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Back and Hip Problems That Can Make Sex Hurt    

“Thigh bone connected to the hip bone/Hip bone connected to the back bone”: we’ve all heard these lyrics from the song “Dem Bones.”

A pelvic floor physical therapist might jokingly add, “Hip and back bones connected to the vagina.”

It’s not as far-fetched as it sounds. The lumbar spine (lower spine), sacrum (bottom of the spine), coccyx (tailbone), pubic bone, and hip bones form a “cage” known as the pelvis. Misalignment of these pelvic bones can throw off the joints, muscles, connective tissue, and nerves in the pelvis—causing vaginal pain and pain during intercourse.

As the National Vulvodynia Association says, “When any portion of the skeleton is injured, the effects radiate . . . both the musculoskeletal system and the nervous system [are] pathways for sexual pain.” (Please note that there can be other causes of sexual pain. This article focuses on musculoskeletal factors.) 

The anatomy of pelvic pain

These common pelvic-area issues can set off a chain reaction leading to vaginal pain and pain during sex:

Low back problems—injuries, osteoarthritis, bulging disks, spinal cysts, tumors, and scoliosis (sideways curvature of the spine)

Hip problems—labrum tears and femoroacetabular impingement (jammed ball and socket)

Coccydynia (tailbone pain)

Unstable sacroiliac joint (joint connecting the sacrum and the pelvic bones)

Injured pubic bone

Inflamed iliopsoas conjoined tendon (muscles and tendon connecting the front of the spine to the hip bones)

Injured ischial tuberosities (sit bones)

Diastasis recti (separated abdominal muscles resulting from pregnancy)


To “pinch hit” for these sidelined body parts, the muscles and connective tissue in the hips and pelvis may contract, stretch, or weaken. Then they can press, pinch, stretch, and irritate the pelvic nerves. All can cause vaginal pain and pain during intercourse.

How physical therapy can help

Like other musculoskeletal conditions, pelvic-area orthopedic problems usually respond beautifully to physical therapy. At Raquel Perlis Physical Therapy, we take an integrated approach, combining any of the following techniques to rehabilitate your pelvis and relieve pain during sex. Some will be familiar if you’ve had physical therapy in the past.

  • Core stabilization exercises to support and strengthen your abdominal muscles and back. People often do these exercises incorrectly, straining their pelvic floor and back. Learning proper technique is vital.

  • Exercises to strengthen your hips and legs.

  • Exercises to relax, release, and stretch your back, hips, and legs.

  • Hands-on techniques such as massage, myofascial release, soft-tissue mobilization, and scar mobilization.

  • Muscle-energy techniques to gently improve joint alignment.

  • Muscle reeducation to improve your posture, balance, movement, and body mechanics.

  • Ergonomics.

  • Hot and cold packs.

  • Cold laser (not recommended for pregnant women).

  • Ultrasound (not recommended for pregnant women).

  • Relaxation and breathing techniques.

After a course of physical therapy, most women feel significantly better and can start to enjoy pain-free, pleasurable intercourse.