Tuesday, December 9, 2008

Q & A: Post-anal sex headaches

Q. The past few times my wife and I have had anal sex, with her doing the receiving anyway, the act itself went smoothly and pleasurably. However, not a minute after she went to sit on the toilet to clean herself up, she would be struck by a brutal headache. My wife does suffer from the occasional non-sex-related migraine, and her post-anal sex headaches are worse by far. I am convinced that the headaches and the anal sex are somehow related. The easiest fix is to just not have anal sex. My interest in doing it is far outweighed by my not wanting her to suffer. I was wondering what an expert thought, but I've been to shy to ask a doctor about it.

Pain in the Ass?

Dear Pain in the Ass:

I, too, suffer from migraines, so I empathize with your wife, because if she's having a headache worse than a migraine, it must be extremely painful and debilitating. At first glance, the problem seems completely unrelated to anal sex; however, it's too much of a coincidence since it's happened several times. Stress and tension can often cause a severe headache, so I have a few theories. First, while you're fucking her ass, your wife may be in a position that's putting undue strain on her neck. I know that sometimes I end up in weird positions—especially when I have my ass in the air and my head down—while buttfucking. Afterwards, I often feel pain in my neck, and that pain could lead to a headache. See how her body is positioned the next time you do it, and make sure her head and neck have plenty of support. My second theory has to do with her breathing patterns during sex. Many people (me included!) often take very shallow breaths when we get aroused on our way to orgasm. It's a natural instinct, and one that often gives us a brief "high."Masturbation guru Dr. Betty Dodson scolded me once that if I am not taking deep breaths, then the blood cannot properly circulate throughout my body during sex. Shallow breaths may cause a quick high, but deep breaths ensure that the blood is flowing and the high people often feel during sex will last throughout the act. If your wife is taking quick breaths, or even holding her breath at some points, she could be depriving her brain of oxygen. This repeated deprivation could cause an intense headache, especially if she's susceptible to headaches in the first place. Finally, an answer lies in your question. You may feel shy, but it's a good idea for *her* to talk to her doctor about the problem. There may be something else going on, and her body is trying to tell her something.


A fellow reader who's a physical therapist emailed this to me on the subject of migraines and anal sex, and he gave me permission to reprint it. Thanks, Matthew!

If you look at any anatomy text that shows images of the pelvic floor musculature from above or below, there are intimate relationships between the these muscles and the sacroccygeal complex. The coccyx forms the cornerstone of the pelvic floor with muscles and ligaments attaching to the coccyx and extending forward to the pubic bones and other areas of the pelvis. These muscles form the vaginal opening, urethral sphincter, and anal sphincter with the latter having the largest influence on the coccyx and are themselves dependent on the mechanics of the coccyx and sacrum for normal tone.

The covering of the spinal cord [dura] has attachments at the second segment of the sacrum and the very last fiber of the spinal cord blends into this dura which is then continuous with the periosteum of the coccyx. The dural tube should [in the absence of pathology] hang loose in the spinal canal up to the upper 2-3 segments of the neck. It then continues inside the cranium to become the covering of the brain. This system, called the craniosacral system, has been referred to as a closed hydraulic network responsible for the distribution of cerebrospinal fluid. A small change in pressure in one area will affect the rest of the system.

Disturbances can very often result in headaches for both pressure related reasons and mechanical pull via the dural tube on the neck and cranial bones. There are numerous cases of instant headache relief with manipulation of the coccyx [providing, of course, this is the cause of the particular headache].

You also need to look at the extensive vascular and neural network supplying the pelvic floor and surrounding the rectum itself. While entrance is possible and potentially pleasurable, the anus was designed as exit only. Repetitive or even sustained in and out will disturb the normal pressures which in turn creates neurologic feedback. Some people will get headaches when their stomach is too full immediately after a meal. Brain freeze from a slushy is in a similar category--neurovascular over stimulation.

There are other reflexive effects as well. The muscles of the pelvic floor work together as a diaphragm, functioning in conjunction with the respiratory diaphragm. The other primary diaphragms include the thoracic inlet [the connective tissue spreading over the upper ribs and clavicles] and the cranial diaphragm [floor of the cranium]. These all work together as one system to move fluid and air and adjust pressures in the different body
cavities. As a result, change in one will change the others.

Then there is the toxicity that can get stored in any body tissues but especially of the digestive tract. Repeated stimulation of an area can release toxins into the system with reactions elsewhere--headaches included.

There are other less significant and in some instances less understood associations between the pelvis and cranium that could produce headaches.

So what can be done about all this?

-There are all the factors you mentioned in your response to the initial question and the suggestions you made. Very good stuff.

-Next, general health is important, of course.

-Exercises which involve breath control such as yoga and tai chi/qi gong will benefit spinal posture, flexibility, and diaphragm health.

-Proper nutrition, especially avoiding any foods that you are sensitive to is important. Depending on the person these could be the more publicized alcohol and caffeine or the more subtle but equally insidious gluten, processed sugar, or dairy allergies. If a person is exposed to an active allergen the result is inflammation throughout the body as an immune response is mobilized. This response is most profound at the source, the digestive tract. Very often we have chronic inflammation in our guts yielding adhesion and scarring as well as spasm at the sphincters [rectal included] and storage of the allergen in the tissues to prevent it from getting to the rest of the body.

The treatment is prolonged TOTAL avoidance of the suspect allergen to minimize the bodyƒs response.

-Manual therapy to correct the mechanics of the craniosacral system, pelvic joints, and abdominal organs [yes. organs have mechanical relationships as well].

To find people who do these types of treatments look up:

CenterIMT.com Integrative Manual Therapy
Upledger.com Craniosacral Therapy and Visceral Manipulation
ICAKUSA.com Applied Kinesiology

All of these have effective treatments for the things I described above and for headaches in general. My personal nbias is towards Integrative Manual Therapy, my field of study. In craniosacral practitioners you will find a very big variance in how people practice and level of skill. The Applied Kinesiologists probably do the most nutritional/supplement work, but again you will find huge variability in exactly how individuals practice. Traditional Chinese Medicine should never be scoffed at for improving health either.

If interested, I even know a couple of people in New York who are very skilled. I don't know if any of them are near you, but they probably know other people who would be.

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