Health Organization for Pudendal Education

I am wondering is anyone feels like their pubic symphysis is separating or pulling apart? It happens the most during the night when I roll over in bed. It hadn't happened for a long time but now is happening again. Even if I twist or turn while standing it can happen. I have to be very careful to turn my whole body at the same time (as opposed to my upper torso first.) It scares the heck out of me. I feel like my pelvis is going to fall apart. Many times it is accompanies by a flare of severe clitoral pain. Anyone have any idea what's going on? Thanks for the input.

Hi,
Ugh I answered this once already and then the site crashed and I lost it
Trying again:
Simplest solution first. If your pubic symphysis feels like it is separating or pulling apart, it might be separating or pulling apart. this is called pubic symphyseal diastasis and is most common in women who have had babies. You can be checked for pubic symphyseal diastasis by an Osteopath or PT Manual Therapist.
The pubic symphysis is more of a shock absorber than an actual mobile joint; it is not really designed for motion. If yours is separating and has more mobility, it is is probably also causing greater mobility at the sacroiliac joint. If you are not too familiar with the structure of the bony pelvis, google some images of it and you should be able to see why this is logical.
A change in the mobility or position of the sacroiliac joint is known as sacroiliac joint dysfunction or SIJD, and it can put tension on structures within the pelvis which might in turn put pressure upon the pudendal nerve.
Hope this helps!
edit: forgot this from previous reply: Conversely, SIJD can cause tension on the pubic symphysis, so this is the next thing to investigate.

Thanks, HerMajesty, I actually have been told that my SIJ does shift in/out and when out i have terrible clitoral pain. When the chiropractor aligns me the next day the pain is down to a 2/3 and stays there. It's interesting that this may be causing my pubic symphysis pain. I never thought of that. I have been told the PS space on my xray is larger than normal. I have seen dr.'s about this and of course they just blow me off saying there isn't anything they can do which I am so sick of hearing. I am seeing a PT and she says be careful and that's about it.

...frustrated!

You can see if you get any relief by wearing a sacroiliac belt low around the hips, positioned so that it would logically be encouraging the pubic syphysis to close, and see if that gives you any relief. Maybe the PT or Chiropractor can lend you one to try out before you buy; it has potential to help but might not so why spend if you don't have to?
I think ultimately you will need to make a series of phone calls to local practitioners that are D.O's (Osteopaths) as opposed to MD's, Physical Therapists, and Chiropractors to find out who is in your area and insurance network with experience / success in treating pubic symphyseal diastasis. There are practitioners out there that know how to treat this; they are just far outnumbered by the clueless.

smitzel,
I find your case interesting because I may have the same situation. Dr. Potter casually mentioned that my pubic bones were quite separated. I have SIJD and see a manipulation PT for this. I haven't associated my clitoral pain with my PT session because it just hurts all the time. I'm going to tell my PT (who only works once a week...doesn't help matters, I need someone 3 times a week to keep my sacrum rotated properly)about my pubic bone issue and see if that helps complete my picture.

My doctor seems to think it's an alignment issue with me, since it came on in 1 day after using a pickaxe.

cari

Cari,

Do you know how to do at home exercises to help with pelvic alignment/stabilization? There are pretty easy ones on Vicki Sims DVD "Understanding Sacroiliact Joint Pain" if you know your type of dysfunction and even if you don't. You might start there. It would be awesome if you could get relief without surgery! (Me too!)

Faith,

I'll order up that DVD from amazon right now! I'm hoping for both of us that we can avoid surgery, I guess that's what we all hope for.
cari

Hi, Cari,
It's interesting for sure. I do the exercises my PT suggested to put my sacrum back in alignment each night before bed and when I feel something isn't right. I think it helps but it continues to go out all the time. no one seems to know why it won't hold. Your PT should be able to show u how to do put it back in. IT's quite simple. Yeah, I don't know if it's related to my clitoral pain or not but seems like it may be since it's all in the same area. I do wear a sacroiliac belt which helps support my back but i am told not to wear it much b/c my ligaments need to learn how to do that on their own. I do wear it at night though b/c the Pubic Symp. pain is worse when I roll over in bed. Also, muscle relaxers seems to help if I take it before bed. I take Baclofin. If you come up with any more info please let me know and I will do the same. Good luck!
Stephanie

Stephanie, maybe it won't hold because your ligaments are chronically strained. That's the same problem I have and unfortunately ligaments are notorious for not healing easily and as you age they can become hardened and sclerosed or calcified. Some people have had good luck with prolotherapy but now that my pain is so much better since surgery I haven't gone to the time or expense of trying it. I had one injection into the Si ligament that helped but didn't feel like I needed anymore.

Hi all,
I don't normally post here, but i found you when I was researching pubic symphysis pain. the ps is right next to the clitoris, so it is very likely the cause of your clitoral pain: "It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis. In males, the suspensory ligament of the penis attaches to the pubic symphysis. In females, the pubic symphysis is intimately close to the clitoris." Problems with the ps could possibly even cause symptoms that mimic pn or at least irritate nerves enough to cause pn. When I had some kind of ps movement/inflammation, i suddenly developed clitoral pain while on a walk. Afterwards the clitoral area even looked bruised and swollen. Hope this helps.