Comfortable Sex Positions for Women with Pelvic Floor Disorders

Life can take its toll on your lady parts. Pregnancy, childbirth, menopause, and even chronic constipation and obesity can weaken your pelvic floor muscles. These important muscles act as a hammock, stretching across your pelvis and holding your organs (bladder, bowel, uterus, vagina) firmly in place.

When the pelvic floor muscles are weakened or the connective tissues of the pelvic area are damaged—whether from a rambunctious baby doing somersaults in your belly, or hormonal changes during menopause—you can develop a pelvic floor disorder (PFD).

PFDs can include:

• Urinary incontinence (a common condition that affects one in three women)
• Pelvic organ prolapse (when an organ in the pelvis slips from its normal position and presses on other organs, often the vagina)
• Fecal incontinence (loss of control of bowel movements)
• Vulvodynia (pain around the opening of the vagina)
• Vaginismus (tightening of vaginal muscles that makes sex painful)

The three most common PFDs are urinary incontinence, pelvic organ prolapse, and fecal incontinence. Pelvic organ prolapse is especially common in women after pregnancy, childbirth, and menopause. Types of prolapse include:

• Uterine prolapse: Occurs when the uterus drops down into the vagina, causing a bulging sensation in the vagina.
• Vaginal vault prolapse: Occurs when the top of the vagina becomes detached from the ligaments and muscles of the pelvic floor (often after a hysterectomy), and drops down into the lower part of the vagina.
• Bladder prolapse (cystocele): Occurs when the bladder becomes detached from the supportive ligaments securing it to the pelvic bones and drops down into the vagina, creating a bulging sensation; bladder prolapse is a common cause of stress incontinence.
• Rectal prolapse (rectocele): Occurs when the rectum (the last section of the bowel) drops down and presses against the back wall of the vagina, creating a bulge.
• Small bowel prolapse (enterocele): Occurs when the small intestine drops down and presses against the top of the vagina, causing a bulging sensation.

These video animations by the American Congress of Obstetricians and Gynecologists are helpful for visualizing what happens when an organ prolapses.

If you have a PFD, sex can be uncomfortable or painful, which can seriously impact your self-esteem and intimacy with your partner.

Here are tips for more comfortable sex if you have a PFD.

If you have a prolapsed pelvic organ:

• Avoid being on top (“cow girl” position), as well as having sex standing up; these positions allow your prolapsed organ to drop down toward the vagina, which can make sex painful or uncomfortable.
• Instead, try a modified missionary position (man on top, you on your back) with pillows placed under your pelvis, which tilts your pelvis back and allows your prolapse to retract into your body; this can help lessen discomfort and ease any worries you might have about whether he’ll be able to feel the prolapse (he won’t). Make sure to use plenty of water-based lubrication to avoid discomfort or pain.

If you have urinary incontinence…

• Avoid the missionary position and “doggy style” (you on all fours with him behind), which can agitate the bladder and cause leaks.
• Instead, lie down and place pillows under your lower back to raise your pelvis, which will help reposition the bladder out of the way.

If you have coital incontinence (incontinence with penetration)…

• Avoid the missionary and “doggy style” positions, which can press on the bladder and cause leaks.
• Instead, try sex in the shower (to mask leaks), as well as the cow girl position (you on top).

If you have vaginismus or vulvodynia…

• Experiment with different positions to find one that is most comfortable.
• If intercourse, or even the insertion of a tampon, continues to be painful we recommend seeing a pelvic health specialist like a urogynecologist. Ultimately, you may need vaginal dilators, topical anesthetic creams, or Botox injections (at your doctor’s discretion) to help relax the muscles and/or relieve pain.

Hope for Women with PFDs

The good news is that there are things women can do to address pelvic floor dysfunction. Some conditions may require a pessary or surgery to correct (such as a severely prolapsed organ), while milder cases of prolapse may be correctable by strengthening the pelvic floor muscles with regular Kegel exercises. In fact, doctors recommend strengthening the pelvic floor as a woman’s first line of defense against pelvic floor problems.

The PeriCoach pelvic floor exerciser is an innovative biofeedback device designed to help guide you in performing Kegel exercises correctly, and it tracks your progress in real time. Learn more about PeriCoach, and hear stories from real women about their experience using the PeriCoach Kegel exerciser.