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

Where can it go wrong?

There are a couple of different things that can disrupt how well a muscle functions during any activity, including sexual activity. Weak muscles may have a difficult time contracting or generating enough force to increase blood flow or maintain blood flow around the genitals, an important part of sexual response and function for everyone. Poor coordination or control and awareness of muscles can make it difficult to contract OR relax muscles. Difficulty relaxing your pelvic floor muscles can lead to decreased tolerance for penetration or decreased tolerance to increase blood flow. Short and tight muscles in the pelvic floor can cause weakness or pain in trigger points, similar to pain in other tight muscles wherever people hold tension (neck, upper back).

Weak muscles have a hard time generating enough force to do their intended job. In sexual function if a muscle is weak, it can make it difficult to increase blood flow to the sexual organs and structures. As you will read below increased blood flow and swelling of genitals indicates an individual is in the sexual arousal phase of the sexual response cycle. A weak muscle can also have a challenging time keeping blood supply increased which negatively impacts the swelling that should happen in the vaginal tissue and penis. Weakness tends to contribute to sexual dysfunctions such as erectile dysfunction and decreased lubrication or vaginal engorgement.

Pelvic floor muscles that are tight (and weak) make it challenging for the pelvic floor to relax and expand to accommodate increased blood flow. We tend to see more sexual dysfunction such as vaginismus, pelvic pain, or erectile dysfunction associated with tighter muscles.  Tight muscles also function as weak muscles, because they are unable to contract through a normal range of motion to generate force. I often compared muscles in the shoulders and jaw to illustrate to people why they may be holding more tension in their pelvic floor muscles. Our bodies are very smart and increase muscle tension during times of stress or pain to prepare us to be able to fight or flee from a situation that causes stress, or brace and protect ourselves when we experience pain. This tension or excessive contraction can make it challenging for us to relax muscles during arousal or involuntarily contract and relax during orgasm.

How can Pelvic Floor Physical Therapy Help?

As a pelvic floor physical therapist I help people identify possible musculoskeletal causes to their pelvic pain.  In an initial evaluation I ask extensive questions about how long symptoms such as pain have been present, when it started, and any other past medical history or past accidents that may be contributing factors. I want to know about what they like to do for sports or recreation. I also ask more personal and thorough questions about bladder, bowel, and sexual habits that help me identify possible dysfunction.  For the physical assessment we look at posture, how well someone is moving through their hips and back, abdominal and hip strength to see if they may be compensating with pelvic floor muscles to provide stability to their pelvis. Physical therapists such as myself who specialize in pelvic health have also been trained to do internal pelvic floor assessments of the pelvic floor muscles with the purpose of identifying one’s strength, muscle tone (tightness), areas of pain or tension, and see how much control one has to contract and relax the pelvic floor.

From there we identify the major contributing factors and work with the individual to help address the main issues we’ve identified through treatment such as manual therapy, neuromuscular reeducation (aka awareness training), and strength training among other possible treatment methods. We also help establish a home program to create more awareness and reduce pain. Many people also benefit from working with a licensed therapist, such as Jessica to address any of the emotional components that also can contribute to pain with sex, anxiety or depression.

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.