Most conversations about sitting posture focus on preventing back pain, but it's high time we focused on healthy posture for your pelvic floor — the part of your body you're actually sitting on — and, more specifically, your vulva. Certain sitting positions (more on those below) put excess pressure on your outer genitals. If you have pelvic floor dysfunction, particularly if you have pain, the way you typically sit could be causing that pain or contributing to it. Even if you don't have pain, a perpetually squashed vulva is an unhappy vulva.
With all the time we spend sitting at a desk, in the car, or on the couch binge-watching Love is Blind, it’s worth understanding how prolonged pressure can potentially impact your vulva, and learning how to shift most of your weight to its rightful place on your sit bones.
Why sitting on your vulva can cause problems
Your vulva — which includes all of your external genitalia, including the inner and outer labia, vaginal and urethral openings, and the clitoris — is bound to take on some pressure when sitting. But certain sitting positions place more pressure on the vulva than others. Two prime examples: If you sit perched on the edge of your seat or continually lean forward, you may be placing too much pressure on your vulva.
If you sit perched on the edge of your seat or continually lean forward, you may be placing too much pressure on your vulva.
A good example of what can happen to our tissues when we sit for too long can be seen in those with spinal cord injuries (SCI). When sitting for too long like in instances of SCI, the tissue that is compressed — no matter which position you are sitting in — has poor blood flow, and is even susceptible to compression injury and pressure ulcer formation. One study showed that muscle injury could be seen in as little as two hours in an experimental setting.
When we look at pelvic floor injury in cyclists, who sit with their pelvis rocked forward on a bicycle seat for many hours at a time, more than 90% of cyclists report sensory changes like numbness in their perineal area. This is thought to be common due to the prolonged compression of the vessels and nerves in the perineal area.
The goal: Check your sitting position (or stand up) every 15-20 minutes.
While these are two more extreme examples of what can happen when tissues are compressed, they can be good to keep you motivated to monitor your posture. The goal, if you're willing and able, is to check your sitting position (or stand up) once every 15-20 minutes, then adjust your posture to take pressure off of your vulva.
The best sitting posture for your pelvic floor
"Good" posture can be any position in which your body is in balance. When sitting in a balanced position, the pressure from your seat is dispersed evenly throughout your pelvis, pelvic floor, and legs. A balanced position doesn't take a lot of effort to maintain.
First, find a sturdy chair with a supportive back. When you slide your glutes all the way to the back of the chair, the seat of the chair should support your thighs and extend within an inch or two of the backs of your knees.
Next, follow the recommendations below:
Your pelvis is a good place to start because, when you sit, it forms the base of your support. Start by sitting with even weight in each of your sit bones (aka your ischial tuberosities). Your body was meant to sit balanced on these broad, strong bony prominences, as they help to limit pressure on other, more vulnerable structures, such as your tailbone or the nerves and vessels in your vulva.
Rock from side to side. As you rock, you'll feel one side of your pelvis get heavier while the other gets lighter. Settle in the middle.
Now rock your pelvis forward and backward. Rocking forward (arch your back a bit) presses your pubic bone into your chair and increases the pressure in your vulva, while reducing pressure on your tailbone. Rocking your pelvis backward (round your low back a bit) increases the pressure on your tailbone while decreasing pressure on your vulva.
Settle in the middle again, right on your sit bones, with even pressure on your pubic bone and tailbone. (Allow your upper back and shoulders to naturally adjust to help find this balance.)
Legs and Feet
Sit with both of your feet resting on the floor. The trick is to have a chair that's at the perfect height, so that when your feet are resting on the floor, your knees are at, or slightly below, the height of your hips. A chair with an adjustable height will help you find the sweet spot, but you can always place your feet on a book or stool if you need the extra height.
Try to avoid crossing your legs or ankles. Either will create a twist in your body that travels up your legs into the pelvis and back, and shifts your weight to one side, disturbing your balance and creating unnecessary strain and tension in the ligaments and muscles.
Even with the best possible posture, it can be helpful to support your back. Place a small rolled towel or pillow near the base of your spine to support your low back and pelvic position. Use pillows or the back of the chair to support your upper back, so you can relax your muscles while staying balanced.
If you have any pain or symptoms of pelvic floor dysfunction, there are many other ways to adjust your posture to achieve proper ergonomics as you work, commute, travel, or take care of your kid(s), so check with a pelvic floor physical therapist for personalized guidance. In addition to a comprehensive physical therapy evaluation, they can evaluate your pelvic floor muscles and sitting posture, and help you sit to avoid pain or strain.