Pelvic Floor and the Sexual Response Cycle
Arousal | Blood pressure | Breathing | Desire | excitement | heart rate | Orgasm | Refractory period | Sexual Response Cycle

February 23, 2020

This post is part 3 of 3 by guest blogger Berrin Boyce, PT. You can read part 1, “What is the Pelvic Floor?” here and part 2, “Pelvic Floor and What Can Go Wrong” here.

Sexual Response Cycle

According to the Cleveland Clinic there are 4 distinct phases of the sexual response cycle:

Desire: aka Libido, is loosely defined as the state of interest or wanting. As sex expert and psychology PhD. Emily Nagowski describes in her book “Come As You Are”, desire is not a drive, but instead it happens when you put yourself in the right CONTEXT for you to increase your accelerators (that get you closer to arousal) and while decreasing your brakes (things that get take you out of the moment). Everyone has different levels of sensitivity to their accelerators and brakes.

Arousal (excitement): This phase is where we notice more physiological changes such as:

  • Increased muscle tension, pelvic floor muscles also have to relax/expand to accommodate movement
  • Swelling of the vaginal walls, and penis as blood flow increases
  • Lubrication from bartholinglands lubricates the walls of the vagina
  • Holding breath or panting increases intraabdominal pressure


  • Involuntary muscle contraction of pelvic floor muscles
  • Rhythmic contractions of the uterus in women
  • Rhythmic contractions of bulbospongiosus in men for ejaculation.
  • Blood pressure, heart rate, and rate of breathing all increase


  • Refractory period, recovery (duration needed varies for individuals and with age)
  • Muscles relax
  • Blood pressure, heart rate, and rate of breathing all return to resting state

As you can see muscles play an important role in each of the phases of the sexual response cycle. If you are having pelvic pain with sexual activity at any phase or even pelvic pain outside the bedroom you may greatly benefit from an assessment and treatment from a pelvic floor physical therapist. Know that there is a wide range of what is normal when it comes to sexual desire, arousal and experiences, but pain should never be brushed aside or thought of as normal. -Berrin Boyce

Reach Berrin at: with any questions, friendly comments, or concerns.

About the Author: Berrin Boyce is a pelvic health physical therapist, who received her bachelor’s degree in Human Physiology at the University of Oregon and her doctorate of physical therapy from Northeastern University in Boston. She currently works in the Denver Metro area at N2 Physical Therapy treating a wide variety of conditions including: persistent abdominal and back pain, persistent pelvic pain conditions, sexual dysfunction, urinary incontinence, pelvic organ prolapse, fecal incontinence, constipation, and pregnancy/post-partum related musculoskeletal conditions. She enjoys working with both women and men to address any pelvic floor issues related to the musculoskeletal system. In her free time she is an avid cyclist and runner, and has practiced yoga for over 15 years.




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