By Cambria Oetken, PT, DPT
In every one of my pelvic floor evaluations, I always ask about your sexual health. How does it function? Do you experience any pain? Where is the pain located? Can you achieve an orgasm? If so, is it painful or difficult to achieve? The list of questions depends on what brings you into pelvic floor therapy. Everyone’s experience with sexual wellness may look a little different; however, one major factor that stands out—whether or not you can orgasm—can tell us a lot about what’s going on with your pelvic floor.
Everyone “should” be able to achieve an orgasm in one way or another. If you’re unable to, it could indicate an underlying issue related to pelvic floor dysfunction. It’s important to note that achieving an orgasm is complex: it requires the coordination of our brain, muscles, peripheral nervous system, and cardiovascular system. In fact, the ability to get an erection is sometimes called the “5th vital sign” because it’s closely tied to cardiovascular health.
Also, orgasms should never be painful, nor should they be extremely difficult to achieve. If you’re struggling in this area, it’s worth speaking with a sexual medicine expert. Don’t get me wrong—an orgasm isn’t necessary for a healthy sexual life. There are many ways to maintain sexual wellbeing, even without orgasm. However, if you’ve experienced orgasm before and are now finding it more difficult, painful, or less satisfying, this is something worth addressing.
Orgasms should be enjoyable. There are even numerous benefits to orgasm beyond just sexual pleasure. Orgasms can indicate good cardiovascular health, improve mood, reduce headaches, provide an analgesic effect (pain relief), and enhance sleep quality. The benefits go on and on.
So, What Even Is an Orgasm?
According to Wikipedia, an orgasm is “the sudden release of accumulated sexual excitement during the sexual response cycle, characterized by intense sexual pleasure resulting in rhythmic, involuntary muscular contractions in the pelvic region.” If you’re a curious nerd like me, you may want to know the physiological process behind this amazing crescendo.
There are four main phases in the orgasmic cycle:
Arousal: During the arousal phase, blood pressure and heart rate rise, and muscle tension and skin flushing may appear as physical responses to sexual stimuli. Key events include engorgement (swelling) of the clitoris, increased vaginal lubrication, and penile erection.
Plateau: Blood pressure, heart rate, and muscle tension continue to rise as arousal increases.
Orgasm: This is the sexual climax, marked by rhythmic, involuntary muscle contractions. In men, orgasm results in ejaculation of semen, while female ejaculation, though less common, can also occur. During orgasm, specific muscles contribute to the experience, including the urogenital triangle muscles (such as the ischiocavernosus and bulbospongiosus), and muscles within the levator ani (like the pubococcygeus and puborectalis). These muscles work together to create consistent contractions and relaxations every 0.8 seconds to create orgasmic release.
Resolution: The resolution phase is when the clitoris decreases in size, and the penis returns to a flaccid state. Blood pressure, heart rate, and respiratory rate also return to baseline levels.
Additionally, there is a refractory period, which can vary from person to person. This period is the time after orgasm during which it’s difficult, or sometimes impossible, to achieve another orgasm as the body enters recovery mode.
Pelvic Floor Therapy and Better Orgasms
You may have noticed how integral the pelvic floor muscles are in creating a positive sexual experience, particularly during arousal and orgasm. These muscles must work in coordination to produce a satisfying experience. If they’re not working together, or if they’ve become too weak or too tight, this can make achieving orgasm difficult—and even painful.
Pelvic floor therapy can be a secret weapon for better orgasms, addressing several key components:
1. Pelvic Floor Motor Control
A pelvic floor therapist can assess how well you activate these muscles and determine if they are strong, weak, or tight. A pelvic floor that’s well-coordinated will be able to perform three tasks; a contraction or “kegel”, it will be able to relax back down from a contracted state, and third it will be able to lengthen. These 3 tasks are necessary for bladder control, preventing or improving prolapse and can also help you have better sexual experiences, including enhanced orgasms.
2. Pelvic Floor Strength and Endurance
Once you are able to have optimal pelvic floor coordination it is important that these muscles are also strong and have endurance to keep up with the demands of daily life, sports, exercising, growing a baby and you guessed it, have optimal and pleasurable orgasms
3. Coordinating Pelvic Floor Length for Relaxation
Even the strongest pelvic floors can struggle with relaxation, a process we call the “pelvic drop.” Pelvic drops are like a big sigh of relief, allowing the pelvic floor muscles to relax and lengthen. If these muscles are in a state of constant tension and can’t “drop” when needed, this can make orgasm difficult and reduce pleasure during sex.
4. . Phy Postpartum, Perimenopause and Menopausesiologic Life Changes:
After childbirth—whether vaginal or cesarean—the pelvic floor may become weakened due to the intense strain of labor. This can affect sexual function and orgasmic potential. On the other hand, in a perimenopausal or postmenopausal state there are significant hormonal shifts (that can also occur post partum aka. genitourinary syndrome of lactation)which can contribute to pelvic floor weakness and tissue irritability that may mute or decrease orgasms. There is a societal misconception that sexual pleasure or orgasms will never be as satisfying after childbirth as well as menopause, but this doesn’t have to be the case. Working with a pelvic floor expert can help restore function and optimize sexual health post-birth.
Final Thoughts
If you’re experiencing difficulty, pain, or changes in your sexual function, don’t hesitate to talk to your pelvic floor expert or sexual medicine provider. Pelvic floor therapy could be the key to restoring comfort and pleasure to your sexual health.
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Check out our recently published e-book titled “Vulvodynia, Vestibulodynia, and Vaginismus,” designed to empower and inform individuals on their journey towards healing and understanding.
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