Your pelvic floor, sex and physiotherapy: what’s the connection?

vector image of a hammock demonstrating pelvic floor

What is the pelvic floor?

The pelvic floor muscles are a group of muscles that attach from the pubic bone at the front of your pelvis, then come between your legs, to attach to your coccyx (tailbone) at the back. Some people describe them as a supportive hammock or sling underneath. We actually have two layers of muscles. Some muscles are near the surface of the skin. These muscles wrap around the vaginal opening and clitoris and are thought to help with sex and pleasure. The deeper muscles are important for controlling your bladder and bowels and they also help to support the pelvic organs (uterus, bladder and bowels).

It is thought that having stronger pelvic floor muscles makes sex feel better and leads to stronger orgasms but actually the findings in the research are hugely varied so this is a very debatable topic.

If your pelvic floor muscles are not working correctly you might experience one of the following effects on your sex life:

Pain during sex

This can be due to several different factors including an infection such as thrush or a dermatological (skin) problem and it is important to get these ruled out. But for some women, this pain does not have a single clear cause and often the pelvic floor muscles will be contributing. It is commonly found that women with pain during sex actually find it difficult to relax their pelvic floor muscles rather than it being a weakness problem.

Leaking urine during sex (different to female ejaculation)

This can either be due to weakness of the pelvic floor muscles with leakage of urine due to pressure on the bladder and this is most likely to occur with penetration OR it can be caused by overactivity of the bladder muscle which will squeeze urine out as the bladder contracts and this would most likely happen during orgasm.

A feeling that the vagina feels more ‘open’ and experiencing less sensation during sex

This is something that some women report experiencing after having children and can be due to pelvic floor muscle weakness.

What can I do about it?

The first thing to do is see your GP. Be open to them about your problems and make sure they listen to you. Sadly women sometimes don’t feel listened to and you may hear things like “you’ve just had a baby so this is normal”. But these problems are not normal.

Depending on your symptoms, your GP may refer you to a specialist such as a women’s health physiotherapist or a doctor specialising in sexual health or urogynaecology. To find out whether your pelvic floor muscles might be contributing to your problems, you should see a women’s health physiotherapist. At your initial physiotherapy appointment, the physiotherapist will ask you several questions and will then offer you a vaginal examination. This is the best way for your pelvic floor muscles to be assessed.

My best advice is…. do not hesitate to get help. Women often put up with these symptoms for years and one thing we often hear is “I wish I’d got help sooner”.


Sarah Wolujewicz, Highly Specialised Women’s Health Physiotherapist – The Havelock Clinic

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