There are many factors that play into sexual function. No matter what sexual organ you have, the general sequence of the act of sex involves desire, arousal, and proper function of the pelvic floor muscles and supportive structures. For those that are not yet aware, the pelvic floor is a group of structures that sit at the bottom of your pelvic bowl and play an integral role in things like bowel and bladder control, core function, pelvic organ support, and you guessed it: sexual function.

Pelvic Floor Physical Therapy + Sexual Challenges

As a pelvic health physical therapist, I often work with individuals who experience sexual dysfunctions. My approach includes an individualized plan that aims to address the function of the pelvic floor and how it connects to the rest of the body, both during and outside of sex. While the list of potential dysfunctions I treat is quite long, I wanted to give you an idea of some of the most common things we see:

  • Vaginismus: While there are different classifications of vaginismus, it can generally be described as the involuntary spasm of the pelvic floor muscles during penetration/insertion/intercourse for someone who has a vagina. This can make things like sexual activity, use of a speculum, or even insertion of a tampon/menstrual cup difficult or painful.
  • Dyspareunia: This is a general way to describe painful intercourse for someone who has a vagina. It is different than vaginismus, because it does not always have to be caused by muscles spasming and usually isn’t present with painful insertion (like with a speculum or tampon).
  • Vulvodynia or vestibulodynia: Vulvodynia is a chronic pain (usually described as “burning” or “stinging”) in the vulva. Vestibulodynia is the same thing but localized to the vestibule. These symptoms are usually “provoked” or can be exacerbated by sexual intercourse, insertion (tampon, speculum, toy), wiping, sitting for a long period of time, and even wearing certain fabrics/tight clothing. Pelvic health physical therapists are able to help with pain management and address the abnormal sensations through myofascial, visceral, and neural mobilizations as well as through addressing the pelvic floor itself.
  • Erectile dysfunction (ED): As previously mentioned, the pelvic floor muscles are vital in sexual function. For an erection to occur, there is a specific pelvic floor muscle, called the bulbospongiosus, that acts as a block to keep blood in the penis and maintain an erection. More often than not, a dysfunction in the pelvic floor is causing people to experience ED. So much so that multiple studies and organizations now suggest pelvic health physical therapy be the first line of treatment for those experiencing ED.
  • Inability to Orgasm/Painful Orgasms: The superficial pelvic floor muscles also play a part in ability to orgasm by producing multiple maximal contractions. If the muscles are unable to function how they should during this part of sex, we will see either pain in the pelvis/abdomen with orgasm or inability to orgasm (anorgasmia or decreased force of ejaculation).
Multidisciplinary Approach

While the treatment of these sexual dysfunctions is very effective through physical therapy, a multidisciplinary approach is usually the best way to go. The American College of Obstetricians and Gynecologists has suggested a mix of pelvic health physical therapy and sex therapy as the most effective approach in treating those who experience pain with sex or sexual dysfunctions. While these sexual dysfunctions are a physical manifestation, we cannot ignore the mind-body connection. Having a pelvic health physical therapist and sex therapist on your team will best prepare you in addressing your concerns.