What a Pelvic Floor Physical Therapist Taught Me About Sex

Your pelvic floor is a group of muscles found at the base of your pelvis. These muscles have 2 main jobs. The first is to be the floor for the organs that sit above it (the bladder, uterus and rectum) and the second is to provide constraint that allows us to do things such as use the restroom only when we want to, and be able to experience pleasure in physical intimacy. One of the biggest issues people have with their pelvic floor is it being too tense which can lead to less than pleasurable sex. Any past or current injury (to any part of the body!) as well as any mental blocks can cause tension in our pelvic floor which can lead to painful intercourse or underperforming. 

We recently met a couple of amazing pelvic floor physical therapists who shared tips and tricks to help us relax our pelvic floor as well as use it to our advantage during and after major events like first time intercourse and giving birth. These techniques help women and men alike!

Newlywed Needs

A common client for a pelvic floor physical therapist is a newlywed experiencing painful sex. Sex doesn’t have to be and shouldn’t be painful (it can truly be wonderful!) and that is something a pelvic floor physical therapist can help you realize. Treatment may consist of proper preparation techniques,such as plenty of lubrication and foreplay before intercourse, or even dilators to help stretch your pelvic floor if needed. A good pelvic floor therapist will also help you address any previous injuries at any part of the body or teach you different breathing techniques.

Dr. Becky Allan and Dr. Corie Maguire emphasized learning to breathe properly.   Proper breathing reduces pressure on your pelvic floor and lets your pelvic floor act as the trampoline it should be. When you are lifting something, whatever it may be, exhale with the lift. Practice this every single time you lift something! You will then be directing all of the force and pressure up and out instead of down and onto your pelvic floor. 

Mommy Phase

It is recommended for moms to go in and get checked out by a pelvic floor physical therapist about 6-8 weeks postpartum. They will work with you to get you back to the activities that you love. Whether you are a runner, a singer, are chasing other kids around the house, or anything else, you will want to get in and find ways to promote healing of the pelvic floor and help you learn how to use your pelvic floor muscles correctly in everyday situations. A few things you can do at home to promote this healing postpartum: 

  1. BREATHE! We’re back to this great point we talked about earlier! Remember- exhale while lifting. Our brains default to holding our breath when lifting and that will actually push down on our pelvic floor instead of allowing the pressure to escape. 
  2. Stretches! Try out the poses commonly known in yoga as the cat and cow, practicing your breathing while you do so. Move on to really gentle strengthening, focusing on your breathing again. Squats are a great way to practice coordination- just be sure to inhale on the way down and exhale on the way up! Coordination is going to be key to getting back to normal postpartum, so be sure to be working on that. 
  3. If you had any tearing at all, do some scar massage after 6 weeks when the tearing is healed. Touch it, move it around, and moisturize it with a moisturizer that is approved by your provider for that region. Don’t just try and let this tearing heal on its own- you will get back up to normal much quicker this way!

Do you Need to Stretch your Pelvic Floor Muscles?

Not every woman needs to stretch their pelvic floor muscles. Only a trained professional can really help you know if you need to stretch these muscles, so please don’t go out and buy the drug store stretchers for your pelvic floor- you could end up doing much more harm than good. Putting something up there and purposely holding it in place is one of the worst things you can do unless recommended by a professional. It’s the same idea as grabbing any random piece of medical equipment and assuming you know how best to use it for you. The pelvic floor muscles are a muscle group that is hard to see, feel, or even just know what it’s supposed to do. So consulting a professional in this area is always a good idea.

Most people with pelvic floor issues need to learn how to relax this part of their body. If you walk around all day long with your bicep flexed and then someone asks you to straighten out your elbow, you might not be able to. You are constantly contracting the muscle and never letting it go. The same goes for your pelvic floor. If you are constantly contracting your pelvic floor muscle, it is going to be very tight and contracted all the time. This may lead you to think you need to stretch your pelvic floor. But the reality is that you just need to learn to relax it!

Are Kegels the Answer?

Most likely- no. They aren’t! Sometimes they can be very helpful, but studies show that about 50% of women are doing kegels incorrectly. And if they’re doing them correctly, odds are they don’t even need to be doing them. Kegels tend to be thrown around as the fix all cure for the pelvic floor muscles. These are just one of many treatments however. If you injured your shoulder and went to a physical therapist and they only gave you bicep curls to help you heal from your injury, you would fire them. Bicep curls alone are not going to get your shoulder better! The same approach for only one strengthening exercise doesn’t work on your pelvic floor. 

In order to properly treat a pelvic floor issue, you need to figure out what’s going on, what’s causing the issue, and then what kind of resolution is going to work best specifically for you. Maybe you just need to stretch and relax your body in general. Perhaps you need specific trigger points to release your points of tensions. Or maybe a more global approach would be appropriate for you- your tension in your pelvic floor may not go away until the tension in your neck or jaw does. 

Like any exercise, it is best to have a professional assess you and see if kegels are the best exercise for you. There is a patient population whose pelvic floor is actually just weak and does need kegels to help them in strengthening that area. A pelvic floor physical therapist will teach the kegel and then make it functional. You would learn how to add a kegel into other exercises that are also targeting strengthening your pelvic floor in different ways- squats, planks, etc.  You will start to make movement more complex and just call upon the pelvic floor to start doing what it was made to do. 

Good Sex Postpartum

If you were coming out of a major injury to your leg, you would start walking for a while before you got back to running. Giving birth does in fact injure your body, particularly your pelvic floor. So when you feel ready to get back to that intimacy you share with your spouse, remember to walk before you run. Look down there yourself, touch down there, and massage the injured area. Make sure everything is okay before trying out the pelvic floor version of running- sex!

If you’re newly postpartum and you’re trying to have sex again for the first time, consider taking penetration off of the table. Just stick to all of the external stuff like clitoril stimulation, caressing, nipple stimulation, and so on. Both go into it knowing you are going to do all of the external stuff first for a bit. And when you’re ready for penetration again, remember- lubrication, lubrication, lubrication! You can’t use too much lube. It’s better to have way too much then not enough at this time… And then be sure to take it slow!

Remember that your body is amazing and heals from injury all the time. It will heal from giving birth as well, but be sure to treat it kindly while it does so it can heal properly. There are so many other ways to be intimate with your spouse besides penetration at this time. Realize the power of the clitoris. The clitoris’s only purpose is to bring you pleasure and has twice as many nerve endings as the glans of the man’s penis. So let it do its job and bring you that pleasure you’re hoping for!

Pelvic Floor Health for Men

While the pelvic floor is often more focused on women due to pregnancy and childbirth and thereafter, the pelvic floor is also an extremely important area for men to focus on. In general in our society, we equate tension with strength when in reality, in a physiological perspective, they are quite the opposite. If you have a tight pelvic floor it is neither strong nor mobile, both of which limit its function. 

If you enjoy running, cycling, or have a high stress job, you are most likely clenching your pelvic floor. Common symptoms of a tight, clenched pelvic floor include lower back pain, pelvic pain, or constipation. Also, premature ejaculation, hard time orgasming, or difficulty achieving an erection can be symptoms of an unhealthy pelvic floor. Breathing, again, is the number one way to relax these muscles! The microscopic muscles that allow blood to flow into the penis require relaxation to work. Being too excited can even limit your ability to perform, so you need to learn how to relax those muscles in order to get started at all. 

Finding a Quality Pelvic Floor Physical Therapist

Here are a few tips that Dr. Becky Allan and Dr. Corie Maguire gave to find a pelvic floor physical therapist near you:

  1. Typically, you want to choose a therapist that does not accept insurance. You will most likely get superior care from them as they are able to treat you based on what you need, not just on what the insurance dictates to them. 
  2. Word of mouth is a great way to find one. Ask around to see if anyone you know has used a pelvic floor physical therapist in the past and see what they thought of them. Do some research online as well. 
  3. Ask a few questions such as:
    1. How much time will I have one on one with the physical therapist?
    2. Will you be using technicians at all? You want the answer to this one to be “no”.
    3. What is the long term goal for me coming to you?

Follow Dr’s Becky and Corrie on Instagram at @genesisptwellness for more of their tips and tricks on how to treat your pelvic floor right so it can treat you right, right back!

Like what you heard? Be sure to listen to the full podcast episode here! And be sure to download the Intimately Us app, the fun and sexy app for your marriage! It’s full of games, connecting activities, and ideas to increase connection and pleasure in the bedroom.

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<h3>Jaina Thurston</h3>

Jaina Thurston

Hi there, my name is Jaina (pronounced like Jay-Nuh) and I am so happy to be here! I am an outdoor enthusiast and love doing everything with my hubby and 3 dogs. I focus a lot on fertility in my own life and am learning to help other couple's on their intimacy journeys while struggling with infertility. I have a degree in psychology and absolutely LOVE helping others discover their greatness!

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