The importance of healthy pelvic floor muscles for women is central to maintaining the stability of our core; for essential bodily functions.  Besides the obvious trips to the bathroom, common in both pregnancy and in more mature women, they are also key to comfortable sexual relations.

The pelvic floor muscles (PFM) form the base of your ‘core muscles’, which include abdominal and back muscles, and the diaphragm, which controls breathing.  Together they attach to the pelvis and spine, creating stability throughout the body’s center.  The PFM are located between the tailbone (coccyx) and the pubic bone, within the pelvis.  They support the bowel and bladder, as well as the uterus and vagina muscular bands (sphincters), and also encircle the urethra, vagina and anus as they pass through the pelvic floor. The muscles and connective tissue support these reproductive organs and provide the flexibility to assist with urination and bowel function as well as sexual relations.

Over time, the PFM can weaken due to injury, and even the normal aging process.  Conditions such as incontinence or pelvic organ prolapse can arise. However, exercising your PF muscles can be very helpful to counteract the negative effects of having weakened muscles. ( I will suggest some exercises at the end). 

PF disorders can result from either having overly relaxed, weakened muscles or  excessively tight muscles; balance of both is the goal. Ideally our PFM should be strong enough to stabilize our core and secure our organs, but flexible enough to be able to relax and stretch.

When PFM are too loose or weak (due to childbirth, surgery, injury or trauma), interventions may be necessary.  The muscles can become stressed during pregnancy or overuse (due to heavy lifting, chronic coughing or constipation).  Hormonal changes can also weaken them during menopause, as a natural part of aging, as well as diabetes. If left untreated, weakened PFM could lead to stress incontinence and pelvic organ prolapse (bulges into the vagina of unsupported pelvic organs such as the uterus, rectum or bladder).

Hypertonic PF is a condition when the muscles are too tight, which could lead to constipation, or difficulty moving your bowels, pelvic pain, back,  hip or lleg pain, painful intercourse or urinary urgency/frequency.  Overly tight pelvic muscles can also be associated with sexual trauma, accidents or other trauma, childbirth, stress and other gynecologic conditions.

Common Treatments to Strengthen PFM and improve Sexual Health

The most common exercises are the Kegels, requiring routinely squeezing and relaxing the PFM to build more control slowly.  Your health care provider may use biofeedback, a sensor in your vagina which measures which muscles you’re contracting and how strongly, similar to how one would treat incontinence.  Kegel exercises should not be attempted if you’ve recently injured or strained your PFM, such as during childbirth..

The following techniques are used to gradually strengthen the PFM:

  1. Diet, exercise and medications which are also used to relieve constipation, can prevent stressing the PFM when using the bathroom.
  2. Vaginal weights / Kegel balls, inserted into the vagina and held into place during day-to-day activities.
  3. Medical devices like a vaginal pessary can hold pelvic organs in place if PFM are too weak to provide adequate support ,for PFM to strengthen key muscle groups in the body core.
  4. A trained Physical Therapist specializing in PFM can help strengthen key muscle groups in the core of the body.
  5. Surgery may be required to reconstruct the pelvic organs into place to treat prolapse or a procedure called colpocleisis, where the vaginal walls are sewn together to prevent internal organs from extending outside the vagina, which can be uncomfortable and interfere with sexual functioning..

Nearly one-quarter of all US women experience a pelvic floor disorder such as weakness, and incidents rise with age. 40% of women 60-79 years of age have PF weakness.  However, despite the fairly common occurrence, it remains misunderstood by many women since they might not speak about it or are self-conscious. They are at least as important as other drooping body parts such as weak knees or sagging buttocks!  Prolapse of the uterus, upper vagina, bladder or bowel can result in a hernia-like disorder and is more common among women who have had hysterectomies.

How does a weak pelvis affect sexual health?

Although a prolapse isn’t life threatening, it can lead to health conditions as mentioned, and women may avoid intimacy for fear of embarrassment or reduced sensation, making them feel less sexual.  In addition to muscle strengthening exercises one can also use estrogen replacement therapy in addition to the insertion of a supportive device. 

Those at risk should discuss the condition with a urologist or other specialist in advance, to get to know the signs, such as pain during intercourse, pressure in the pelvis, or a lump of tissue at the opening of the vagina.  A urologist can usually diagnose a prolapse with an exam, and recommend surgical and non-surgical treatments.  You can have sexual intimacy after a prolapse, but first it must be treated.

Summary & References

It’s common to ignore PFM until a medical issue arises, but don’t wait for a problem like incontinence or prolapse to begin taking care of your PFM.  Exercising them gives you more control over your bladder and bowel function, and can potentially improve sexual function, arousal and the intensity of orgasm.  So make the maintenance of your PFM part of your regular exercise routine!

7 pelvic floor exercises