PELVIC HEALTH AND SEXUALITY – A MUST READ

Dr. Alison Ankiewicz

Issues with sexuality and intimacy are very common and can affect people of all genders, ages, and backgrounds. While prevalence varies depending on the population studied and the definitions used, here are some well-supported statistics:

Prevalence in Women

Sexual dysfunction affects 40–50% of women at some point in their lives.

Common issues include:

• Low desire
• Arousal difficulties
• Pain with intercourse (dyspareunia) – affects 8–22%
• Orgasm difficulties
• Vaginismus (involuntary tightening) – affects 0.5–5%, but may be underreported

Prevalence in Men

Sexual dysfunction affects about 30–40% of men, increasing with age.

Common issues include:

• Erectile dysfunction (ED): affects up to 52% of men aged 40–70
• Premature ejaculation: affects 20–30%
• Low libido: 10–25%, depending on age and health

Transgender and Non-Binary Individuals

High rates of sexual difficulties are reported due to:

• Gender dysphoria
• Hormonal treatments
• Post-surgical healing
• Body image and trauma history

 Some studies suggest up to 50–70% report changes or difficulties with sexual function at some point during or after transition.

Across All Genders

• Pain during sex (dyspareunia, pelvic pain, prostatitis, etc.): 10–20% overall prevalence
• Low sexual satisfaction: Over 40% in some studies report dissatisfaction with their sexual lives
• Intimacy and relationship strain: Common secondary effects of sexual dysfunction

Contributing Factors

• Chronic conditions (e.g., diabetes, endometriosis, MS, cardiovascular disease)
• Mental health issues (depression, anxiety, PTSD)
• Medications (e.g., antidepressants, birth control, cancer treatment)
• Hormonal changes (menopause, postpartum, andropause)
• Pelvic floor dysfunction (tightness, weakness, coordination issues)
• Cultural, relational, or emotional challenges

Sexual and intimacy-related issues are extremely prevalent and often go underreported due to stigma, embarrassment, or lack of access to care. They affect up to half the population at some point in life and are very treatable with multidisciplinary approaches—including pelvic floor physical therapy, medical care, and counseling

Pelvic Floor Physical Therapy for Sexuality

Pelvic floor physical therapy (PFPT) plays a significant role in supporting and improving sexual health and function in people of all genders. Here’s how:

1. Improving Pelvic Floor Muscle Function

The pelvic floor muscles support sexual organs and play a direct role in sexual response (arousal, orgasm, penetration). Dysfunction can result in:

• Pain with intercourse (dyspareunia)
• Erectile dysfunction
• Decreased sensation or arousal
• Difficulty achieving orgasm

PFPT helps by:

• Strengthening weak muscles (to improve tone and function)
• Relaxing overactive muscles (to reduce pain or tension)
• Improving coordination for better control and response during sexual activity

2. Reducing Sexual Pain

Pelvic floor therapists address underlying causes of pain during or after sexual activity, including:

• Vaginismus (involuntary tightening of vaginal muscles)
• Vestibulodynia or vulvodynia
• Prostatitis or chronic pelvic pain
• Scar tissue or trauma from childbirth, surgery, or abuse

Through techniques like manual therapy, biofeedback, dilators, and neuromuscular reeducation, PFPT can significantly reduce or eliminate pain.

3. Enhancing Blood Flow and Sensation

Healthy pelvic floor muscles promote better circulation to genital tissues, which supports:

• Arousal and lubrication
• Erectile function
• Overall genital sensitivity

4. Supporting Sexual Confidence and Intimacy

Sexual dysfunction can lead to emotional distress, relationship strain, or avoidance of intimacy. PFPT can help by:

• Restoring function and reducing pain
• Educating patients on anatomy, function, and communication
• Empowering patients through body awareness and control

5. Addressing Issues Across the Gender Spectrum

PFPT can support:

• Cisgender women and men with common sexual dysfunction
• Transgender and non-binary individuals through pre- and post-gender-affirming surgeries, addressing scar tissue, muscle tone, and sexual comfort.

Common Techniques Used in PFPT for Sexual Health:

• Internal and external manual therapy
• Breathing and relaxation training
• Pelvic floor exercises (like Kegels, but more nuanced)
• Postural and movement retraining
• Use of vaginal or rectal dilators
• Biofeedback for muscle awareness

Pelvic floor physical therapy enhances sexual health by treating physical dysfunction, reducing pain, and improving pelvic muscle coordination and awareness. It’s a key, often underutilized, approach to sexual wellness—especially when sexual issues are related to pain, trauma, or musculoskeletal imbalances.

Stretching

Stretching can significantly enhance your sexual health and experience by improving flexibility, circulation, endurance, and muscle control. Here’s a breakdown of stretches that can help, organized by the benefits they offer:

Top Stretches for Better Sex

1. Hip Flexor Stretch (Lunge Stretch)

• Why: Opens up the hips and improves thrusting range.
• How: Step one foot forward into a lunge, lower your back knee, and push your hips forward. Hold 30 seconds per side.

2. Pigeon Pose

• Why: Deep hip opener, relieves tension from prolonged sitting.
• How: From a plank, bring your right knee toward your right hand, resting your shin on the floor. Extend the left leg straight back. Hold for 30 seconds.

3. Butterfly Stretch

• Why: Improves groin flexibility and blood flow to the pelvic area.
• How: Sit with soles of your feet together, knees dropped to the sides. Gently press knees toward the floor.

4. Cat-Cow Pose

• Why: Increases spine flexibility, core engagement, and body awareness.
• How: On all fours, alternate arching and rounding your back in rhythm with your breath.

5. Bridge Pose

• Why: Strengthens glutes, core, and lower back—essential for control and stamina.
• How: Lie on your back, knees bent, feet flat. Lift hips and squeeze glutes. Hold for 30 seconds.

6. Seated Forward Fold

• Why: Lengthens hamstrings and lower back.
• How: Sit with legs extended, hinge at hips, and reach forward.

7. Happy Baby Pose

• Why: Opens hips and reduces lower back tension.
• How: Lie on your back, grab the outsides of your feet with your hands, and pull your knees toward your armpits.

Tips for Best Results

• Stretch consistently: 3–4 times per week or more.
• Breathe deeply: Enhances relaxation and connection to your body.
• Warm up first: Don’t stretch cold—start with light movement (like walking or jumping jacks).
• Include core and pelvic floor work: Try Kegels and planks for strength and control.

Top Strengthening Exercises for Better Sex

1. Kegels (Pelvic Floor Exercises)

• Why: Boosts orgasm control and intensity, improves endurance and erection quality (for men) or tightness (for women).
• How: Squeeze the muscles you use to stop urinating midstream. Hold 5 seconds, rest 5, repeat 10 times, 3x/day.

2. Glute Bridges

• Why: Strengthens glutes, hips, and core—great for thrust power and hip stability.
• How: Lie on your back, knees bent, feet flat. Lift hips, squeeze glutes. Do 2-3 sets of 10.

3. Squats

• Why: Improves lower body strength and stamina, essential for positions involving bending or thrusting.
• How: Stand with feet shoulder-width apart, lower your hips like sitting in a chair, then rise. 2-3 sets of 10 reps.

4. Planks (and Side Planks)

• Why: Builds core stability and endurance—critical for holding positions and rhythmic movement.
• How: Hold a forearm plank for 30–60 seconds. Repeat 3x. Add side planks for obliques.

5. Lunges

• Why: Strengthens hips, thighs, and improves balance and flexibility.
• How: Step forward into a lunge, then push back to standing. 2-3 sets of 10 reps per leg.

6. Push-Ups

• Why: Builds upper body strength and endurance—useful for being on top.
• How: Lower chest to floor with tight core. Modify on knees if needed. 2-3 sets of 10–20 reps.

7. Deadlifts (Bodyweight or Weights)

• Why: Strengthens back, core, glutes, and hamstrings for better control and power.
• How: With good form, hinge at hips and lower weights to mid-shin, then rise. Use dumbbells or a barbell if available.

Bonus: Add Cardio

• Improves blood flow and endurance for longer sessions and better arousal.
• Try: brisk walking, cycling, dance, or HIIT 3–4 times per week.