Tailbone Pain, Painful Intercourse, and an Unexpected Cervical Finding During Pregnancy: A Clinical Case Study on the Pregnant Body

What happens when persistent tailbone pain, painful intercourse, and pelvic instability during pregnancy don’t fit the expected clinical picture? In this fascinating case study, Lynn Schulte, PT and founder of the Institute for Birth Healing, shares how following the body’s subtle tissue restrictions led to an unexpected finding that changed her clinical perspective. Discover why looking beyond symptoms, respecting tissue responses, and assessing the whole body can reveal important insights while remaining safely within scope of practice.

I have a really interesting pregnancy case study to share with you today. 

This is one of those cases where you keep listening, you keep following the tissues, and you keep feeling like there is something more going on than what you can initially see or understand.

It is also a reminder that, as pelvic health therapists, we need to stay humble. We need to stay curious. And we need to know when something is outside of our normal expectations so we can proceed carefully, communicate with the birth team, and support our clients appropriately.

This is not a blog about going in and working on cervixes during pregnancy. Please hear me clearly on that.

But it is a blog about what can happen when there is restriction in the pelvis, the uterine support structures, and the tissues surrounding the cervix – and what we may notice when we are paying attention.

Details have been changed to protect the client’s privacy.

The Initial Presentation

This client was a first-time mom who came to see me at 13 weeks pregnant.

Her main complaint was tailbone pain. She had been sitting at a computer all day for work, and sitting made the pain worse. She described the discomfort as feeling like her tailbone was off to the left.

She was also having left SI joint pain with sitting, pain with insertion and thrusting during intercourse, and a strange cold and numb sensation in the front of her thigh when lying on her back. If she rolled onto her side, the numbness would go away. If she kept her knees bent, it would go away.

On top of all of that, she was having a lot of crampiness in her belly. Her midwife was beginning to get concerned and was considering whether an ultrasound or further evaluation might be needed.

Any persistent or concerning abdominal pain, cramping, bleeding, fluid leakage, fever, or change in fetal movement needs prompt communication with the prenatal provider. Pelvic health therapy is supportive care, not a replacement for medical assessment.^[1][2]

What I Found Initially

Because she was only 13 weeks pregnant and reporting crampiness, I did not do much with the uterus in that first session.

Instead, I focused on her pelvis, sacrum, coccyx, and pelvic floor.

Her lower sacrum and coccyx felt very hard, especially on the left side. As I held the sacrum, I felt a pull up the left side of her body that seemed to travel all the way toward the cranium. I held the cranium and the sacrum, and eventually that left side began to soften and settle.

Her pelvic floor was also tighter on the left, although both coccygeus muscles were involved.

At that point, I remember getting the feeling that her baby was okay, but that something was not entirely happy with the uterus and its relationship to the pelvis.

I did not have all the answers yet. But I knew I needed to keep paying attention.

Restricted Uterine Support Structures

When she returned nearly three weeks later, at approximately 16 weeks pregnant, she reported that the pain had been gone for four or five days after the first session, but then it came back. It did feel different, though, which told me something had shifted.

Her left SI joint had been especially painful that week. When I assessed her again, I found that her uterine mobility felt restricted. Her right round ligament was very restricted, and I could not get much inferior glide along the labial region.

I worked gently through the inguinal canal to support more mobility in the right round ligament. I also addressed the right uterosacral ligament and the relationship between the uterus and bladder.

Internally, she had bilateral levator ani tension and tender, tight coccygeus muscles. The left endopelvic fascia also felt significantly tighter.

Again, I kept coming back to the same thought: something did not feel quite right in the connection between her uterus and sacrum.

Painful Intercourse During Pregnancy

By 20 weeks, her coccyx pain was back. She felt that inversions were helping with the round-ligament discomfort, but she was waking at night to urinate and feeling pelvic pain when she got up.

Sex was still very uncomfortable.

She had tried intercourse again, but it caused burning during and after. Her pelvic floor felt irritated afterward, and intercourse was essentially off the table for her at that point.

Painful intercourse during pregnancy is not something we should dismiss as “normal.” There can be many contributors, including pelvic floor muscle overactivity, vaginal tissue sensitivity, positional compression, changes in pelvic mechanics, or deeper pelvic structures that are not happy. A pelvic exam is one tool clinicians may use when indicated, but it should be individualized, consent-based, and connected to a clear clinical reason.^[3][4]

That session, I found more restriction through the right side of her sacrum, bilateral round ligaments, the right broad ligament, and the uterosacral ligaments. I also noted an anterior rotation of her left ilium.

There was a lot happening in her pelvis.

The Finding I Was Not Looking For

At around 21 to 22 weeks pregnant, she came back reporting numbness in her left thigh with both sitting and standing.

Externally, the top of the fundus actually seemed to have decent mobility. But the lower third of her sacrum still felt very hard, and I could still feel that the connection between the sacrum and uterus was not quite right.

After external work, I did an internal assessment. And this is where things got really interesting.

As I followed the bowel back, I unexpectedly ran into her cervix. I was not looking for it. I do not go looking for cervixes during pregnancy. But there it was – much lower than I expected to find it at that stage of pregnancy.

The cervix felt elongated, firm, and restricted. It did not feel like it wanted to move. I was not pushing it around or doing direct cervical mobilization. I was simply sensing into the tissue and noticing that it felt held down.

Suddenly, the puzzle started to make more sense.

Externally, I had been able to feel mobility at the top of the uterine fundus. But internally, it felt as though the lower half of the uterus and the tissues around the cervix were not moving well at all. It was like I had only been feeling the tip of the iceberg.

What I Treated – and What I Did Not

I want to be very clear here: I did not treat her cervix directly.

I did not go to the cervical opening. I did not perform a cervical mobilization. I did not pull, stretch, or manipulate the cervix.

I worked gently with the tissues around the cervix.

I focused on the uterosacral ligaments and the endopelvic fascia bilaterally. I followed the tissues, waited for softening, and allowed the body to respond without force.

By the end of that session, the tissues had softened significantly. When I reassessed internally, the cervix was higher, softer, and no longer sitting directly in the path where I had initially encountered it.

When she stood up, she said, “Whoa, that feels different.”

She felt lighter and freer through her pelvis. She also said her uterus felt calmer.

What Changed Afterward

At her next session, she reported that intercourse had been much better.

The first time she had intercourse, there was no pain. The second time, there was a little discomfort with movement, but it did not linger afterward.

Her cramping was gone.

Her cervix remained higher and softer than it had been at the prior visit, although I still noticed a slight pull and twist toward the left. I continued to work gently with the left uterosacral ligament and left endopelvic fascia.

Her coccyx was still talking to her. Her SI joint was still not fully happy. But the deeper pelvic symptoms had changed in a very meaningful way.

Don’t Miss the Mechanics

One thing I had not fully followed up on in the earlier sessions was her left leg.

She had a very significant valgus pattern on the left side that was not present on the right. This was shortening her left leg and contributing to an anterior rotation of the ilium and instability through the SI joint.

I had been so focused on the sacrum-uterus relationship that I had not fully appreciated the lower-extremity contribution at first.

That is another important reminder: keep looking at the whole body.

We addressed the valgus pattern with stretching and movement education. I also gave her a heel lift. I am not a huge fan of heel lifts as a long-term answer because they can become a bandage. But during pregnancy, sometimes a temporary support is exactly what the body needs.

The lift immediately helped balance her pelvis more evenly from side to side.

Could a Low, Restricted Cervix Affect Birth?

I cannot say exactly what would have happened in this client’s labor if she had not come in for care.

I do not know if the cervix would have stayed restricted. I do not know whether it would have affected dilation. And I am not claiming that this work “fixed” her cervix or guaranteed a particular birth outcome.

But I do think it is worth asking questions when we find a cervix that is unexpectedly low, firm, and restricted in a pregnant client who is also experiencing cramping, tailbone pain, SI pain, and deep pain with intercourse.

To me, it felt like there had been a tug-of-war happening.

The uterus was continuing to grow upward, but the cervix and surrounding tissues felt anchored low in the pelvis. That relationship did not feel happy. And after the surrounding fascial and ligamentous tissues softened, the client’s symptoms improved.

That is important information.

Clinical Takeaways

Here are the biggest lessons I took away from this case:

• Tailbone pain in pregnancy is not always just a tailbone issue. Look at the sacrum, SI joints, pelvic floor, lower extremities, and the tissues that connect the pelvis to the uterus.
• Pain with thrusting during intercourse can be a clue that deeper pelvic tissues are not happy. It does not automatically mean the cervix is involved, but it is worth being curious.
• External uterine mobility does not always tell the whole story. The fundus may move while the lower uterine segment and surrounding support structures remain restricted.
• Do not go looking for or directly treating the cervix during pregnancy. If you unexpectedly encounter something concerning or unusual, proceed with caution, stay within your scope, and communicate with the prenatal provider.
• Never force tissue. Sometimes the body needs gentle support, stillness, listening, and time.
• Keep assessing the whole body. Pelvic symptoms may be influenced by leg-length asymmetry, foot and knee mechanics, pelvic alignment, and load transfer through the SI joints.

A Final Word of Caution

I am not promoting cervical work during pregnancy.

I understand the concern around cervical contact, the mucus plug, and the potential risks of doing too much. I fully agree that we should not be messing around with cervixes during pregnancy.

But when a cervix unexpectedly presents itself in a position where it does not seem like it should be – and when there is a clear pattern of symptoms around the pelvis and uterus – I believe we need to respect that information.

We can work indirectly. We can work with the tissues around it. We can be gentle. We can communicate with the midwife or OB provider. And we can support the client without forcing anything.

This was a wild case for me. I had never encountered anything quite like it before.

But it reminded me that the body is always communicating with us. Our job is to listen carefully, respond respectfully, and help create more space for the body to do what it already knows how to do.

Here’s to smoother births and faster recoveries.

Frequently Asked Questions

Can pelvic floor physical therapy help tailbone pain during pregnancy?

Pelvic floor physical therapy may help address contributors to tailbone pain during pregnancy, including pelvic floor tension, coccyx and sacral mobility, SI joint loading, posture, and lower-extremity mechanics. The treatment plan should be individualized and coordinated with prenatal care when symptoms are concerning or unusual.^[4][3]

Is painful intercourse normal during pregnancy?

Some people experience changes in comfort with intercourse during pregnancy, but persistent pain, burning, deep pain with thrusting, bleeding, cramping, or pain that lingers afterward should not simply be brushed aside. It is appropriate to assess the pelvic floor and discuss symptoms with the client’s prenatal provider when needed.^[1][4]

Should pelvic health therapists treat the cervix during pregnancy?

No – this is not a routine pelvic health intervention during pregnancy. Any internal examination should have a clear clinical purpose, informed consent, appropriate training, and attention to scope of practice; unexpected or concerning findings should be communicated to the prenatal provider.^[3][4]

When should a pregnant client contact their midwife or OB provider?

Clients should contact their prenatal provider for vaginal bleeding, leaking fluid, severe or persistent abdominal pain or cramping, fever, contractions, or other symptoms that feel concerning. If they cannot reach their provider and symptoms are urgent, they should seek emergency care.^[2][1]

What educational resources would help me better support pregnant clients?

Holistic Treatment of the Pregnant Body: Learn 40+ treatment techniques and manual skills that get your clients out of pain and prepared for a smoother birth. Understand what to look for, where and how to work with the pregnant body, and what truly helps prepare clients (and their baby) for a more optimal birth.

About the Author

Lynn Schulte is a Pelvic Health Therapist and the founder of the Institute for Birth Healing, a pelvic health continuing education organization that specializes in prenatal and postpartum care. For more information, go to https://instituteforbirthhealing.com

Citations and References

1.      https://www.acog.org/womens-health/faqs/bleeding-during-pregnancy  

2.     https://saferbirth.org/wp-content/uploads/urgent-maternal-signs_V5_Final_2022.pdf 

3.     https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/10/the-utility-of-and-indications-for-routine-pelvic-examination  

4.     https://www.acog.org/womens-health/faqs/pelvic-exams

5.     https://www.acog.org/clinical/search

6.     https://www.acog.org/womens-health/faqs/chronic-pelvic-pain

7.     https://www.acog.org/womens-health/faqs/pelvic-inflammatory-disease

8.     https://my.clevelandclinic.org/health/symptoms/22044-bleeding-during-pregnancy

9.     https://www.webmd.com/women/pregnancy-when-to-call-your-doctor

10.  https://www.acog.org/store/products/patient-education/pamphlets/pregnancy/bleeding-during-pregnancy

11.  https://assets.ctfassets.net/07cwnclyy106/6mzpvIP4kTlSVTZ9PyC0PC/4afc1564e63cfef13f439d344edfa42c/EGT-1630.v1_Download.pdf

12.   https://www.acog.org/giving/programs/quality-and-safety/resources

13.   https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/03/chronic-pelvic-pain

14.   https://www.mayoclinic.org/symptoms/bleeding-during-pregnancy/basics/when-to-see-doctor/sym-20050636

15.   https://www.aafp.org/pubs/afp/issues/2016/0101/p41.html