Pelvic Floor Muscle Function: Breathing Into Sexual Pleasure

By Karah Charette, DPT, PHRC Berkeley & San Francisco

As a human being, you have a right to pleasure- safe, consensual, and sexual pleasure.

We are fortunate to participate in a culture where conversations about sexuality and sexual function are becoming more mainstream and accepted. We are now having nuanced conversations about the myriad of factors that affect sex- including the pelvic floor!

You may be thinking that you already know what there is to know about the pelvic floor when it comes to sex. The classic and overused advice is to “do more kegels.” We should reconsider using this language. Firstly, the word “kegel” comes from the name of a white male doctor who founded this exercise. It continues to perpetuate the idea of hidden or coded language when it comes to referring to the pelvic floor. Call it what it is- a pelvic floor contraction!

Secondly, doing more pelvic floor contractions is not the key to good sex. This stereotype derived from a misogynistic view that vaginas need to be “tighter” for sex to be pleasurable, reinforced from a predominately male view point. The reality is that sex requires a balance of both strong and relaxed pelvic floor muscles.

When you think of a healthy muscle, hopefully you picture one that is both long and strong. You would (ideally) never only do hamstring curls and then not stretch your hamstrings. The same concept applies to your pelvic floor muscles.

Let’s consider orgasm. One of the most, if not the most, pleasurable parts of sex, orgasm requires a rhythmic contraction and relaxation of the pelvic floor muscles. If your muscles are too tight or you are not practicing relaxation coordination with orgasm, this can decrease the fullness of your orgasm or even prevent it from occurring.

How can you try this at home? First, start by connecting to your pelvic floor:

Come into a child’s pose with your feet together and knees apart, lowering your head onto the floor with arms outstretched.
Breath into your lower back rib cage and feel your diaphragm expand as you inhale.
Bring your attention to the sitz bones of your pelvis. As you inhale, imagine them separating.
See if you can notice the anus or vagina start to soften or even widen as you do this. If you feel a sensation in your pelvic floor, you are starting to experience a pelvic floor drop!

Being able to relax your pelvic floor with breath is key to improving the overall health of your pelvic floor muscles. Check out this blog here for more techniques on how to relax the pelvic floor.

However, one essential component to this work is that you must also apply to function- in this case sexual function! At home, start to experiment with bringing this sensation of pelvic floor relaxation with sexual activity. For instance, you can explore with masturbation.

With whatever toy suits your fancy, try contracting your pelvic floor muscles and relaxing them fully. Practice this in the beginning of arousal, and as you progress this coordination you may start to attempt this during orgasm. Though it may be tricky at first, this could be the missing piece to you achieving a full climax and all of its glory.

What if just practicing contraction and relaxation is not working? Pay attention to your breath. Notice if as you become more aroused the breath starts to travel to your chest, or if you are even holding your breath. As difficult as it might be in the beginning, allow yourself to slow down and find that expansion at your rib cage and belly. Use this time to connect more with your body and what you are feeling, not just what you are anticipating can or should happen. With patience and time, the connection between your breathing and the pelvic floor muscles can enhance your sexual appreciation.

What if this still is not enough? You may also have some true physical tightness or weakness at the pelvic floor muscles that need to be addressed!

The pelvic floor muscles are made up of both superficial and deep layers. The more superficial layer is also known as the urogenital triangle. Two muscles called the bulbospongiosus and the ischiocavernosus aid in orgasm for both men and women. In people with vulvas, these muscles actually feed into the clitoral hood and participate in contracting the clitoris against the pubic bone in order to achieve enough friction and feedback to produce orgasm. For people with penises, these muscles help maintain an erection. If these muscles are severely tight and shortened, or they are too weak, they cannot help out in this all important task.

What can you do at home? Try this:

Find your pubic bone and palpate with two fingers on either side, in line with where either your clitoris or base of the penis would line up.
Try gently pulling this fascia upwards towards your belly with one finger and then the other and compare side to side. Does one move more than the other?
If one side feels tighter, maintain the stretch of pulling upwards for 30 seconds while breathing.

This is one way to perform a self-evaluation of the fascia at home. As always, it is helpful to work with a professional if you are not sure what you are finding. A pelvic floor physical and occupational therapists can assess each of the pelvic floor muscles for you and determine what could be affecting your function. Learning techniques on how to self massage and stretch these muscles can be a game-changer, especially because some of the more superficial pelvic floor muscles do not stretch on their own. Many of those muscles lay between the frontal bones of the pelvis that have limited range of motion, so often pelvic floor stretches such as child’s pose may not be enough to effect the change those muscles need.

Overall, it is important we start changing the conversation about what can cause sexual dysfunction. All too often we eagerly jump to medication or can even think something is wrong in our relationships because we are not having a sexual experience that feels satisfying. The reality is, your pelvic floor muscles play an essential role in sexual health, pleasure, and orgasm. You need to make sure you have addressed this area of your body when exploring ways to improve your sexual appreciation. Try relaxing, breathing, and even gentle self-stretches to see if any difference is made! If not, consult a physical and occupational therapists. You can find a list of our locations here. There is always more to learn when it comes to the pelvic floor, and there is power in rediscovering your connection to pleasure.

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Are you unable to come see us in person? We offer virtual physical and occupational therapy appointments too!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical and occupational therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical and occupational therapistss committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online.

Virtual sessions are available with PHRC pelvic floor physical and occupational therapistss via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical and occupational therapistss, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical and occupational therapists who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.

PHRC is also offering individualized movement sessions, hosted by Karah Charette, DPT. Karah is a pelvic floor physical and occupational therapists at the Berkeley and San Francisco locations. She is certified in classical mat and reformer Pilates, as well as a registered 200 hour Ashtanga Vinyasa yoga teacher. There are 30 min and 60 min sessions options where you can: (1) Consult on what type of Pilates or yoga class would be appropriate to participate in (2) Review ways to modify poses to fit your individual needs and (3) Create a synthesis of your home exercise program into a movement flow. To schedule a 1-on-1 appointment call us at (510) 922-9836

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FAQ

What are pelvic floor muscles?

The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.

What is pelvic floor physical and occupational therapy?

Pelvic floor physical and occupational therapy is a specialized area of physical and occupational therapy. Currently, physical and occupational therapistss need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical and occupational therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical and occupational therapy education in this unique area.

What happens at pelvic floor therapy?

During an evaluation for pelvic floor dysfunction the physical and occupational therapists will take a detailed history. Following the history the physical and occupational therapists will leave the room to allow the patient to change and drape themselves. The physical and occupational therapists will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical and occupational therapists will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical and occupational therapists will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical and occupational therapists will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.

What is pudendal neuralgia and how is it treated?

Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.

Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical and occupational therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical and occupational therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical and occupational therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.

What is interstitial cystitis and how is it treated?

Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical and occupational therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical and occupational therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.

Who is the Pelvic Health and Rehabilitation Team?

The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical and occupational therapistss who work at PHRC have undergone more training than the majority of pelvic floor physical and occupational therapistss and as a result offer efficient and high quality care.

How many years of experience do we have?

Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.

Why PHRC versus anyone else?

PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.

Do we treat men for pelvic floor therapy?

The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical and occupational therapistss focus solely on people with vulvas, this is not the case here.

Do I need pelvic floor therapy forever?

The majority of people with pelvic floor dysfunction will undergo pelvic floor physical and occupational therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.