The Sex Lives of the Pelvic Floor: Part 1 of a 3 Part Series

Our pelvic floor muscles form the base of our spine and deep core. They wear many hats:  bladder and bowel elimination, sexual activity, support and stability, pressure management, and shock absorption. I often refer to this group of muscles as Grand Central Station: there are a million convoluted routes to take! There is a TON going on down there. Not only are there about 16-20 muscles, but numerous ligaments, tendons, nerves, and fascial connections that help us complete ADLs/IADLs without the very embarrassing occurrence of urinary or bowel leakage and passing gas uncontrollably. Carter et al. (2015) found that a strong and coordinated pelvic floor leads to enhanced sexual function and higher levels of sexual activity. To me, this is reason enough to learn about the backstage crew. 

Let’s talk about what roles these pelvic floor muscles & organs play in our favorite occupation - sex!

Before we start, we’ll get into the nitty-gritty with a quick anatomy refresher...

The pelvic floor is composed of 3 layers of muscle:

Layer 1: AKA the urogenital diaphragm, creates the initial support of the vaginal and rectal canals with a triangle-shaped structure. This layer includes the superficial transverse perineum, bulbocavernosus, and ischiocavernosus. The posterior portion of this layer includes the external anal sphincter. 

The Sex Life of Layer 1

These muscles play a role in stabilizing this superficial region, as well as lengthening and contracting to assist with erection and orgasm. The bulbospongiosus and the ischiocaverbosus specifically assist in orgasm. In vulva owners, these muscles feed into the clitoral hood and aid in clitoral contraction yielding orgasm. 

For clients with vaginismus and dyspareunia, they are the culprit to pelvic pain with penetrative sex, medical exams, and tampon insertion. When these muscles misinterpret any of these experiences as threatening, they create a “guarding” experience and work with the nervous system to protect the body from what they perceive to be unwanted threats (a penis, sex toy, speculum, or menstrual hygiene materials).

Layer 2: This layer includes direct contact with the urethra and helps to support bladder functions. For example, the compressor urethra muscle helps allow for voiding to start and stop. Perineal support is covered by the deep transverse perineum muscle that stretches across to each ischial tuberosity. 

The Sex Life of Layer 2

These muscles again provide overall support for the system and ensure no urine escapes during sex. 

For individuals who experience frequent UTIs, these muscles and surrounding tissues typically present with hypertonicity and mobility restrictions. 

Layer 3: This layer is by far the most robust layer of pelvic floor muscles. Within this region, we have muscles such as puborectalis, muscles of levator ani (pubococcygeus and iliococcygeus), coccygeus, piriformis, and obturator internus. 

The Sex Life of Layer 3

Layer 3 muscles coordinate to relax and widen the vaginal canal.  Pelvic pain or pain with sex is sometimes described as “hitting a wall” due to posterior muscle hypertonicity and limited ROM. If these muscles are unable to coordinate properly, pain can occur. 

The Sex Life of the Pelvic Organs

 The penis and clitoris are certainly the star of the show when thinking about the sex organs. Their ability to become erect with blood is how the body heightens its sensitivity to sexual touch and receives pleasure. Overall, our pelvic floor muscles, when coordinating properly, allow for the range of motion and adaptability necessary for arousal, erection, and orgasm.  

The Sex Lives of Our Clients

We know that often, education is the most important part of our sessions with clients. Breaking down the various roles of the pelvic floor muscles and organs and connecting them directly to sex can help clients absorb the information and understand. 

Stay tuned for the next entry in our 3 part series: the connection of the pelvic floor and the nervous system!

_{This blog was written in collaboration with Chrissy Daigle, OTR/L, OTD of Pelvic Solutions in Tampa, FL.}  

_References:

_{Kanter, G., Rogers, R. G., Pauls, R. N., Kammerer-Doak, D., & Thakar, R. (2015). A strong pelvic floor is associated with higher rates of sexual activity in women with pelvic floor disorders. International urogynecology journal, 26(7), 991–996. https://doi.org/10.1007/s00192-014-2583-7}