Sexpectations :: How Pelvic PT Empowers Women To Have The Sex Lives They Deserve

Let’s face it. There is stigma around sex for women. 

Sex is often thought of as a taboo topic in and of itself, so issues or complications with sex are even more elusively discussed, inquired about, mentioned to medical professionals, or shared with partners.

And we often see the flip side. If these topics are discussed, they are often dismissed, labeled as “normal”, over medicated or brushed aside. For any other area of our body, if pain or difficulty presents, you may get a doctor consult, have a discussion with a loved one, or start a text chain with your girlfriends. But women who experience issues with sex find themselves feeling isolated, often with feelings of inadequacy and resentment towards their body, and generalized lack of hope or options.

As pelvic health PTs, sex is discussed every hour of every day in our office. We see the shame and the hesitancy on the faces of our patients as they quietly whisper that they’ve never orgasmed, that they dread sex with their partner of several years because it hurts, that they have no desire, no hope, and no identity as a sexually empowered woman.

Often, they are not even there in the first place for their issues or complications around sex. They come in because they are leaking or just had a baby or because their doctor or friend said to come. So when we start asking about this crucial aspect of their life, they often find themselves answering questions that no one has ever asked them before:

• Do you have pain or discomfort with sex? 
• Does it hurt at the opening when you have penetrative intercourse?
• Does it hurt when penetration is deep? 
• Do you ever feel like you are worried that there will be pain during intercourse?
• Do you feel numb or have decreased sensation during sex?
• Do you have a hard time feeling aroused or in the mood?
  Are you able to orgasm?
• Are you able to ejaculate? Did you know that you can ejaculate?
• Do you like sex?
• Do you have complicated feelings and emotional responses around sex and have you ever talked with anyone about this?

Take a breath and read back through that list. See if any of those feel true for you.

All of these questions are just part of our initial assessment when it comes to painting a picture of a woman’s sexual and pelvic health.

Answers to the above give us clues to what we, as pelvic health physical therapists, need to assess to see how we can help restore this vital aspect to one’s life. Everyone can choose whether or not they engage in sex or intimacy in any form, but pain and dysfunction should never be allowed to make this decision for you. When there are issues affecting one’s ability to be intimate, feelings of frustration, resentment, failure, indifference, sadness, or even crises of one’s sexual identity can cause ripple effects across that person’s life. 

Do you have pain with sex?

Pain is always a message. Anywhere. Anytime. If you wouldn’t ignore pain in your knee every time you run, you should not ignore pain in the pelvic floor when you attempt sex, tampon use, or gynecological exams. The pelvic floor is a dynamic muscular, neuromuscular, and fascial system that depends on the fact that those muscles and tissues are free moving, strong, and healthy. 

These muscles are also very protective and loving. If, for example, you feel unsafe, scared, ashamed, or have ever felt this way, they may respond by tensing or tightening subconsciously, to protect you from harm or from assumed harm. This all happens involuntarily and often without control or knowledge that this is occurring. The pelvic floor consists of 3 layers of musculature and 10+ different muscles with hip, abdominal, back, and leg muscles crossing into its walls as well. Tension can increase in these muscles from trauma, injuries, stress, perfectionism, posture issues, sports, workouts, etc. 

Tension is not bad as long as you can regulate it when needed. When that isn’t the case, we often see pain and dysfunction in the pelvic floor. Sex becomes painful, tampons hurt or won’t stay in, annual gynecological visits are delayed/dreaded, and feelings of resentment towards one’s body often ensue. Pain can occur at the opening or you can feel stabbing deeper in. The cervix often gets blamed when, in fact, it is muscle tension at the deepest layer of the pelvic floor. All of this can and should be addressed by a pelvic PT to normalize this tension and relieve this pain.

Do you have low or no sensation, arousal, orgasm or ejaculation? Do you even like sex? Do you have complicated feelings around this topic, this experience, this aspect of your life? 

Many, many, many women struggle with these things. We cannot emphasize enough how many women we see for these issues and how many more need treatment for these issues but may not know help is available.

Several things can affect your body’s decrease in arousal, including hormones, pregnancy, breastfeeding, thyroid issues, medications, history, or trauma (sexual, emotional, physical, racial, or religious trauma). We often rely on our collaborative partners to help you determine any outlying issues that may be affecting you, but we specifically assess and treat any musculoskeletal issues that may be affecting your ability to get blood flow and sensation to this part of your body.

We also emphasize and provide education around this area of your body. Many of us have had subpar sex education, if any at all, so the more you know, the more empathy and understanding you have towards your body. If you want, we even educate and involve partners in your treatments. Often having them understand what is going on (and why) helps you feel like they are a participant in your reality. We also can give you both “homework” to do to help with some of these issues. 

We take sexual pleasure seriously and feel that its value is worth the time and energy needed to ensure it. Difficulty or inability to orgasm or to be aroused is essentially erectile dysfunction for women. If that phrase can get a slew of medications and treatments for men, we are only asking that it be addressed as quickly and effectively when it applies to women. We should all be orgasming, regularly, and we shouldn’t feel ashamed when we need help figuring out why we aren’t or why it’s hard.

If sex is a part of your life, or if you want it to be in the future, your pelvic floor deserves the support and assessment by a pelvic floor physical therapist. 

Our MOJO motto is: We See You. We Hear You. We Understand You.

Our website is MOJOph.com for more information about our work. You can also email info@MOJOph.com for inquiries or for direct responses about this blog post. At MOJO, we talk about and treat the things that are often talked about the least, but often affect us the most. Let us know if you’re ready for that to change in your life.