Wednesday, April 15, 2009

Petite Pelvis?

Dr. Kate,

During intercourse with my girlfriend it feels like her vagina is very tight...too tight! It can actually be painful for me. My girlfriend does not admit to experiencing pain, but sometimes I wonder if it hurts her and she is afraid to admit it. However, I only notice this tightness in certain positions.

I did some research online and thought it was vaginismus; however now I'm starting to believe that isn't the problem. Since we have been together for a long time and I've had a chance to "explore" the area in detail, it seems that it is her pubic bone getting in the way. Can it be possible that her pubic bone is too low? If so, is this causing her pain even though she is not admitting it?

I sometimes wonder if it has anything to do with her being very petite? She is a size 00, so she is very small. But since I am not an overly endowed male I wouldn't think that would make a difference?

I'm also concerned about child birth problems if we get married. I can't imagine child birth going well if her pubic bone is partially blocking the way. Will this cause complications?

Thanks for the help,

Dear Boned,

It's true that women do have different shapes to their pelvis. The pubic bone may be higher or lower, along with different positions of the hip bones. You can't tell the shape of your pelvis based on your hip measurements or height, though. Your girlfriend being petite doesn't mean her pelvis is any more likely to be different from someone else's. She can ask her gyno at her next exam to perform "pelvimetry"--describing the shape of the pelvis via a vaginal exam--to see if her pelvic shape could be contributing to the difficulty.

But I haven't heard or read of women with a narrow pelvis having more difficulties with intercourse. If her vagina really feels "tight," it's likely because it is - and the most common reason for this is insufficient arousal before sex. While men can achieve arousal in the time it takes me to type this paragraph, the average woman needs 20 to 30 minutes of good foreplay to have enough vaginal engorgement and lubrication to make intercourse comfortable. (By "good foreplay" I mean whatever turns her on and gets her blood moving south.)

Vaginismus is certainly a possibility as well - women's vaginal muscles are quite strong, and can really clamp down before or during intercourse, often unconciously. While there is therapy available for vaginismus, I think your first move is to talk with your girlfriend about how she's feeling during intercourse. She may be reluctant to tell you that she's experiencing pain, too, and your being kind enough to begin the conversation may open the door for her. If she's not feeling pain at all, you may need to try different positions to find the ones that are comfortable and pleasurable for both of you.

If she does turn out to have a narrow pelvis, I wouldn't worry at this point about how she'll experience labor and delivery. My patients have surprised me quite frequently in the past--women I thought would sail through labor aren't able to fit the baby through their pelvis, and really petite women have birthed 9 pound babes without anesthesia (or pelvic damage).

Best of luck,
Dr. Kate

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