Do you ever wish you were told, “sex is complicated and there is more that you should know that how to prevent getting pregnant”? Or

“sex can be uncomfortable at times, but shouldn’t be painful and if it is then you need to reach out to a health care professional who can help”?

In the United States, Sex Ed is a lacking and a taboo topic that most people want to ignore or feel way too embarrassed to discuss. Unfortunately, that leaves each generation having to figure it out on their own, which creates a cycle of poor education. It’s important to discuss more than just the act and address the physical body parts and hormones related.

I’m talking about the pelvic floor, pelvic organs and the reproductive hormones.

Sex could not happen without these and having a better understanding of their role in sexual health can empower everyone.

So sit back and get ready to learn what you should have in Sex Ed!

The Role of the Pelvic Floor During Sex

The pelvic floor is a multi layered group of muscles and tissues that closes the bottom of your pelvis. Some describe it as a hammock from your pubic bone to your tailbone, or like a diamond branching out the sides of your pelvis. Within the pelvic floor are your pelvic organs, the bladder, uterus/vagina or penis/testes, and colon/anus.

The pelvic floor has many roles in general and for the act of sex has two main roles. The first is to relax for insertion during penetrative sex and the second is to contract during arousal and orgasm.

That being said your pelvic floor can also influence your reproductive hormones and vice versa. For example, a healthy pelvic floor that is strong and has good (not tight or stretched out) tone is more likely to have better circulation thus a more balanced hormone communication. Which can be one factor in libido.

How the Pelvic Floor can Impact Sex

Two of the main ways the pelvic floor can impact sex is:

• responding with pain during non-harmful/threatening touch or penetration

• diminished or lack of arousal or orgasm

Both of these impacts can be super charged by emotions and many other factors can play a role. So typically should not be taken out of the equation if you are trying to heal your sexual health; however for the purposes of this piece, I am going to focus on the physical aspect of the pelvic floor.

Painful Sex

Sure sex can be uncomfortable at times, but pain with sex is never normal. It is your body telling you something is wrong and you need to stop.

Factors that can impact the comfort of sex are:

• Size of partner & you

• Lubrication

• Pelvic floor trauma or injury

• Desire

• Position during sex

It is common for sex to be uncomfortable after giving birth due to inflammation, healing abrasions or pelvic floor injury, lack of lubrication, and scarring (even from a cesarean). Many women are more worried about the pelvic floor being super stretched out after giving birth that it doesn’t cross their mind that the opposite can happen where the pelvic floor actually becomes more tense.

Let’s investigate some of these scenerios a little deeper…

When the pelvic floor (or even some surrounding muscles) are tense, tight, restricted, scarred in any way it has a hard time stretching. During penetrative sex the pelvic floor needs to stretch. So when they can’t, the sensory nerves respond with pain to tell you to stop. Think of when you stretch tight hamstrings, if you push the stretch too far, it can be really uncomfortable and you probably stop. Or you just can’t stretch because they are so tight they won’t give. The same can happen with the pelvic floor.

Tension and scarring may also inhibit the movement of the uterus during orgasm and can cause pulling and pain later in sex.

On the other hand the pelvic floor muscles may not be tense or tight (yet) but you may be lacking lubrication or the tissue is inflamed for another reason (like an infection) thus causing irritation or friction with touch or movement/penetration. Once you treat the underlying cause of the irritation or friction the pain may go away. However, these can always lead to tension and restrictions in the pelvic floor tissues if not addressed.

And the more you try to push through the pain the more your body is going to response with guarding and more tension to try to protect you from the pain you are provoking. Becoming a viscous cycle.

Pain with sex can start from the first experience, with a new partner, a stressful situation (or build up of stress), after birth, transition into menopause or other injuries. If you were taught that pain with sex is not normal, even without knowing all the reasons why it can happen, you at least can be empowered to know something is wrong and to seek care.

Diminished Libido/Orgasm

When it comes to the pelvic floor’s role in libido, arousal and orgasm, more of a balanced approach is necessary in the tissues. What I mean by that is you want your pelvic floor to be strong, but that requires muscles that are able to contract and relax.

That means your pelvic floor is able to go through its full range or length tension, rather being stuck in too short or unable to contract enough. When your pelvic floor is “strong” it can:

• improve circulation to the area &

• coordinate better with the task at hand

You want uninhibited circulation through the pelvis. Tension, atrophy, scarring, inflammation/swelling can all hinder your circulation, thus hormone (and oxygen & nutrient) communication to the tissues and organs. When you are aroused your pelvic floor becomes flush with blood, this can’t happen your blood flow is blocked in any way.

Having your pelvic floor be able to coordinate with the task at hand means it will relax or contract on demand (without you having to think about it. Your pelvic floor is meant to contract during orgasm. Your clitoris is actually a muscle and part of the pelvic floor. If your pelvic floor is unable to contract or lacks coordination it may not respond appropriately during sex.

To recap, your pelvic floor is a very important part of your sexual health and can change your experience over your life time. Knowing it’s role and what is normal can help you avoid or catch early signs of problems.

There is so much to learn about your body that is left for you to figure out by yourself, when it doesn’t have to be. You are not alone and talking about sex doesn’t have to be taboo. If you suspect a problem or know you have an issue with any thing I addressed in this blog, reach out. A pelvic floor Physical Therapist can help with most (if not all in some way) pain with sex or arousal and orgasm issues.