765
  11. 11.
    Bø K. Pelvic floor muscle exercise for the treatment of stress urinary incontinence: An exercise physiology perspective. Int Urogynecol J. Published online September 1995:282-291. doi:10.1007/bf01901527
  12. 12.
    Cross D, Waheed N, Krake M, Gahreman D. Effectiveness of supervised Kegel exercises using bio-feedback versus unsupervised Kegel exercises on stress urinary incontinence: a quasi-experimental study. Int Urogynecol J. Published online July 8, 2022:913-920. doi:10.1007/s00192-022-05281-8


Jessica Lloyd - Vulvovaginal Specialist Naturopathic Practitioner, BHSc(N)

Jessica is a degree-qualified naturopath (BHSc) specialising in vulvovaginal health and disease, based in Melbourne, Australia.

Jessica is the owner and lead naturopath of My Vagina, and is a member of the:

  • International Society for the Study of Vulvovaginal Disease (ISSVD)
  • International Society for the Study of Women's Sexual Health (ISSWSH)
  • National Vulvodynia Association (NVA) Australia
  • New Zealand Vulvovaginal Society (ANZVS)
  • Australian Traditional Medicine Society (ATMS)
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