What You Need to Know About Your Pelvic Floor According to a Doctor

Have you ever been on your perfect date with your perfect partner with no responsibilities for the night, and you’re dreaming of that much needed alone time? You’ve been looking forward to this night all week because, you know life gets in the way with all of its responsibilities, work, and stressors, and you are relieved this night has come to reconnect intimately. And then, you clam up.

“Why does this hurt?”

The thoughts start running through your mind, “no it doesn’t really hurt…wait yes it does.” “I just want my partner to be happy so I won’t say anything.” Meanwhile your partner knows you better than anyone so can tell something isn’t right. You then think, “Is there something wrong with me? Oh well maybe this is normal, and this is just what sex is like.” What if I told you this could be related to a sling of muscles down by your lady bits called the pelvic floor that have to relax and contract properly for sex?

So, what exactly is the pelvic floor?

…and what does it have to do with your date night? The pelvic floor is a sling of muscles that goes from pubic bone to tailbone that acts like a hammock. It goes through the vagina (in women), the urethra (where urine exits when you go to the bathroom), the prostate (in men), and the anus. Because of these structural openings in the pelvic floor, the flexibility and strength of these muscles affect vital functions like urination, pooping, and sex.

I often teach my patients that your pelvic floor is working for you all the time. Imagine a hammock that sinks really low. When you sit on it, the weight of your body sinks, and sometimes that hammock falls to the ground and is unable to support your body weight if it’s hung too low or now being held up by the proper support from the ceiling. If your pelvic floor becomes weak, like after childbirth, a hysterectomy, or menopause, your hammock might be sinking, and it may be unable to support the pelvic organs. You may experience urinary incontinence (leaking pee), decreased sexual sensation, lack of an orgasm or weak orgasm, fecal incontinence (leaking poop), pelvic organ prolapse, and even low back pain.

What if your hammock is too high?

When you sit on the hammock, you can’t get comfortable and feel squished by the taughtness of it pushing you up. You try to move around to get comfortable, but it’s just so taught. This is what is happening if your pelvic floor hammock is too high. The muscles are so tight, they are not able to stretch under the appropriate circumstance, such as during sex/intercourse. This can occur due to hormonal and inflammatory conditions such as endometriosis or interstitial cystitis, following childbirth, especially those with perineal tears vaginally or following cesarean section births, or simply just having a tight pelvic floor.

Statistics show that over 50% of women will experience pain with intercourse at some point in their lifetime. Now that society has more knowledge, experience, patient data, and more women are speaking up about their painful intercourse, pelvic floor physical therapy has become more clinically relevant. Women have options to address these symptoms without judgment and as an alternate route to medication or surgery. You can even prepare for labor and birth to aid in prevention of pain or tearing and to be more empowered to understand how to address symptoms as they arise rather than waiting months or even years after symptoms have been lingering. 

If you are experiencing any of the above symptoms, it’s a good idea to find a pelvic floor physical therapist who is trained in performing internal and external exams to address the “why” behind your symptoms and can personalize treatment for you to optimize your function, including your sex life. You can follow me on instagram @drmelthompson and download my FREE guide “Pelvic Health Myths” that discusses pain with sex and answers questions about kegels.

About the Author

I’m Dr. Melissa Thompson, PT, DPT, MTC. I’m a board-certified Doctor of Physical Therapy with a specialty certification in Manual Therapy, which is a tool for hands on treatment. I live in south Louisiana and enjoy Cajun cooking, pilates, and dates with my husband.