Piriformis Syndrome & Sexual Dysfunction

[Kevin Lee]

Hi Kit!

I remember at the teachers training, you mentioned about stretching piriformis could help with sexual dysfunction, as some related nerves could be impacted by tight piriformis..

My first question is am i remembering correctly? 

I have done some quick research on the topic but is getting mixed messages (some research say it would help, others say those related nerves do not run through piriformis..

Can you give me some pointers?

Thanks!!

Kevin

[Kit_L]

Hello there, @Kevin Lee,

You are remembering correctly. And because fascia is still a largely misunderstood substance/function (I am thinking of fascia here in a dynamic sense, rather than static 'slice of time' sense) you will not find coherent perspectives from Western anatomy. 

The two key poses to target the dysfunction are the tailor pose, and the advanced piriformis pose.

The problem with establishing whether particular innovating nerves are involved is that there are at least eight different ways the two trunks of the sciatic nerve can exit the pelvis—the four main groups as discussed in Travell's and Simons' chapter in Myofascial Pain and Dysfunction, and the further subclasses of Chiba et al., as referenced in Overcome neck & back pain. And if you look at the relevant myotome and dermatome charts, you'll see that there is not a predictable relation from one nerve to a particular muscle, necessarily. In "Musces, Testing & Function", the four current dermatome and myotome charts intersect at many points, so they are more like guidelines than maps.

And (this is never addressed anywhere I have seen) all of the five sacral nerves emerge anteriorly through piriformis, and these nerves are directly involved in sexual function and pelvic floor function. This emergence through piriformis is clearly seen in Travell and Simon's illustrations.

So, in the absence of a clear, causal diagnostic pathway, better to rely on improving function in the two key functions that we know will affect the fascia and the nerves of this area the most directly.

Excellent question, and do please follow up.

[hainew]

Kit, by "advanced piriformis pose", are you refering to the bent leg version of the last of the basic five?

[Kit_L]

Have a look at this video; the instructions are for the advanced piriformis stretch, but held in a long form. The bolster, or something similar, is essential, to tip the body in the right direction. Olivia is demonstrating the long-held version, but you don't need to do all of that—simply get into the setup position for the exercise, and try it. Once you get into the position and have got as comfortable as you can, the contractions are two: press the front leg's knee onto the support, and press the outside of the ankle into the floor; re-stretch.