Your Pelvic Floor Can Seriously Affect Your Sex Life

Physical therapy to the rescue. A lot of us have had PT for the shoulder, knee, hip or back. PT for your pelvic floor is a bit different. But it’s absolutely a go-to for every physician I talked to for this column.  

Here’s what to expect: Pelvic floor physical therapist Amanda Olson says that at the first meeting, the PT will take a medical history. Next, if you are comfortable with it, the therapist will assess your pelvic floor strength and muscle function by putting a gloved finger into the vagina. 

Many of you have heard of Kegels, and, true, much of the therapy involves Kegels and other exercises.

However, if you’re in pain or the muscles are super tight, Olson says Kegels are never recommended.

If your therapist does OK them, Olson says this is how to do it: Imagine you are pulling a blueberry up and into your vagina. Hold for a count of three to five seconds, then release the muscles.

To help the pelvic floor muscles unclench, Olson recommends stretches, deep squats and yoga positions like happy baby and child’s pose. She’s also a fan of bridges, clam shells and squats to increase gluteal strength.

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The glutes and pelvic floor are close neighbors and work as a team. When they are weak, Olson says, the pelvic floor often has to work overtime to compensate, which can lead to fatigue, tension, leakage or pain.

Another pelvic floor physical therapy tool: biofeedback. “You can’t see the muscles, so this can be an important tool that gives us a great visual cue,” says Olson, author of Restoring the Pelvic Floor for Women.

How it works: An electrode that looks like a tampon is inserted into the vagina and hooked up to a computer screen, providing a visual for how the pelvic floor muscles are behaving. The PT can use that information to develop a customized plan. Typically, Olson says patients have physical therapy once a week for four or five weeks (regardless of whether the issue is tightness or weakness) and then every other week for a month or two. Most patients will experience less urinary leakage and pain during sex after four to six weeks, she says, adding that it can take up to eight weeks to build up pelvic floor strength to where it should be. 

Options beyond physical therapy. In addition to PT, overly tight pelvic floor muscles can also be treated with meds.

Here are two medical treatments I’ll bet you’ve never heard of. I sure hadn’t.

• Vaginal Valium. Yes, it’s a thing. Kaufman says it’s basically using diazepam (the generic name for Valium) as a muscle spasm relaxant that can relieve acute symptoms associated with penetrative sex. It’s compounded in a pharmacy and applied like a suppository. It starts working an hour after it is administered and lasts for 12 to 24 hours.
• Botox injection. When the pelvic floor muscles are tight, sex can cause spasms, making penetration painful, Kaufman says.

Botulinum toxin (best known as Botox) can be helpful here because it’s a potent neurotoxin that blocks the nerve from signaling the muscles to contract, so they relax instead.

A doctor injects Botox into the vagina under sedation in an office setting. It takes two weeks to work and wears off after three to six months. Kaufman, however, says you can get repeat treatments. Kaufman recommends Botox for women who do not have success with vaginal Valium or pelvic floor physical therapy.

Both vaginal Valium and Botox are typically covered by insurance.

What you can do at home. Kandadai says the best thing you can do to optimize pelvic floor health is to manage constipation.

“Anybody can help the pelvic floor by making sure they get enough fiber every day and not straining when they poop,” she notes.

That strain can take its toll on pelvic floor muscles and can result in painful hemorrhoids. It also places pressure on the vaginal canal and bladder, which contributes to discomfort.

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Kandadai often recommends that patients place a footstool 6 to 8 inches high under their feet when on the toilet.

That position — creating a squat and maintaining hip mobility – allows the pelvic floor muscles to relax when emptying the bowels and urinating.

Olson’s recommendations include: 

• Paying attention to what you eat. Adhere to a diet that helps digestive health, choosing foods like leafy greens, watermelon, dates and pineapple and proteins like chicken, beef, nut butters and beans. The result? Well-formed stools that are easy to pass means reduced strain on the pelvic floor muscles.
• Exercising. In addition to the exercises you will learn in physical therapy, Olson says to do some sort of cardiovascular exercise — pickleball, swimming, walking — four to five times a week for 30 minutes. “It moves blood flow to the pelvic floor and the whole body,” she says. “When circulation is strong like that, the pelvic floor muscles have what they need to contract well, relax fully and build endurance.”

Parting thought: A lot of women experience pelvic floor issues but don’t talk about it. Hopefully, Kaufman says, that will change.

“It’s one of those topics that’s been relegated to the back table,” she notes. “Talking about it demystifies the topic for women so that they can seek resources.”