Ah yes, sexual health, the taboo topic of the millenia! One thing we know for sure is that sex and intimacy looks different to everyone.When we think about this topic, we typically think about it in two ways: physical and mental. But what does this even mean? 

Let’s think about the pelvic floor in a physical and anatomical way. We have 3 main layers to the pelvic floor. The first layer of the pelvic floor lays right behind our external genitalia.The second layer of the pelvic is heavily involved in our bladder function and the third layer can be associated with bowel function, and hip/low back function. 

The other piece of the puzzle is our nervous system! We have an autonomic nervous system and a central nervous system, in our case, we will be chatting through the autonomic nervous system functions. Our autonomic nervous system can be separated into 2 distinct parts- the parasympathetic and the sympathetic nervous system. 

The Parasympathetic Nervous System 

This is our “rest and digest” center that helps our physical body decide we are safe and able to fully be present in the moment. I want you to picture being curled up with a good book on the couch in your favorite lounge set. Our nervous system is sending a message to all of our muscles that there is no threat or danger present. You will notice that you may yawn more or have more digestive sounds coming from your stomach. When we think about sex and intimacy, this section of our nervous system tells our muscles- specifically the pelvic floor, that we are safe and trusting that this experience will bring us pleasure and honor our needs.

The Sympathetic Nervous System

This is our “fight, flight or freeze” complex of the body. It is our body’s line of defense against potential harm, pain, discomfort. Our sympathetic nervous system is highly trained and intelligent. It creates a response based on previous experiences. For example, if you have experienced pain while inserting a tampon, the thought of getting your period makes your pelvic floor muscles tense up. Similarly with sex/intimacy, if this was ever painful or uncomfortable- the nervous system may tense your pelvic floor muscles even reading this blog post! This is the connection between our physical muscles and our nervous system.

Pelvic Floor During Sex: What’s Really Happening?

We’ll talk about external stimulation first! The clitoris is the only organ in the human body with one true purpose… pleasure! How awesome is that? The clitoris is a complex and much larger structure than what we can see externally! It has over 8,000 nerve endings and branches that run along our pelvic bones. During arousal and stimulation, these structures fill with blood and engorge the area. This happens with our pelvic floor muscles as well! When experiencing an orgasm whether that’s from clitoral stimulation or penetrative sex, the pelvic floor muscles contract and respond to the nervous system’s input. 

A Pelvic Floor Therapist’s Role in Sexual Health

Pelvic floor therapists have specialized training in assessing the pelvic floor muscles and also addressing the nervous system! Common sexual dysfunctions include pain with sex/intimacy in general (dyspareunia), pain with initial penetration or menstrual device insertion (vaginismus), external pain around the vulva (vulvodynia), pain at the clitoris specifically(clitoraldynia), pain around the groin related to specific nerves (pudendal neuralgia), and more. Pain should never be dismissed or accepted as normal. Sex and intimacy is an integral part of the human experience and can be optimized with the help of a pelvic floor therapist. 

Learn more about our approach to treatment of sexual issues.

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By Dr. Bria Stark