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The ability to enjoy sex is anything but straightforward. It requires a dizzying amount of alignment between emotional, psychological, interpersonal, hormonal, and physical factors, just to name a few. 

From a physical standpoint, arousal and orgasm require good blood flow, good neural and hormonal response, and good muscle function.1 Specifically, according to the American Psychological Association, an orgasm occurs when the “peak of pleasure is achieved, marked by the release of tension and rhythmic contractions of the perineal muscles, anal sphincter, and pelvic reproductive organs.”

When it comes to ensuring that all of the above happens, your pelvic floor plays a surprisingly large role. 

So how exactly are the pelvic floor muscles involved?

First, let’s go over some anatomy. Your pelvic floor consists of several layers of muscle located at the base of your pelvis. As shown in the diagram below, they extend from the pubic bone to the tailbone, from sit bone to sit bone, and they surround the opening of the anus, vagina, and urethra.

The pelvic floor muscles surrounding the vaginal opening must be able to do 3 things during penetrative sex:

  1. Relax (aka lengthen) and remain relaxed to allow for pain-free penetration
  2. Tolerate stretch to fit a toy or penis
  3. Contract fully to help produce an orgasm

If these muscles aren’t functioning properly due to pelvic floor dysfunction, sex can be unpleasant, painful, or downright impossible. 

On the flip side, if you have a healthy pelvic floor, it can ehance your pleasure by increasing blood flow to the pelvic area — especially the clitoris — and powering strong orgasmic contractions.

 If you’re able to voluntarily contract your pelvic floor during and after orgasm (aka have a pelvic floorgasm), it can boost sensation and satisfaction even more. 

Is my pelvic floor dysfunctional?

Since these muscles are integral to sexual function, it’s a good idea to first and foremost make sure they are working as intended. Here’s a quick checklist to find out if your pelvic floor muscles may be getting in the way of your sexual function:

  • Do you experience urinary incontinence? This includes leaking with laughing, coughing, not making it to the bathroom in time, jumping, etc.

  • Do you have a history of constipation? This includes straining to pass a BM, difficulty emptying, chronic bowel or GI tract issues, etc.

  • Do you have pain or difficulty with penetration? This includes having difficulty inserting a tampon or menstrual cup, dreading OB exams, having pain when at the beginning of sex, etc.

  • Do you experience pelvic pain? This includes tailbone pain, pubic pain while walking or standing on one leg, pain while sitting, etc.

If you experience any of these issues, then you may have a pelvic floor dysfunction. Depending on the severity of the pelvic floor dysfunction, someone may experience any one of these issues or all of them at once.

How can I fix pelvic floor dysfuction?

If there is a pelvic floor dysfunction, consider reaching out to a physical therapist who specializes in the pelvic floor. They can help retrain and rehabilitate the pelvic floor to reduce these symptoms and improve sexual function. A trained specialist can provide guidance and the tools necessary to restore pelvic floor function by: 

  • Improving awareness and coordination of these muscles
  • Restoring the range of motion, flexibility and resting tone of these muscles
  • Increasing blood flow to the region with more effective contractions

Once your pelvic floor is back in business, you can get to the more fun task of exploring creative ways to build the sex life you want and deserve.

AUTHOR

Celestine Compton, PT, DPT is a doctor of physical therapy specializing in women's health. Dr. Compton is both Herman & Wallace and APTA trained in the areas of pelvic pain and pelvic floor dysfunction, myofascial mobilization, and pregnancy and postnatal care. She has acted as a consultant and content developer for various websites and blogs related to women's health and continues to enjoy writing on the subject. Dr. Compton began exploring her passion for women's healthcare and developing her specialization in women's health physical therapy following her experience in the Women's March of 2017.

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