When it comes to painful intercourse, most women put off looking into it right away and most men are concerned but not sure where to go or how to approach solving the issue. When looking into the cause, the majority of the time we go to the most complex and complicated causes when the more common cause is right in front of us. Unfortunately, painful pain during sex, pain at the point of insertion, and pain at the time of orgasm and ejaculation is becoming more common and not necessarily in older age or infection. This blog will explore the biomechanical aspect of painful intercourse in detail.
Anatomy of the Pelvis
Your pelvis is the housing of the pelvic floor and where the genitals are located. It consists of 3 bones, 6 joints which are the 2 sacroiliac joints in the back, pubic symphysis in the front, lumbosacral joint above, and the hip joints (at Acetabulum) on the two bottom corners.
(courtesy of https://orthoinfo.aaos.org/)
It has nerves that branch off the lower back and sacrum to supply its muscles and organs, arteries and veins, and connective tissues to hold the pieces together.
Pelvic Biomechanics
The pelvis is like a bowl with the ilium and sacrum working opposite of each other with every step you take. In a properly aligned pelvis, the ‘bowl’ is level and parallel to the ground, the thigh bone connected to the acetabulum (see the figure above) is centrally located within the joint. The last vertebra of the lower back is placed evenly and in a balanced place above the sacrum to form the sacroiliac joint.
Now, let’s think about this for a moment! Do you think your pelvis is balanced? Go ahead and stand up in front of a mirror looking at yourself sideways, wiggle in place and stand without posing. Does it seem that your pelvis is in front of, behind, or right on top of the bump on the side of your ankle? (if you were to draw a line connecting the outside of your hip to that bump on your ankle) Is your pelvis is tipped forward, backward or straight parallel to the ground?
Posture and Painful Intercourse
When it comes to intercourse and posture, we need to look at the positioning of the pelvis at the time of intercourse. Many times, you already have figured out in what position your pelvis needs to be in order to experience or manage pain. Most often putting a pillow under the pelvis to create more of a flexion seems to feel better; this means that you have an anterior pelvis where the ‘bowl’ is tipping forward.
If pain happens at the point of insertion in females, in the muscles of the pelvic floor, more from the first layer to the third layer, there is an over-contraction. Manual work on those areas to assess the strength and the tone of those muscles will be needed. More often, devices like dilators can be used if the tightness and contracture in the first and second layers are too much. Once again, we are looking at biomechanics and the contribution of the postural muscles and the skeletal system as the focus of this blog.
In men, sometimes the pain is after the erection or ejaculation; in those instances, the soft tissue at the triangle right above the shaft of the penis at the connection to the pubic area should be assessed as they can be pressed on when the penis is flaccid. There may be an association between the positioning of the pelvis after erection or ejaculation that causes pain. Again, this is a good example of the need for an internal examination to assess the quality of the pelvic floor muscle tonicity and contracture.
In general, when it comes to pain, the medical community seems to be more interested in associating the pain with nerve or muscle issues while disregarding the correlation between pain and pelvic positioning. This is the time to remind you that medication, certain diseases, associated nerves, surgery, and scar tissue are examples of other causes of pelvic pain.
Treatment for Posture-Related Pain
If pelvic floor dysfunction was the name of a book, this book has many chapters one of which is painful intercourse. Addressing all presentations of pelvic floor dysfunction has to be comprehensive or the problem will return sooner than later. In my office, all pelvic floor dysfunction assessments start with a comprehensive examination including postural neurology, functional movement, breathing assessment, and pelvic floor exam externally.
In my blog: “ Why does pelvic floor dysfunction occur’, I discuss the treatment in detail and explain how, the areas that are being missed the most when treating pelvic floor dysfunction are:
- Postural Neurology
- Baby exercises vs the generic exercises prescribed
- Biological breathing vs the supposed abdominal breathing
- Impact of ergonomics on the pelvic floor
- Impact of sleep on the pelvic floor”
- When indicated, Emsella chair to strengthen the pelvic floor muscles at 400 kegels per minute.
If you are wondering if your pain during intercourse may be related to your posture, contact me.