The pelvic floor is a hammock-like group of muscles, ligaments, and connective tissues at the base of the pelvis that holds the pelvic organs in place. Pelvic organs include the bladder, urethra, intestines, and rectum (for men and women), prostate (for men), and uterus, cervix, and vagina (for women).

A pelvic floor disorder can occur when the pelvic floor muscles become weakened or damaged and cannot support the pelvic organs as effectively. On the other hand, the pelvic floor muscles can become shortened and overly tight, which may result in constipation, urinary urgency, pelvic pain, and/or painful sex. The most common pelvic floor disorders associated with weakened pelvic floor muscles are urinary incontinence (loss of urine), fecal incontinence (loss of stool), and pelvic organ prolapse (a condition in which a pelvic organ falls from its normal position into the vagina or rectum).

Pelvic floor disorders are especially prevalent in women because pregnancy and childbirth are predisposing factors, but men can also be affected by these conditions. It is estimated that one in three women will experience a pelvic floor disorder in her lifetime. Additionally, pelvic floor disorders may occur frequently in transgender women who have undergone vaginoplasty with depth. In this gender affirming surgery, vaginal depth is created through the pelvic floor which can make vaginal dilation and penetration difficult or painful.

Given that the pelvic floor supports important reproductive organs and other organs in close proximity, it is understandable that a pelvic floor disorder might impact an individual's sexual functioning. In fact, many studies have demonstrated an association between pelvic floor disorders and sexual dysfunction. Due to the multifaceted nature of sexuality, it is not possible to point to pelvic floor dysfunction as the primary cause of any sexual dysfunction. Nevertheless, the following are some of the ways in which pelvic floor disorders are related to sexual problems.

Dyspareunia (Painful Intercourse)

Pelvic floor disorders have been shown to be associated with dyspareunia, or painful intercourse. In particular, pelvic organ prolapse is often associated with pain during sex because the mispositioned pelvic organ and/or the dryness of the protruding tissue can make penetration painful or uncomfortable. However, in cases of mild prolapse, many people continue to enjoy satisfying sexual relationships without experiencing pain or other undesirable changes.

Overly tight (or hypertonic) pelvic floor muscles are a common cause of pain associated with intercourse. Penetration can become challenging when these muscles are too tense and unable to relax. For example, women with vaginismus experience involuntary spasms of the pelvic floor muscles in response to vaginal penetration, which can make vaginal intercourse, tampon insertion, and gynecological exams difficult and painful.

Reduced Sexual Desire and Arousal

The symptoms of pelvic floor disorders are significantly associated with reduced sexual desire and arousal. This association could be due to a number of factors. Women with pelvic organ prolapse might worry about the appearance of their genitalia during intercourse if the prolapsed organ is protruding, leading to a reduction in sexual enjoyment and desire. Individuals who suffer from urinary or fecal incontinence may worry about leaking urine or stool during sexual activity. Certainly, experiencing pain during sex that is related to a pelvic floor disorder could cause sex-related anxiety for an individual, resulting in a decrease in desire and arousal as well.

Less Frequent Orgasms

Pelvic floor muscles play an important role in orgasms. Healthy pelvic floor muscles allow for stronger, longer-lasting orgasms, and weakened pelvic floor muscles may impair an individual’s ability to achieve orgasm or experience the same quality of orgasm as they did previously. Research has shown an association between pelvic floor disorders and infrequent or less frequent orgasms.

Prevention and Treatment

Although weakened pelvic floor muscles become more common as individuals age, pelvic floor disorders are not an inevitable part of aging. Health care professionals recommend maintaining a healthy body weight, avoiding constipation by eating foods high in fiber, and (for those with a weakened pelvic floor) doing pelvic floor exercises such as Kegel exercises to maintain strong muscles. If you have a pelvic floor disorder or are at risk of developing one, you may benefit from seeing a urogynecologist or a specialist for pelvic floor physical therapy.

Resources:

• Handa, V.L., Cundiff, G., Chang, H.H., & Helzlsouer, K.J. (2008). Female sexual function and pelvic floor disorders. Obstetrics and gynecology, 111(5), 1045–1052. DOI: https://doi.org/10.1097/AOG.0b013e31816bbe85
  
  
• Memorial Hermann Foundation. (2021). What Are Pelvic Floor Disorders? https://www.memorialhermann.org/services/specialties/pelvic-floor/pelvic-floor-disorders
  
  
• NIH Office of Communications. (2020, January 8). About Pelvic Floor Disorders (PFDs). https://www.nichd.nih.gov/health/topics/pelvicfloor/conditioninfo
  
  
• Verbeek M., & Hayward L. (2019). Pelvic Floor Dysfunction and Its Effect on Quality of Sexual Life. Sex Med Rev., 7(4), 559-564. DOI: https://doi.org/10.1016/j.sxmr.2019.05.007