The Role of the Pelvic Floor in Sexual Health
What is the Pelvic Floor?
The pelvic floor is made up of muscles, ligaments, neural tissue, and connective tissue. It covers the entire pelvic cavity extending from the pubic bone to the tailbone. It is arranged like a dome-shaped sheet, and can be pictured like a bowl or hammock. The pelvic floor is vital for daily functioning including urination and bowel movements, everyday movement in stabilising the lower back and pelvis, and supporting the abdominal and pelvic organs.
How Does the Pelvic Floor Support Sexual Health?
The pelvic floor can be considered the engine of sexual pleasure. During arousal, the pelvic floor fills with blood. The dramatic influx of blood then allows healthy blood flow to the genitals for the experience of erection, or swelling of the clitoris. The pelvic floor then amplifies and sustains this arousal by compressing blood in the erectile tissue (penis, clitoris). Furthermore, it is the pelvic floor that acts as the mechanical engine or orgasm. An orgasm is the sudden release of sexual tension arising from the engorgement of tissue and mounting muscular tension, which involves the involuntary rhythmic contractions of the pelvic floor muscles. The active contraction and relaxation of the pelvic floor is necessary for sexual health and sexual satisfaction.
Penis Health: The pelvic floor muscles maximise erectile rigidity through the compression of blood into the penis. The involuntary rhythmic contraction of the pelvic floor muscles pump out semen during ejaculation. It is also this rhythmic contraction that is involved in pleasurable orgasmic sensation.
Vaginal and Vulva Health: Healthy pelvic floor muscles facilitate the experience of arousal, and leads to comfortable, pleasurable, pain-free vaginal intercourse. The involuntary rhythmic contraction of the pelvic floor is also involved in orgasm. Those with a strong pelvic muscle contraction also experience stronger orgasms.
How is the Pelvic Floor Involved in Sexual Dysfunction?
Please note that for the following, the pelvic floor may not always be a sole contributor. However the below outlines the circumstances where the pelvic floor is involved with that specific dysfunction.
Male Sexual Dysfunction
Erectile Dysfunction: If the pelvic floor muscle is spasming this can restrict blood flow needed for an erection. Pelvic floor weakness can also prevent the pressure needed for sufficient erectile rigidity. Read more about erectile dysfunction here.
Ejaculatory Issues: A lack of coordination in the pelvic floor can lead to premature ejaculation. Excess tension in the pelvic floor can accelerate ejaculation. Read more on premature ejaculation here. If the pelvic floor is spasming, ejaculation can also be painful
Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS): This is pelvic/genital pain without infection. 50% of men with CP/CPPS experience pelvic floor spasms. This in turn can lead to erectile dysfunction.
Female Sexual Dysfunction
Incontinence and Avoidance: urinary or anal incontinence due to pelvic floor disorder can lead to fears of soiling during sexual activity. There can be deep embarrassment and fear around this which severely impacts arousal and desire, often leading to avoidance of sexual activity altogether.
Pelvic Organ Prolapse (POP): This is when the bladder, uterus, or rectum bulges into the vaginal canal due to pelvic floor disorder. This then increases painful sex and avoidance on sexual intercourse due to fear of worsening the prolapse.
Vaginismus or Dyspareunia: Read more about vaginismus here, and an overview of dyspareunia here. When the pelvic floor muscles are chronically tight or involuntarily spasm, the vaginal muscles can clamp which results in painful penetration.
What Can Be Done About Pelvic Floor Disorder?
Pelvic Floor Physiotherapists (PFPT) are the unsung heroes of sexual health. As the pelvic floor muscles are skeletal muscle, they can be rehabilitated. PFPT involves restoring muscle function by manually releasing muscle tension through massage, biofeedback, muscle training to learn how to relax the muscles, strengthening control over muscles, improving muscle tone, and vaginal dilators.
PFPT is especially important to consider as it directly deals with the pelvic floor muscles, but it is also a conservative and non-surgical intervention.
While PFPT is crucial, it is also important to consider PFPT in the context of holistic treatment. Recognising the impact of sexual dysfunction on psychological and relational factors, and how this can also perpetuate sexual dysfunction, an approach which includes sex therapy can lead to increased sexual satisfaction.
How Can Sex Therapy Support Pelvic Floor Health?
While pelvic floor physiotherapy is essential in addressing the physical components of pelvic floor dysfunction, sex therapy supports the psychological and relational impacts that often develop alongside these difficulties.
When sexual pain, erectile changes, or incontinence are present, it is common for individuals and couples to experience anxiety, avoidance, shame, or pressure around sex. These responses can then further reinforce the physical dysfunction, creating a cycle where the body and mind are both contributing to the difficulty.
Sex therapy supports individuals and couples to:
• Reduce anxiety and fear associated with sexual activity
• Rebuild a sense of safety and confidence in the body
• Shift away from performance or goal-directed sex
• Improve communication and understanding between partners
• Reconnect with pleasure in a gradual and supported way
Rather than focusing only on the physical function of the pelvic floor, sex therapy supports the broader experience of sexual wellbeing.
I offer online sex therapy across Australia, supporting individuals and couples to understand the interaction between the body, mind, and relationship. Therapy provides a space to reduce pressure, build confidence, and support a more comfortable and satisfying experience of sexual intimacy alongside any physical treatment you may be receiving.
Final Reflection
The pelvic floor plays a significant role in sexual function, but it is only one part of a much broader system.
When difficulties arise, it is rarely just a physical issue. The experience of sexual health is shaped by the interaction between the body, mind, and relationship.
Addressing pelvic floor dysfunction with both physical and psychological support allows for a more complete and sustainable improvement in sexual wellbeing.
With the right support, it is possible to move from discomfort and avoidance toward comfort, confidence, and connection.
Written by Justine
References:
Verbeek M, Hayward L. Pelvic floor dysfunction and its effect on quality of sexual life. Sex Med Rev. 2019;7:559-564.
Cohen D, Gonzalez J, Goldstein I. The role of pelvic floor muscles in male sexual dysfunction and pelvic pain. Sex Med Rev. 2016;4:53-62.
Nasrallah-Babenko M. The integrated guide to treating penetration disorders in women: transforming sexual relationships from fear to confidence. New York: Routledge; 2022
Wylie K, editor. ABC of sexual health. 3rd ed. Chichester: John Wiley & Sons; 2015
Carson CC, Kirby RS, Goldstein I, Wyllie MG, editors. Textbook of erectile dysfunction. 2nd ed. New York: Informa Healthcare; 2009
