The pelvic floor (sometimes known as the pelvic diaphragm) is a structure of muscles, ligaments and fascia, which play a part in supporting your pelvic organs (like your bladder and uterus), sexual function, and continence. In this article, we will explore sex and your pelvic floor, including vaginismus, a condition where the pelvic floor muscles involuntarily tighten, making intercourse challenging or impossible.
Both women and men have a pelvic floor. However, the female pelvic floor is more widely discussed, largely because women’s health is often tied to pelvic issues – from pregnancy and childbirth to menopause. It’s also a common topic in conversations around sex, where the responsibility often falls on women to strengthen their pelvic floor muscles with certain exercises in order to make sex feel more enjoyable for both partners.
Dr Alex Eskander, Consultant Gynaecologist at The Gynae Centre, explains: “While this emphasis on female responsibility can feel one-sided, the general advice to strengthen and care for the pelvic floor is well founded. A healthy pelvic floor can reduce the risk of pelvic organ prolapse and incontinence, and plays a key role in core strength and stability.”
That said, there is some uncertainty about how effective Pelvic Floor Exercises (PFE) really are when not monitored by a doctor, and a limited understanding of how other factors like hormones, vaginal childbirth and age can impact this complex area of the body.
Sex and your pelvic floor: The role of the pelvic floor
The pelvic floor muscles act as a kind of supportive hammock at the base of the pelvis. They hold key organs in place, and work together with the diaphragm and abdominal muscles to help manage intra-abdominal pressure. These muscles also control the openings of the urethra, vagina and anus, meaning they play a vital role in continence (your ability to control movements of the bowels and bladder).
When it comes to sex, the pelvic floor influences sensation and lubrication. A well-functioning pelvic floor can increase blood flow to the genitals, helping with arousal and orgasm. In women, being able to tighten or relax the pelvic floor can help with pain-free penetration. However, when these muscles are too tight, weak or uncoordinated, they can contribute to pain, discomfort or a lack of sensation.
Pelvic organ prolapse
Pelvic organ prolapse happens when one or more of the pelvic organs drop from their usual position and press into the vaginal wall. This is more common after vaginal childbirth, particularly if there was significant tearing or use of forceps, and it can also occur due to ageing, hormonal changes (especially after menopause), and long-term pressure from chronic coughing or heavy lifting.
Symptoms can include a feeling of heaviness or dragging in the pelvis, a bulge in the vagina or discomfort during sex. While mild prolapse can often be managed with PFE, more severe cases may require physiotherapy, pessary support or surgery.
Causes of weak pelvic floor
Pelvic floor weakness can result from a range of factors, including:
- Pregnancy and childbirth: particularly if there was perineal trauma or a long pushing stage
- Ageing: especially during and after menopause, when oestrogen levels decline
- Chronic straining: from constipation or heavy lifting
- Obesity: which increases pressure on the pelvic area
- Surgery: particularly hysterectomy, or prostate surgery in men
In many cases, a weak pelvic floor develops gradually. Symptoms may include leaking urine when coughing or sneezing, difficulty emptying the bladder or bowels, or a lack of sensation during sex (though this can point to a number of different conditions).
Addressing pelvic floor issues – How to strengthen your pelvic floor
PFE, often known as Kegels, involve consciously squeezing and lifting the muscles you would use to stop the flow of urine. For most women, the goal is to build both strength and coordination, which means being able to contract and relax the muscles properly.
To start, try this method:
- Identify the muscles: Imagine trying to stop passing wind and urine at the same time. That subtle lift is your pelvic floor engaging.
- Squeeze and hold: Contract the muscles for a count of 5 to 10 seconds, then release fully for the same amount of time. Aim for 10 reps, three times a day.
- Add shorter pulses: Include sets of quick contractions to improve responsiveness.
It’s important not to overdo it – especially if you already have tight or overactive pelvic floor muscles, which can worsen symptoms.
Vaginismus and the pelvic floor
Vaginismus is a condition in which the pelvic floor muscles around the vagina contract involuntarily, making penetration painful or even impossible. It is not a sexually transmitted disease and is not contagious.
Vaginismus is almost always linked to a negative experience during the first attempt at penetrative sex. This may be due to a physical abnormality at the vaginal opening — such as a thick hymen, a hymenal septum, or a hymen that fails to stretch or tear during the initial attempt. When penetration is attempted repeatedly without addressing the underlying issue, the vaginal muscles may begin to contract reflexively in anticipation of pain — this automatic protective response is characteristic of vaginismus.
In other cases, vaginismus may be associated with psychological factors such as anxiety, past trauma, sexual abuse, or a fear of pain based on misconceptions or childhood beliefs stemming from old wives’ tales.
It is estimated that around one in ten women in the UK experience painful sex, and many of these may be affected by vaginismus. Unfortunately, the condition is still not widely recognised, even among other gynaecological disorders, leading many women to remain unaware they have it until they attempt intercourse for the first time.
Vaginismus is primarily a muscular issue that often has a psychological component, even when initially triggered by a physical abnormality. The involuntary tightening of the pelvic floor muscles becomes an automatic response to anticipated pain, and over time this response can become deeply ingrained.
Recently, a combination of Botox injections and hymenotomy has proven to be highly effective in treating vaginismus, with success rates as high as 91-92%, according to our clinical audits. The treatment involves injecting Botox into the pelvic floor muscles around the vaginal opening and surgically correcting any physical abnormality that may be the root cause of the problem. Once the muscles are relaxed and the anatomical barrier is removed, most patients are able to begin using vaginal dilators at a follow-up visit approximately three weeks later. With regular training at home over a period of 2-4 weeks, the majority of patients are able to tolerate full penetration with their partner after just 3-6 attempts.
At The Gynae Centre, we have found this treatment to be highly successful, even for those with severe cases of vaginismus.
What to do if you think you have vaginismus
If you think you have vaginismus, you may feel confused, worried or alone. If you are not comfortable speaking to your GP about it, we recommend booking a consultation at a private gynaecology clinic, like The Gynae Centre. We specialise in vaginismus, alongside other gynaecological conditions, and our friendly, discreet and non-judgemental team can ensure that your concerns are heard and that you feel looked after.
To make an appointment to discuss your options further, call us on 020 7580 8090 or book online.
