Sexual Function and the Pelvic Floor

Let’s talk about sex baby…. Ok, now that I’ve got that song stuck in your head, it’s time to talk about your pelvic floor’s involvement in your “personal life”. The third and final topic in my “3 P’s of the Pelvic Floor” series is a tough one. Urinary dysfunction and bowel dysfunction were the first two in the series. Please feel free to re-read them. :)

First and foremost, everyone’s experience related to sexual function is vastly different. Some individuals have experiences that are nothing but rainbows and unicorns. While others, and I would argue MOST others, have a history with at least one negative experience. I am talking about anything from an aggressive pelvic exam to pain with intercourse that never went away after you gave birth to actual incidences of abuse. Unfortunately, the prevalence of sexual abuse is high and the prevalence of those with pelvic pain having a history of abuse is EVEN HIGHER.

That being said, this is a very sensitive and serious topic. I tried to write this blog with integrity and thoughtfulness. There will not be as many jokes or funny pictures as normal, because this topic does require a bit more maturity. This blog will also not be vulgar or overly graphic…don’t worry, mom.

Sexuality and Sexual Function

In regards to bowel and bladder health, males and females are really quite similar. When it comes to sexual function, however, males and females are COMPLETELY different.

Another clarification I should make is that within this blog, whenever I reference males/men, I am referring to the anatomic genitalia of the XY chromosome. And vice versa with female. Gender reassignment surgeries and those that identify anywhere on the gender spectrum are a whole other sub-specialty of pelvic floor therapy. If this is something that interests you, feel free to CLICK HERE to learn more.

Developmentally, the clitoris and the head (or glans) of the penis, start out as the same tissue in an embryo. It isn’t until the 7th week in utero, that the tissue differentiates into male and female external genitalia. From the 7th week on, men and women differ greatly in their anatomy, arousal patterns, and sexual function.

As a whole, male arousal (both psychologically and physiologically) is fairly one-dimensional. Men tend to become most aroused with visual stimuli. Men are also more likely to experience spontaneous arousal. Women, on the other hand, are much more multi-dimensional. In order to reach a state of arousal, women tend to fantasize about relationships between individuals and need physical stimuli, rather than just seeing the image of an attractive male.

This makes complete sense if you actually think about it. From an evolutionary standpoint, women do not need to be aroused to reproduce. The male, however, does. Without male arousal and eventual climax/orgasm, the sperm cannot meet the egg to create more life. That does not mean that female orgasm is not important. The hormones released are important for bonding and counter the stress hormones in the body.

Yeah, yeah, yeah. Sex is a good thing.

What happens if you have pain with intercourse?

Potential causes of painful intercourse:

• Vaginismus is when the muscles around the opening of the vagina are in muscle spasm and won’t allow anything “in”. That can also includes tampons and speculums for pelvic exams.

• Pelvic floor muscle spasm

  • described as pain with deeper entry

  • muscle spasms can be felt in the pelvis itself or frequently refer pain into the lower abdomen or into the buttock

• Not enough lubrication can create too much friction (click here to learn more about lube)

  • not enough foreplay

  • hormonal changes, such as a drop in estrogen (menopause, breastfeeding, cancer treatment, etc)

• Injury, trauma, or childbirth including

  • abdominal or gynecological surgeries leading to scarring

  • chemo and/or radiation causing tissue changes

• Emotional factors

  • psychological issues leading to lower arousal levels, anxiety, depression, etc

  • stress increases muscle tension throughout the body

  • history of sexual abuse

• Typically I can recreate the pain experienced during intercourse during the patient’s pelvic floor muscle examination. If the pain cannot be reproduced or improved with pelvic floor PT, further testing needs to be done to rule out more serious causes, such as

  • ovarian cyst

  • gynecological/colon cancer

  • sexually transmitted infections

  • uterine fibroids

  • pelvic inflammatory disease

  • urinary tract infection

  • endometriosis

  • various vulvar dermatological diseases

Sexual Abuse

According to RAINN, one out of every six women is the victim of attempted or completed rape. This statistic is extremely difficult to try and determine, as this is often seen as a silent crime. Many victims do not come forward. This is never something that is someone’s fault. If you are the victim of sexual abuse, first, let me say that I am sorry. This is not fair and is not right. You do NOT have to suffer in silence!

Please tell someone! There are many individuals in the area trained to help counsel those who have experienced trauma. You can also utilize the National Sexual Assault Hotline at 800-656-HOPE (4673) or visit www.rainn.org to live chat if you have been the victim of sexual abuse. All contact is confidential and free.

Frequently, individuals with pelvic pain have a history of abuse of some sort (sexual, physical, emotional). When someone experiences a trauma, the body often remembers. That memory can be conscious or subconscious. In the case of sexual assault victims, the pelvic floor muscles will often respond by increasing tension with various sexual encounters. These patients often experience this even when sexual activity is consensual and occurring many years after the incident.

Research article alert...

One study even looked at pelvic floor muscle activity response to threatening and non-threatening visual stimuli. Researchers discovered that pelvic floor muscle activity increased in those who had a history of sexual assault when they were shown both threatening images and sexually explicit images. This means that there is a subconscious reaction in the pelvic floor muscles to visual stimuli.Since the incidence of abuse is unsettlingly high, it is extremely important for parents to teach their children the anatomical name for their external genitalia.

That way if someone does or says something inappropriate, they are able to communicate that with parents, law enforcement, etc. Nicknames like "lady parts", "cookie", or "bits", will not be helpful if someone inappropriately touches your child. How much detail you share with them is completely up to you. At a bare minimum I would teach them "penis" and "vagina".  Feel free to use the below diagram as a good place to start. 

My previous blogs have had a lot more advice in them. When it comes to pelvic pain, there is no one size fits all treatment. Each person comes with his or her own history, sexual experiences, and goals. If you, or someone you know, is suffering from pelvic pain (at rest, with bowel movements, with intercourse, with pelvic examinations, etc), ask for a referral to pelvic floor physical therapy for your individualized plan of care. A good pelvic floor therapist should be able to differentiate when someone is appropriate for PT and when further testing needs to be done.