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When it comes to painful intercourse, it seems that often it is females that endure the pain and discomfort much longer compared to their male counterparts before seeking treatment. The questions then that need to be asked are: when exactly the pain or discomfort is noticed, when there is a relief, and if that seems to be with every episode. This blog provides the questions that you should have an answer to when seeking advice, the subtle signs of pelvic floor dysfunction, what the comprehensive treatment entails, and who to seek treatment from.

Questions To Ask Yourself About Painful Intercourse

It is ideal to have the answer to the following written up digitally and on paper to give to your provider of service when seeking advice and care regarding pelvic intercourse pain. Please note that while many of these questions are related to intercourse, there are a few that have to do with conditions that are not typically thought of as being part of pelvic floor dysfunction. Unfortunately, pelvic floor dysfunction is very misunderstood and most treatments are therefore not comprehensive in the approach.

The questions you need to answer are:

  • How long have you had this pain?
  • Is it getting progressively worse?
  • What have you done about it?
  • Any Urinary Tract Infection history?
  • What tests, if any have been done?
  • Whom have you sought care and what was done by them?
  • Pain at the point of insertion or beyond?
  • Does it last the whole time or goes away with an orgasm?
  • Does a different position relieve or accentuate the pain?
  • Any pain with urination?
  • Any pain with masturbation?
  • Any pain in the pelvis during the day and not related to intercourse?
  • Any pain in the penis/vagina, rectum, or the tissue in between (perineum)?
  • Any history of lower back pain?
  • Any history of sacroiliac pain?
  • Any history of hip pain or restriction in movement?
  • Any accidents (sports, auto, or other)?

The Subtle Signs of Pelvic Floor Dysfunction?

Subtle mingling of colorsAccording to the blog, ” Pelvic floor dysfunction symptoms”, subtle signs to pay attention to that most often are missed include:

  • Lower back pain
  • Pain in the back joints of the pelvis (SI Joints)
  • Pain in the front pubic area
  • Arched lower back
  • Slouched lower back
  • Slouched mid-back or hunchback
  • Military posture with the chest pushed out
  • A V-stance where the torso is positioned behind the hip joints on the side view
  • Chronic forward neck
  • Inability to bend down below the knees
  • Habitually standing on one leg with the other leg bent
  • Chronic one-sided pain in the lower extremity
  • Hip pain on one or both sides

The question to ask is which one of these you have had or are currently experiencing? If pelvic floor dysfunction is the name of a book, it has many chapters and painful intercourse is one of those chapters. The mistake is that each chapter is often looked at as if it is a book by itself!!

Holistic Treatment For Pelvic Floor Dysfunction

While most often, it is the internal manual treatment that is performed as the main course of treatment for pelvic floor dysfunction, there is some focus on breathing and coordination of breath with the relaxation or proper engagement of the pelvic floor muscles. The pelvic floor is not independent of the rest of the pelvis and the integrity and stability of the pelvis itself and the attachments of the spine and hips to it, play a huge role.

In general, the biggest mistake is to disregard the role of the overall posture and movement biomechanics on the health of the muscles of the pelvic floor. We should not be focused on the ‘floor’ when the ‘house’ that the pelvic floor is the ‘floor’ of is unstable.

In my blog, “Are Yoga Exercises Good for Pelvic Floor Dysfunction“, I explore the comprehensive, non-invasive approach to treating pelvic floor dysfunction as listed below:

  • “Behavior modification which is always part of the solution list to all issues (your behavior about life changes how you do everything in life), is not going to correct any dysfunction fully but addresses some of the feeders of the problem.
  • Postural Neurology: Movement is like a concert and the body parts are like the musicians; in that the musicians not only need to know their part but to know when to chime in and phase out. That means the pelvis and pelvic floor need to know how to ‘play’ with the rest of the body if they are to sustain their strength and integrity. This is what Postural Neurology is all about.
  • Functional Movement: Common sense says that the most authentic way to move is the way babies move. After all, all babies from all over the world go through the same developmental stages of movement (Developmental Kinesiology) which means that we are hard-wired to move that way. So if the issue is movement-related or supported, then we should see how we compare to the way we moved as babies. All discrepancies are then highlighted and can be corrected through Dynamic Neuromuscular Stabilization (DNS) exercises which are baby movements.
  • Kegels? There are machines like the Emsella Chair that do 400 Kegels per minute involving all of the muscles of your pelvic floor and not the ones that you hope to be engaging. Note that Kegel exercises are not for all types of incontinence and pelvic floor muscle issues.
  • Breathing is what babies do automatically and that is what we need to do in order to sustain the bottom of the breathing apparatus, the pelvic floor!
  • Internal manual work which ideally should be done to assess the muscles inside the pelvis BUT does not have to be done in all cases.
  • Nutrition:  Avoid Citrus, caffeine, soda, artificial sweeteners, and spicy foods! Take collagen, Vit. C, Vit. D, Omega 3, and protein if no conflict with any other conditions that suggest their avoidance.
  • Ergonomics: Sit on an exercise ball vs a chair, get a keyboard that is as wide as your shoulders, limit your sitting to no more than one hour and alternate with standing, and make sure the middle of your monitor is at eye level to name a few.
  • Postural Awareness: It is important to pay attention to the posture and catch yourself when not standing on both feet, slouching, or shifting the pelvis forward and in front of the ankles. Best to associate the increase in attention with activities done each day; for instance, when talking to someone pay attention to the feet and pelvis positioning.
  • Sleeping habits: do not sleep on the stomach and if you are a stomach sleeper get a body pillow to minimize that.”

Who Is The Best Provider For Treatment of Pelvic Floor Dysfunction?

In my practice, while I have the training to perform internal work for pelvic floor dysfunction, I prefer referring patients to those providers who prefer not to do the pelvic stability work that I do with my patients. However, most often, by the time the patient is done with their pelvic stability regimen at my clinic, they do not need any internal manual work.

Pelvic floor dysfunction should not be a life sentence and painful intercourse is often resolved once the comprehensive treatment is finished. The most important goal for you should be to understand the principles and functionality of your movement which should be achieved from your treatment. Freedom is in understanding how to see the issue at hand and how to prevent it from happening. If you have painful intercourse and are wondering if it has to do with your unstable pelvis and posture, do not hesitate to contact me.

Dr. Shakib

Who Needs Pelvic Floor Therapy?

Constipation, Pelvic Floor Dysfunction, and Pelvic Stability