Pelvic floor 101: If you want to avoid back pain and have great sex, you need to start thinking about your pelvic floor

September 16, 2021

When’s the last time you thought about your pelvic floor? If the answer is never, you might want to start considering it: Recent studies show that 1 in 3 adult women in the U.S. have pelvic floor issues and 95% of back pain in women is associated with pelvic pain. While those stats are surprising, the good news is that there’s help, thanks to physical therapy clinics on a mission to diagnose, treat and boost women’s pelvic floor health.  

What’s the pelvic floor? 

“The pelvic floor is a string of muscles that literally make up the floor of the pelvis. Its functions are vast; it helps with continence [prevents you from peeing and pooping when you don’t want to], holding up your organs and stabilizing your pelvis and low back,” says Dr. Caitlin Abusambra, PT, DPT, who works at Origin, a physical therapy studio that focuses on women’s health in Los Angeles.  

And that’s not its only job: The pelvic floor is partly responsible for great sex, too. “It facilitates blood and lymph flow in the area, helping you orgasm and feel pleasure,” she adds.  

Pelvic floor dysfunction at a glance.  

Without a properly functioning pelvic floor, many issues could arise—especially when the body is going through intense changes, like during and after pregnancy as well as menopause.  

“Pelvic floor dysfunction can be caused by whole host of things, from chronic constipation, hip or lower back pain, falling on your tailbone, chronic UTIs and endometriosis, to anxiety/stress, hormonal changes, cancer treatments, pregnancy and childbirth,” says Kristin Sapienza, PT, DPT, and founder of FemFirstHealth, a New York physical therapy clinic focused on women’s pelvic health. “It’s important to address the problem as soon as possible, because pelvic floor dysfunction can lead to painful intercourse, pelvic pain, incontinence and instability with activity,” she continues.  

Enter: Pelvic floor physical therapists.  

“Pelvic floor physical therapists act as detectives to assess all of the specific areas that may be tight and creating pain, or too loose and contributing to incontinence or prolapse,” Sapeinza says. 

In a world where women’s health issues are sometimes dismissed, pelvic floor physical therapists offer much-needed support. “Painful sex, postpartum incontinence and pelvic organ prolapse are common problems, but I’ve had patients whose doctors told them it’s normal, or there’s nothing that can be done about it,” Abusambra says. “Physical therapy is an evidence-based way to treat these issues, especially with incontinence. There’s proof that PT can help treat it.” 

What should you expect at a pelvic floor PT appointment? 

Nope, it’s not all kegels. Over at Origin, Abusambra notes, “We take in a detailed medical history, including surgeries, orthopedic issues, injuries, sexual history and symptoms. Then we figure out what your goals are and if PT is going to help you reach them.” Following the assessment, there’s an hour-long session with a physical therapist to evaluate your posture, breathing and areas of muscle weakness all over the body. 

For those with specific symptoms, an inner-vaginal assessment is also performed to figure out which muscles are weak, tender, tight and dysfunctional.  

The road to healing. 

As for healing the pelvic floor, both clinics recommend tailored physical therapy and at-home exercises. “Our goal is for women to coordinate their pelvic floor better when they’re breathing, squatting and walking. Try doing a basic pelvic floor contraction with your breath and focus on getting a good squeeze on your exhale and fully release and open the vagina when you inhale,” says Abusambra, who recommends doing 1-3 sets of 10 during the day, starting with lying down then working your way up to sitting then standing.  

Adds Dr. Amy Hoover, PT, DPT, and member of the clinical advisory board at fitness studio P.volve, “While it can take up to 6-8 weeks to build muscle, you may feel changes within a week or two of starting pelvic floor strengthening. The most important goal early on is to be able to understand and feel what you are doing so that you can do it correctly. Building a strong mind-body connection with your pelvic floor helps a lot, too.” 

The views expressed in this article do not necessarily represent the views of Murad, and are for informational purposes only, even if the advice of physicians and medical practitioners are included. This article is not a substitute for professional medical advice, diagnosis or treatment, and should not looked be considered specific medical advice. 

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Ramona Saviss is a freelance journalist based in Los Angeles. She has worked as an editor at Variety, The Hollywood Reporter, Time Out Los Angeles, Los Angeles Confidential, and Angeleno. When she’s not writing, you can find Ramona either traveling or planning her next adventure.