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 therapist 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 therapist. 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.
Are you unable to come see us in person? We offer virtual physical 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 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 therapists 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 therapists 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 therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist 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 therapist 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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