Sexual health can change throughout different stages of life, and concerns around libido, arousal, orgasm, sensation, comfort and sexual function are more common than many people realise.
The pelvic floor plays an important role in sexual function, but it is only one part of a much bigger picture.
Hormones, relationships, stress, medications, pregnancy and childbirth, menopause, pain, previous experiences and general health can all influence sexual wellbeing.
Understanding what has changed and what may be contributing can help determine what type of support may be appropriate.
Sexual Health & the Pelvic Floor: Can Your Pelvic Floor Affect Sex?
The pelvic floor muscles are involved in sexual sensation, arousal and orgasm as well as supporting the pelvic organs and contributing to bladder and bowel control.
For comfortable sexual activity, these muscles need to be able to contract, relax and coordinate appropriately.
Changes in pelvic floor function may contribute to symptoms such as:
Pain with penetration
Difficulty relaxing for penetration
Reduced sensation
Pelvic tension or discomfort
Changes in orgasm
Pelvic pain during or after sex
However, sexual function is complex, and pelvic floor function shouldn't be considered in isolation.
How Does the Pelvic Floor Affect Sexual Function?
Changes in sexual desire can happen for many reasons.
Libido may be influenced by:
Stress and fatigue
Relationship factors
Pregnancy
Postpartum recovery
Breastfeeding
Perimenopause and menopause
Hormonal changes
Pain
Medications
Mental health
Previous sexual experiences
Body image
General health
Sometimes there isn't one obvious explanation.
Low desire also isn't automatically a pelvic floor problem. Depending on your concerns, your GP, psychologist, sex therapist or other healthcare professionals may be more appropriate or form part of your care.
Why Has My Libido Suddenly Changed?
Pelvic floor muscle overactivity can contribute to sexual difficulties for some people.
If the pelvic floor has difficulty relaxing or lengthening appropriately, penetration may feel uncomfortable, tight or painful.
Some people may also experience aching or pelvic tension during or after sexual activity.
Importantly, a pelvic floor that feels tight doesn't necessarily need more strengthening. Management depends on how the muscles are functioning and what symptoms you're experiencing.
Can a Tight Pelvic Floor Affect Sex?
Pelvic floor strength and coordination can contribute to sexual function and sensation.
Some people with reduced pelvic floor function report changes in sensation or orgasm, although sexual function is influenced by many factors beyond muscle strength.
If pelvic floor strengthening is appropriate, rehabilitation can be individualised rather than relying on a generic program of Kegels.
Can a Weak Pelvic Floor Affect Sexual Function?
It's very common for sexual function to feel different following pregnancy and birth.
Changes may be influenced by:
Pelvic floor changes
Perineal tearing or episiotomy
Caesarean birth recovery
Vaginal dryness
Breastfeeding and hormonal changes
Fatigue and sleep deprivation
Pain
Changes in body confidence
Stress
Changes in desire
The emotional adjustment to becoming a parent
If something doesn't feel right or you're experiencing pain, you can seek support rather than simply waiting for it to resolve.
Why Does Sex Feel Different After Having a Baby?
Hormonal changes associated with breastfeeding can contribute to reduced vaginal lubrication and changes in vulvovaginal tissues for some people.
This may make penetration feel dry, irritated or uncomfortable.
Pelvic floor tension, birth-related injuries and other factors may also contribute.
Persistent pain is worth discussing with a healthcare professional, and your GP may also be able to assess whether hormonal factors require medical management.
Why Is Sex Painful While Breastfeeding?
Yes.
Hormonal changes during perimenopause and menopause can influence sexual desire, arousal and vulvovaginal comfort.
Some people experience:
Reduced libido
Vaginal dryness
Burning or irritation
Pain with penetration
Changes in sensation
Changes in orgasm
Urinary symptoms
Changes to the vulva, vagina and urinary tract associated with declining oestrogen are collectively known as Genitourinary Syndrome of Menopause (GSM).
There are management options available, so these changes don't simply have to be accepted as an inevitable part of ageing.
Can Perimenopause or Menopause Affect Sex?
Changes in orgasm can occur for many reasons.
Orgasm involves the pelvic floor, nervous system, blood flow, sensation and psychological and emotional factors.
Changes may therefore be influenced by pelvic floor function, hormonal changes, medications, pain, stress, arousal, neurological factors or other health concerns.
If you've noticed a significant or persistent change, assessment can help determine whether pelvic floor rehabilitation is relevant or whether another healthcare professional may be more appropriate.
Why Can't I Orgasm Anymore?
Potentially for some people — but this isn't as simple as “do more Kegels and your orgasms will improve.”
Pelvic floor muscle contractions form part of the physiological response during orgasm, so strength and coordination can be relevant.
However, someone with an already overactive pelvic floor may not benefit from simply increasing strengthening.
Sexual function also involves far more than muscle strength alone.
Can Pelvic Floor Exercises Improve Orgasms?
Sometimes the pelvic floor tightens or guards automatically during sexual activity.
This may occur alongside pain, previous painful experiences, anticipation, fear, pelvic floor muscle overactivity or conditions such as vaginismus.
This isn't necessarily something you can consciously switch off by simply being told to “relax.”
Understanding why your body is responding this way can help guide an appropriate and gradual management approach.
Why Do I Feel Like My Body Won't Relax During Sex?
Yes. Experiences of trauma, including sexual trauma, can influence sexual wellbeing and how the body responds to touch, penetration and intimacy.
Some people experience protective pelvic floor guarding, pain, changes in desire or arousal, or difficulty feeling safe during sexual activity.
However, there isn't one universal response to trauma.
Where trauma is relevant, pelvic health care should be trauma-informed and centred around choice, consent and control.
Psychological or specialised sexual health support may also be an important part of care.
Can Previous Trauma Affect Pelvic Floor and Sexual Function?
No.
An internal pelvic floor examination may provide useful information in some circumstances, but it is not automatically required to discuss sexual health concerns or begin pelvic health care.
If an internal assessment is recommended, your practitioner should explain why it may be useful and what it involves.
You can consent, decline, request modifications or stop at any time.
Do I Need an Internal Pelvic Floor Examination?
This depends on what you're experiencing.
Sexual health can involve multiple areas of healthcare, so appropriate support might include:
A pelvic health practitioner
GP
Gynaecologist
Psychologist
Sex therapist
Relationship therapist
Menopause practitioner
Other medical specialists
Sometimes a combination of practitioners provides the most appropriate care.
Who Should I See About Sexual Health Concerns?
Where pelvic floor or musculoskeletal factors are contributing, pelvic health care may form part of your management.
Depending on your symptoms and goals, this may include:
Pelvic floor assessment
Pelvic floor relaxation or rehabilitation
Pelvic floor coordination
Breathing strategies
Pain education
Scar assessment where relevant
Movement and exercise
Vaginal trainer guidance where appropriate
Education and self-management strategies
Referral or collaboration with other healthcare professionals
Most importantly, your goals should guide your care. Improving sexual health doesn't have to mean achieving penetrative intercourse if that isn't what you want.
How Can Pelvic Health Care Support Sexual Function?
You can seek support whenever a change in sexual function is concerning you — it doesn't need to meet a particular level of severity.
Medical assessment is particularly important for new or unexplained symptoms such as vaginal bleeding, bleeding after sex, new vulval changes, unusual discharge, significant pelvic pain or sudden changes in sensation.
When Should I Seek Help for Changes in Sexual Function?
Sexual Health & Pelvic Health Care in Healesville
At Yarra Valley Women's Health, our pelvic health osteopaths provide individualised assessment and management where pelvic floor or musculoskeletal factors may be contributing to sexual health concerns.
Our approach focuses on education, knowledge, consent and individual choice, while collaborating with other healthcare professionals where appropriate.