We’re talking about sex, but don't run away! Sexuality is a fundamental human right and is a core aspect of being human. (WHO)
You may not feel comfortable discussing problems concerning the more intimate parts of your body, but know that you are not alone! About 40% of women and 30% of men have sexual dysfunction. (Rosen)
If you, or someone you care about, is having trouble in the bedroom speak up and find help. We want to help get you back to peak performance, so let’s talk about how pelvic floor therapy can help. We will talk about where to find help later in blog.
SEXUAL DYSFUNCTION
Sexual dysfunction prevents an individual or couple from satisfaction with sexual desire, arousal, or orgasm. Both physical and mental factors can affect these functions, and although symptoms vary, it affects people of any age; however, it is more common as we get older, especially for those over forty years old. (Jenkins)
Sexual Dysfunction in Females
The primary types of female sexual dysfunctions include:
· Lack of desire (decreased libido)
· Impaired or absent arousal
· Difficulty achieving orgasm (anorgasmia)
· Painful sex (dyspareunia)
· Urine leakage during sex or with orgasm
· Vaginismus (muscular closing of the vaginal opening)
Female sexual dysfunction is more common in women with: (van der Velde, Constantini)
· Pelvic pain
· Urinary leakage
· Overactive bladder
· Cancer
· Infertility
· Endometriosis
· Physical or emotional abuse
· Substance abuse
As women get older, these dysfunctions are often associated with pelvic floor disorders. They can cause the pelvic floor muscles to become weak, uncoordinated, and unable to perform the necessary functions of helping with clitoral erections, orgasm, and support.
In many instances of pelvic pain, the pelvic floor muscles are overactive and unable to “let go” and relax. Consequently, this can make it difficult, or sometimes impossible, for penile insertion and penetration. This can also be a cause of painful sex or penetration. When the muscles are overstretched, female vaginal tone and sensation may be decreased. When the muscles are tight, vaginal tone and sensation may be too much.
Sexual Dysfunction in Males
There are several types of male sexual dysfunction including:
· Urine leakage with orgasm
· Premature ejaculation (PE)
· Lack of ejaculation
· Delayed orgasm or lack of orgasm (anorgasmia)
Male sexual dysfunction is often associated with: (Cleveland, Lipschultz, Jenkins)
· Heart disease
· Diabetes
· Obesity
· Hormone level imbalance
· Medication side-effects
· Smoking
· Alcoholism
· Psychological factors
ORGASMIC DISORDER
Orgasms should be an enjoyable experience! An article from the Mayo Clinic website describes them as, "a wonderful feeling of intense physical pleasure and release of tension, accompanied by involuntary and rhythmic contractions of your pelvic floor muscles." Wow!
Not only do orgasms provide pleasure, reports show that men and women who have more orgasms may live longer! (Davey, Friedman)
If you’re unable to have orgasms, if you experience pain during orgasms, or if you suffer from premature ejaculation, you may have orgasmic disorder.
Many factors may contribute to this problem, including problems with the pelvic floor muscles (PFM). These muscles can either be weakened and overstretched or weakened and tight. These muscles are just like any muscles in our body and can not only become injured, but they can also be trained and rehabilitated!
Sex and myPFM
So what’s the big deal with pelvic floor muscles, and how do they affect our sexual performance?
Pelvic floor muscles are super supportive layers of muscles that help keep pelvic organs in place—and we all have them! Think of them as a hammock at the base of the pelvis. They start at the pubic bone at the front and stretch to the tailbone at the back.
The clitoris and the penis are the principal sex organs and pelvic floor muscles surround both. The superficial pelvic floor muscles help achieve and maintain erections in both the clitoris and penis and are also active during orgasm and ejaculation. (Gray, Costantini)
Contraction of the superficial pelvic floor muscles in males during an erection can more than double the blood pressure inside the penis. (Lue)
Pelvic floor muscles are designed to stretch, support, and rebound back up. However, if these muscles are damaged or weakened, they may lose support and strength.
But there is hope! Correcting or improving your pelvic floor muscles the natural way can lead to successful intimacy between partners, providing a strong bonding experience and an expression of love. Pelvic floor physical therapy is an excellent way to address any pelvic floor muscle issues.
Treatment for sexual dysfunctions and orgasmic disorder
We believe sexual health is vital for a person's well-being, happiness, and development, and we hope you do too. If you could improve your orgasm frequency, intensity, and overall pleasure, wouldn't a few hours each week be worth it?
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.
A dedicated and expert pelvic floor physical therapist will develop and coordinate a treatment plan especially for you. They will want to talk with you and discuss your concerns privately. The therapist will ask questions about your medical history and sexual function to better understand your condition.
The PT may want to perform an external evaluation of your hips, back, and posture, as these can all affect your pelvic floor muscles. Frequently, the PT will also want to perform an internal examination to best access the pelvic floor muscles and help with assessment and treatment.
This internal examination is generally through the vagina in females and through the rectum in males. The PT will make sure you are comfortable with all steps of the internal examination before beginning. If you are not comfortable with having an internal exam on your first visit (or at all), let your therapist know! There are still things that the PT can discuss with you to help address your concerns.
Treatment options may include soft tissue massage to relieve tension in the pelvic floor or surrounding muscles, or biofeedback to help you visualize and connect with your pelvic floor muscles to relax and/or contract them .
Your treatment plan may also include other interventions that will help to optimize the functioning of your pelvic floor. Some examples include:
Dietary changes to optimize functioning of your digestive and urinary systems
Proper toileting habits
You can also check out this IGTV video with 10 Tips for Pain-Free Sex After A Baby
Not sure where to find a pelvic therapist? On myPFM.com we have links to four extensive pelvic health databases to help you find a therapist!
Check out our amazon store* to see some of our favorite resources and products for sexual dysfunction and pain with sex.
Head to OhNut's website for one of our favorite tools to help both partners enjoy pain-free sex! Use the promo code "MYPFM" for a discount!
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics: Learn where the pelvic floor muscles are, what they do, and how they work
Read our new book Sex After Baby: How to Resume Intimacy with Confidence and Ease
Watch our interview on low sex drive with Dr. Staci Tanouye MD, FACOG/GYN
Watch our interview on painful penetration with Dr. Amanda Olson, DPT, PRPC
Watch our interview on sex without pain with Dr. Heather Jeffcoat, DPT
Watch our interview on premature ejaculation with Dr. Susie Gronski, DPT, PRPC, WCS
Watch our interview on erectile dysfunction with Dr. Nicholas Vernola Jr. PT, DPT
Watch our interview on sex and orgasms with Dr. Uchenna Ossai, PT
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Did you learn something new? Interested in learning more? Follow us on Instagram where we cover various topics connected with pelvic floor muscles. Watch our video on sexual dysfunctions here. And don't forget to join the conversation below!
By Zemrie DaCosta with Jeanice Mitchell, PT and Emily Reul, PT, DPT
SOURCES
Perelman MA. Introduction: advocating for a transdisciplinary approach to the management of sexual disorders. In: Management of Sexual Dysfunction in Men and Women. New York, NY: Springer-Verlag; 2016:1-8.
Sexual Health, Human Rights and the Law. Geneva: World Health Organization; 2015. https://apps.who.int/iris/bitstream/handle/10665/175556/9789241564984_eng.pdf. Accessed February 19, 2020.
Constantini E, Villari D, Filocamo M, et al. Female Sexual Function and Dysfunction. Springer International Publishing; 2017. doi:10.1007/978-3-319-41716-5
Gray H, Clemente CD. Grays Anatomy of the Human Body. Philadelphia: Lea & Febiger; 1985.
Anorgasmia in women. The Mayo Clinic Website. https://www.mayoclinic.org/diseases-conditions/anorgasmia/symptoms-causes/syc-20369422. Published April 19, 2018. Accessed February 7, 2019.
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
Friedman HS. The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study. Hudson Press; 2011.
Dean RC, Lue TF. Physiology of penile erection and pathophysiology of erectile dysfunction. Urol Clin North Am. 2005;32(4):379-95, v. doi:10.1016/j.ucl.2005.08.007
Rosen RC. Prevalence and risk factors for sexual dysfunction in men and women. Curr Psychiatry Rep. 2000 Jun;2(3):189-95.
Jenkins LC, Mulhall JP. Delayed orgasm and anorgasmia. Fertil Steril. 2015 Nov;104(5):1082-8. doi: 10.1016/j.fertnstert.2015.09.029. Epub 2015 Oct 9.
van der Velde J, Everaerd W. The relationship between involuntary pelvic floor muscle activity, muscle awareness and experienced threat in women with and without vaginismus. Behav Res Ther. 2001 Apr;39(4):395-408.