• Emily Reul, PT, DPT

Orgasms & the Pelvic Floor

Updated: Feb 18

Hi friends, Valentine’s Day is coming up soon, so today we’re going to talk all about orgasms! When they happen, orgasms are great, but 1 in 4 people report some type of orgasmic dysfunction including: taking too long to orgasm, being unable to reach orgasm, or reaching orgasm too quickly (McCabe, 2016; Bo 2015). For those with vaginas, sexual dysfunction becomes more common as they age (Bo, 2015).


What exactly is an orgasm? In fancy terms it’s a “sensorimotor reflex that may be triggered by a number of physical and mental stimuli” (Bo, 2015). To put it simply, an orgasm is a physical and emotional experience. It often involves rhythmic, involuntary contractions of the pelvic floor muscles (PFM) (Bo, 2015). The sexual response is a complex process involving the hormonal, vascular, nervous, muscular, connective, and immune systems of the body (Bo, 2015).


Orgasms can feel great and are usually followed by a period of euphoria. But did you know that there are health benefits with having regular orgasms? Not only do orgasms provide pleasure, reports show that men and women who have more orgasms may live longer! (Davey,1997; Friedman, 2011)


When the pelvic floor muscles contract during sexual activity, this often increases pleasure for both partners (Bo, 2015). However, the pelvic floor muscles can be overactive and cause dyspareunia (pain with sex) or vaginismus (spasm of the pelvic floor muscles which make penetration difficult or sometimes impossible). If you have difficulty or pain with penetration, seeing a pelvic floor physical therapist can be extremely helpful! There are also products like OhNut which help to make penetration more comfortable. (Use the code “MYPFM” for a discount!). If you are having pain with sex after a baby, try our self-paced course on dealing with pain with sex postpartum.


If you are having penetrative sex, lubrication is important! Lubrication helps to avoid tissue irritation and can improve the overall sexual experience. Lubrication is made naturally by the body, but using additional lubrication can help. Not all lubricants are created equal! Choose the best lubricant for you, but remember it can be as simple as coconut oil! You can find some of our favorite in our Amazon Store.


Conversely, if the pelvic floor muscles are weak and/or uncoordinated, achieving orgasm may be difficult. The intensity and length of an orgasm are linked to the pelvic floor muscle contractions (Bo, 2015).


The pelvic floor muscles are important for sexual stimulation and orgasm but act in different ways in each sex. The ischiocavernosus (in vaginas) attaches to clitoral hood, enhancing sexual function, and works with the bulbospongiosus and puborectalis to assist with vaginal tone and sensation (Bo, 2105). For the penis the PFM (particularly the bulbocavernosus) contract repetitively for several seconds for ejaculation (expulsion of semen) (Bo, 2015). The PFM also help with erection of the penis and give it a lift angle when erect.


Pelvic floor physical therapy has been shown to improve sexual function, including arousal, lubrication, and orgasm in women, and reduce or eliminate pain, urine leakage, and premature ejaculation.


Sex and orgasms can be a complex process for your body which means there are many reasons why you may be having a hard time achieving orgasm. One study shows hormonal contraception (i.e. the pill) may contribute to orgasmic disorders (Bo, 2015). Topical sexual hormones (like an estrogen cream) may partially reverse orgasmic disorder in postpartum women (Bo, 2015). Some medications like SSRIs (antidepressants) can inhibit orgasms (Bo, 2015). Lack of desire and arousal or other emotional stressors can make having an orgasm hard. Performance anxiety, fear of leaking, and fear of penetration can be problematic.


Common Questions About Orgasms

How long after having a baby do I need to wait to have an orgasm?

In general, it’s your choice (unless your birth provider instructs you otherwise)! Some people may feel like resuming quickly. Others may prefer to wait. Just remember to always get birth provider clearance first prior to resuming penetrative activities like intra-vaginal sex. Check out our new book Sex After Baby: How to Resume Intimacy with Confidence and Ease.



Why don’t I have an orgasm with penetration?

First of all, you are not alone! Most female bodies need clitoral stimulation to achieve orgasm. There are many ways of doing this- and some can happen at the same time as penetration.



How can I work on my PFM to have better orgasms?

Seeing a pelvic floor physical therapist will be the most helpful. They will help you to figure out if your pelvic floor muscles are weak and have a hard time contracting, or if they are overactive and have a hard time relaxing. They can also address any other pelvic floor symptoms you may be experiencing like urinary or fecal incontinence, prolapse, and pelvic pain.


Here are some great resources to learn more about orgasms and your PFM:

  • Ask your healthcare provider for a referral to a pelvic therapist.

  • Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.

  • Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics

  • Sign up for our email newsletter!

  • Visit our Instagram page for more on pelvic health.

  • Watch our interview with Dr. Uchenna Ossai, PT, DPT on Sex and Orgasms


For Healthcare providers, check out all our continuing education courses here to help you better serve your clients. You can purchase courses individually or join our Ambassador Program and most of our courses are included with your membership!


Written by Emily Reul, PT, DPT

References

1. McCabe MP et al. Incidence and prevalence of sexual dysfunction in women and men: a consensus statement from the fourth international consultation on sexual medicine 2015. J Sex Med. 2016;13:144-152.

2. Bo K, Berghmans B, Morkved S, Van Kampen M. Evidenced-based physical therapy for the pelvic floor bridging science and clinical practice. 2nd edition. 2015.

3. Davey Smith G, Frankel S, Yarnell J. Sex and death: are they related? Findings from the Caerphilly Cohort Study. BMJ. 1997 Dec 20-27;315(7123):1641-4. doi:10.1136/bmj.315.7123.1641

4. Friedman HS. The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study. Hudson Press; 2011.

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This information is for awareness purposes and not individual medical advice. You should seek your own professional counsel for any medical condition or before starting or altering any exercise or fitness program.

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